If the insurance company denies your workers compensation case, your attorney will file a claim at the Department of Industrial Accidents. The goal of filing the claim is to have a judge order the insurance company to pay your benefits. If you’re scheduled for a “conference,” this is actually the first time you’ll be in front of a judge who can make a decision on your case.What Happens at a Conference?
As we have discussed elsewhere on our website, the stages of a workers’ compensation claim are: filing the claim, conciliation, conference, independent medical examination, and hearing. After the conciliation, the conference is the first meeting with the Judge.
Even though the Department of Industrial Accidents (the “DIA”) is not a court, it has a judge assigned to each case. The Judge acts very similar to a judge in a traditional court and will decide whether the insurer has to pay the employee.
Before the conference, each party will submit what is called a conference packet. The conference packet will include the documents that the judge will need to answer the questions outlined above. The packet will include medical records, potentially pictures of the accident, pictures of the incident, statements from witnesses, and things of that nature.
The actual procedure of going in front of the judge is relatively fast, and also relatively informational. The judge will allow the employee’s lawyer to describe the case, and then the insurance company’s lawyer will also have a chance to do the same. The judge can ask questions and try to narrow down the issues. The judge is looking to make determinations as to whether the employee is injured, whether the employee was injured in the course of their employment, and whether the injuries cause the employee to be unable to work.
While the employee is almost always present at the conference, he or she rarely has to speak. The employee is not required to give testimony, and will not have to answer questions posed by the insurance company's lawyer.
At the end of the conference, the judge will issue an order. If the judge finds for the insurer, the employee likely will get nothing. If the judge finds for the employee, they will order the insurer to pay a certain amount of money. That amount will depend on the amount of weeks that the judge decides the employee should receive compensation for. Sometimes it is an open- ended order, having the insurance company pay you benefits until the hearing.
If the Judge finds in favor of the employee, the insurer will have to pay for the employee’s attorney fees.Insurance Company Doctors
Part of almost every conference is a discussion about the medical records. The employee’s lawyer will explain why they say that you’re hurt. The insurance company will try to explain that you’re not hurt, or that it didn’t happen at work.
Another aspect to this is that the insurer is entitled to have their “own” specialist examine the employee. This expert is paid for by the insurer and will write a report about the employee’s injuries. As you can imagine, these reports favor the insurer. These doctors are not looking out for you. They want to say that you’re fine and that you can work. This type of report would be introduced by the insurer at a conference if it was helpful to their case.The Case Does Not Stop There
If the employee or insurer are dissatisfied with the Judge’s order, either (or both) party can appeal the conference order. The case then moves onto a hearing, which is discussed on another page.
But, even if the case is appealed, the judge’s order has to be followed. So, if the judge awards you benefits, the insurance company will pay, even if it appeals the decision.
One of the many things our hypothetical was supposed to illustrate was that the workers’ compensation process can be complicated. That is why you need an effective and tenacious attorney on your side. Marcotte Law Firm has those attorneys.
Call us today for a free consultation, (978) 458 – 1229.