Workers Compensation: How is My Case Resolved? 

Whether you are injured at work or want to learn more about the workers’ compensation system, we are here to help. Workers’ compensation or “workers’ comp” provides cash benefits and medical care to covered employees injured at work in exchange for mandatory relinquishing a tort claim against their employer.

Mediation

Depending on the nature of your case, mediation can last a few minutes or many hours. It’s a less formal process than a hearing and could feel like one to you, but it will have some structure. Your workers’ compensation attorney will assist you.

The mediator may begin by meeting with you and your workers compensation attorney in one room and the employer or insurance company representative(s) and their attorney in another. Each side presents their case in a brief presentation. Then, the mediator moves everyone into separate rooms for private discussions.

During these sessions, you and your workers’ compensation attorney discuss what is important to you, medical treatment, strengths and weaknesses of each party’s arguments, and whether or not a settlement is possible. Statements made during mediation are confidential and are not admissible in court if you later need to file a Petition for Reconsideration or a Request for Modification.

Administrative Hearings

A workers’ compensation hearing is an administrative proceeding to address case issues. They are held by an administrative law judge (ALJ) at the district office having jurisdiction over the case.

Typically, you and the insurer or self-insured employer have an attorney present at a hearing. The ALJ will review the issues and the exhibits with each party before “going on the record.”

Then, the ALJ will thoroughly review the evidence in the file and issue a written decision called a Compensation Order. The ALJ may decide to resolve your dispute or award discretionary benefits such as a 308a wage differential or a scar and disfigurement evaluation.

If you are not happy with the outcome of your hearing, you have the right to appeal the ALJ’s ruling in the Appellate Division. It is the only appeal that leaves the administrative process’s confines and enters the civil courts.

Conciliation

Conciliation is an informal session where you and the insurer can talk to one another to devise a voluntary agreement about your case. You need to ensure you have sufficient medical documentation to support your claim and bring it to conciliation.

At conciliation, the conciliator will review the information you and the insurer provided. The conciliator can ask for a medical referee to prepare a report that might help you and the insurance company agree on your case.

Suppose you and the insurance company cannot agree on conciliation. In that case, the conciliator will write a recommendation to a Department of Industrial Accidents law judge for an informal proceeding called a conference. The law judge will schedule your conference as soon as possible.

Trial

Most workers’ compensation disputes can be resolved without a trial. If an injured worker gathers factual and medical evidence to support their claims, the insurance company may voluntarily agree to pay benefits. At a trial, the judge examines the case much like a civil non-jury trial held in a circuit court.

The parties submit evidence, typically in the form of written documents. This process is called discovery. Injured workers usually testify in person at the hearing under oath. Other witnesses can provide testimony through a recorded deposition. Injured workers’ attorneys can ask each witness questions during the hearing.

If the judge rules against the injured worker, they can request a review by the workers’ comp board. A three-member panel reviews the judge’s decision based on your arguments and the evidence you submit. The outcome of this review can impact any future workers’ comp decisions by the judge. If the workers’ comp board disagrees with the judge’s ruling, they will make a new decision.