The Workers’ Compensation Claims Process- How To Pursue A Claim For Workers’ Compensation Benefits

"Once I contacted Richard Hyman about my injured neck I no longer had to deal with the insurance adjuster or case manager. Once we got a court date and were in front of the judge he commented three different times that I had hired a very good lawyer. The settlement was better than I had hoped for. I couldn't think of a better recommendation than the judge’s comments and the settlement’s outcome." KN, Bellingham

THE DEPARTMENT OF INDUSTRIAL ACCIDENTS

Any injured worker entitled to workers’ compensation benefits has the right to file a claim for those benefits at the Department of Industrial Accidents (DIA). Upon the filing of a claim, an initial proceeding called a conciliation is scheduled approximately two weeks later at a regional office of the DIA. The DIA locations are: Boston, Fall River, Lawrence, Worcester and Springfield.

Depending on the type of claim filed and the nature of the dispute concerning that claim, the insurance company and the employee may be able to reach an agreement at the conciliation. Failing to reach an agreement, the claim is then scheduled to come before an administrative judge.

A CONFERENCE BEFORE AN ADMINISTRATIVE JUDGE

At a proceeding called a conference, the attorneys for the employee and the insurance company are given the opportunity to submit supporting documentation (such as medical records, doctor’s reports and affidavits) and to present oral arguments to the Judge.  Within a few days of this conference, the judge issues a temporary order outlining what, if anything, the insurance company’s obligations are to the employee.

Both the employee and the insurance company have the right to appeal the conference order. Pending resolution of that appeal, however, the parties must continue to abide by the Judge’s conference order.

THE HEARING

If the conference order is appealed, a hearing is scheduled before the judge, at which time the employee, along with other witnesses, has the opportunity to provide testimony in support of the claim for benefits. The hearing is similar to a trial, with the rules of evidence governing the proceedings.

In most cases, the employee is required to be examined by an impartial medical examiner (otherwise known as an impartial physician) during the time period between the conference and the hearing. This impartial medical examiner is selected by the judge from a panel of medical experts (unless the parties agree on a particular doctor to use).  Unless the Judge rules otherwise, the impartial physician’s opinions are the only medical evidence in the case.

Following the conclusion of the Hearing, the Judge will issue a hearing decision which contains an analysis of the issues to be decided, the facts presented at the Hearing and, most importantly, the findings of the Judge as to what benefits the insurance company is required to provide to the employee.  Although the hearing decision of the Judge may be appealed, it will only be changed if the Judge made some type of error or law.

Pursuing a claim for workers’ compensation benefits is a complicated process with its own unique rules and regulations. If you have been injured at work, you need an attorney who is skilled at dealing with the insurance companies and their attorneys and also experienced in presenting workers’ compensation claims before the Department of Industrial Accidents.

The attorneys at Yellin & Hyman have the experience and dedication needed to properly handle your case.  With offices conveniently located in Franklin and Hyde Park, Yellin & Hyman is readily available to assist you with your most urgent and pressing legal needs.

Contact a Workers' Compensation Attorney for a free consultation

For more information or to schedule a free initial consultation with an experienced lawyer, please contact Yellin & Hyman today.

Make sure that you are fully compensated for your injuries. Call our Franklin office at 508-528-8885 or our Hyde Park office at 617-361-5310. You can also e-mail to learn more about our legal services.