Workers’ compensation benefits are paid to workers that are injured while on the job. Typically, injured workers receive medical, wage loss and vocational benefits.
Every state has its own workers’ compensation system with different rules and procedures.
The first step in a workers’ compensation claim is to notify your employer of your injury and file a claim. Your claim will be investigated and either approved or denied. If your claim is denied, you have the right to appeal. The appeal process can be time intensive.
Every workers’ comp claim is different. Some claims are undisputed and resolve quickly. For example, a worker may cut her hand and need stitches. She may not lose any time from work and may only require a few doctors’ appointments. Most of the time, these simple claims are approved (and closed) without incident or delay.
However, disputed workers’ compensation appeals may take years to resolve. In a disputed claim, you must file an appeal and go through your state’s litigation process. This process typically involves multiple court hearings.
- In California, you will have a settlement conference within 10 to 60 days of filing an appeal. If necessary, a hearing is scheduled after this conference. The judge will typically issue a decision within 30 to 90 days of the hearing.
- Illinois law typically requires that you reach maximum medical improvement (MMI) before your hearing. In other words, a doctor must certify that your medical conditions will no longer improve before a hearing is scheduled.
- In Florida, mediation is scheduled within 130 days of filing an appeal. If the mediation is unsuccessful, a pre-trial hearing and a final hearing may be necessary.
- In Michigan, it typically takes about a year to have a hearing before a magistrate (a workers’ compensation judge). During this time, multiple hearings and a settlement conference are scheduled.
- Pennsylvania workers’ compensation appeals are usually decided within a year.
If additional appeals are filed with the state courts, a case will take even longer.
Over time, workers’ compensation laws have become increasingly complicated. They often require detailed medical, vocational and legal analysis. If a claim is disputed, many claims involve:
- Review of all of your relevant medical records and employment files,
- Depositions (testimony taken under oath) from doctors and vocational experts,
- Independent medical examinations and functional capacity evaluations (a test that sets work restrictions),
- Vocational examinations and labor market surveys (evaluations of your ability to work),
- Mediation or settlement hearings,
- Settlement negotiations,
- Coordination with Medicare and Medicaid, including setting up a Medicare Set Aside account,
- Trials or hearings before a workers’ comp judge,
- Post-hearing briefing (written legal arguments), and
- Appeals to administrative bodies and state courts.
Some states will not let a claim settle or go to trial until the worker is at MMI. A worker reaches MMI when his or her conditions have plateaued and the doctors do not foresee additional improvement. If you are unsure whether you are at MMI, speak with your doctor and an experienced workers’ comp lawyer.
Even if your state allows settlement before MMI, you may want to wait until your condition has stabilized. Most workers’ comp settlements terminate your right to future medical and wage loss benefits in exchange for a lump sum of money. If you settle before MMI, you may become financially responsible for your future medical expenses.
Workers’ compensation cases are very technical. To win your claim, you must interpret medical records, take expert testimony, evaluate vocational information and apply legal principles and rules (such as the rules of evidence). If you were injured at work, it is probably in your best interest to contact a employment lawyer.