Chapter 6: The Workers' Compensation System

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Summary of Chapter 6:

The Workers Compensation System __CHAPTER B CHAPTER OBJECTIVES At the completion of this chapter, you should be able to: * Explain how a workers' compensation case is presented * Discuss discovery in workers' compensation cases * Define the powers of the administrative law judge * Explain how a workers' compensation case is scheduled * Compare and contrast benefit review conferences and arbitration hearings INTRODUCTION TO THE WORKERS' COMPENSATION SYSTEM In this chapter, we will address the issue of contested disputes between the employee and the employer concerning workers' compensation benefits. We will discuss contested hearings, including how the parties prepare for the hearings, the paperwork involved in bringing a claim, and when and how the hearings are actually conducted. We will begin by addressing the issue of benefit disputes and how they lead to workers' compensation hearings. Benefit Disputes The vast majority of workers' compensation cases are uncontested. This means that the employer and employee are satisfied with the benefit arrangement that comes when an employee is injured. However, there are situations where the parties may wish to contest the benefit arrangement. This is especially true when there is a death. See Exhibit 6-1, Workers' compensation benefit disputes can arise for any of a number of reasons, including; * Employer contests the award of benefits to employee * Employee's benefits are terminated by action of the Workers' Compensation Board * Employee's medical provider declares that the employee is ready to return to work When the parties are unable to resolve the dispute voluntarily, their only option is to request a hearing before the Workers' Compensation Board to make a final determination about benefits. Either the employee or the employer can request a hearing before the Board when they have a dispute about benefits in a workers' compensation case. Most states have hundreds of such I1earings every year. Even though most cases are uncontested, there are still thousands of employees injured every year in every state in the union. With that number of cases, it is no wonder that even with a small percentage contested the workers' compensa- tion system is extremely busy. Because of this caseload, most hearings are set 60 or more days from the time when they are initially filed. It is not unusual for claimants to wait a year before a hea.ring date is set. During this time, both sides will prepare their case for the hearing. We will discuss that preparation later in this chapter