The Typical Life of a Workers’ Compensation Claim
- Petition for Benefits - A Petition for Benefits is the vehicle used to formally pursue an injured workers’ claim or benefit. A Petition can only seek benefits that are in default and which are ripe, due and owing. There are specificity and evidentiary requirements with which you must comply to avoid having your Petition dismissed. The litigation process ensues from the filing of a proper Petition for Benefits. Often times, the filing of multiple Petitions for Benefits is required during the life of the case as entitlement to medical and/or indemnity benefits becomes at issue.
- Mediation - After a Petition for Benefits is filed, a Judge issues an Order requiring the parties to attend mediation. A case cannot proceed to trial unless the parties have attended mediation. Mediation is one of the most valuable tools in the workers’ compensation system. The mediator is an unbiased third party, who is often an attorney. Mediators do not make rulings and instead serve as professional negotiators between the parties. Mediation can be used to resolve issues while the claim remains open or to effect a lump sum settlement to close the entire claim out. It is not uncommon for there to be multiple mediations during the life of a case as multiple Petitions for Benefits are filed.
- Lump Sum Settlements - Neither the injured worker nor the insurance company can be forced to settle a case. An injured worker can continue to treat indefinitely as long as the industrial accident remains the major contributing cause of his or her injury and need for treatment and as long as he or she is treating as often as is required to toll the statute of limitations. However, most workers’ compensation cases are settled, as they reach a point where a settlement is in the best interest of the injured worker. There are many factors that come into play in every case, all of which can change the value of the case. Because of the complexity of the law and the variables that are implicated when evaluating a case for settlement, it is essential to have a lawyer’s assistance in order to obtain the maximum value on the case. Furthermore, the settlement of a case is a formal process which requires the execution of extensive documentation, usually prepared by the attorneys for the insurance company. It is advisable to have an attorney review the settlement paperwork to protect your interests before signing.
- Final Hearing/Trial - If the parties are not able to resolve the issues or the entire claim, a Final Hearing (trial) is scheduled. It is important to have the assistance of an experienced attorney. Rules of evidence and procedure must be followed both leading up to and at trial. The testimony of physicians is usually required. Without certain evidence being properly and timely admitted, the Judge cannot consider it and you could lose your claim even if you had a legitimate injury. It is not uncommon to have more than one Final Hearing as different issues arise and the parties are unable to reach an agreement out of court.
