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The Flow of a Workers’ Compensation Claim

If you were hurt at work, your employer’s insurance company is required to issue a document either accepting or denying your claim. If the claim is denied, meaning that for some reason or another, the insurance company will not acknowledge your work injury, they will issue a Notice of Compensation Denial. If the claim is accepted in full, the insurance company will issue a Notice of Compensation Payable and will be responsible for the payment of your wages and medical bills. The insurance company can also accept liability for medical bills only, and not wage loss. If this is the case, they will issue a document called a Medical Only Notice of Compensation Payable. Depending on which document is issued, if at all, will determine which type of Petition will be filed in Court. 

If you are out of work entirely and not collecting Workers’ Compensation benefits, or if the insurance company issued a Notice of Compensation Denial or Medical Only Notice of Compensation Payable, a Claim Petition should be filed with the Court. The Claim Petition can seek wage loss, medical bills, and specific loss benefits for a limited period or on an ongoing basis. 

What happens once a Claim Petition is filed?

Once a Claim Petition is filed, it will be assigned to a Workers’ Compensation Judge. Workers’ Compensation petitions are normally assigned to a Workers’ Compensation Judge according to the county in which the injured worker lives. A Notice of Assignment is issued to the parties advising them as to which judge is assigned to the matter. Each Judge has a different set of procedures for how His or Her Honor handles the litigation. The lawyers at Stern & Cohen are familiar with each Judge’s rules and procedures and have practiced before these Judges for over 30 years.

Yellow Freight Motion

Once the Notice of Assignment is issued, the insurance company has 20 days to file an Answer to the Claim Petition. If no Answer is filed within 20 days and there is no reasonable excuse for the late Answer, a Yellow Freight motion can be made. A Yellow Freight motion is made by an injured worker asking the Judge to accept as true the allegations in the Claim Petition. If the Judge grants the motion, the well-pled allegations in the Claim Petition, including the description of injury, wages, notice, and disability are deemed admitted by the insurance company for a certain period. When this motion is granted, the only remaining question is whether an injured worker is entitled to ongoing disability benefits, meaning, whether he continues to be disabled as a result of the work injury.

In the more likely scenario, if an answer is timely filed within 20 days of the assignment of the Claim Petition, the Judge to whom the Petition is assigned will issue a trial schedule, giving the parties adequate time to present their case. The trial schedule usually spans about 180 days. This includes presenting the injured workers’ testimony, either at the deposition or before the Judge, presenting the deposition of a medical expert, and cross-examining the insurance company’s medical expert. Questioning a medical expert, either via direct examination or cross-examination, includes questioning the doctors on qualifications, diagnoses, and treatment plans.

Deposing a fact witness

The parties may also need to present additional medical evidence to the Judge to further corroborate the allegations in the Claim Petition. Finally, the parties may need to depose or present a fact witness. A fact witness is usually presented by the insurance company, in an attempt to disprove a factual element of the case. Fact witness testimony varies immensely from case to case but can include testimony on issues such as job offer letters, a notice of the injury, wages, and disciplinary issues.

What if it goes to Mediation?

The Workers’ Compensation Judge will also schedule the case for mediation unless the judge concludes it would be futile. Judges usually schedule the mediation toward the middle of the litigation, giving each side time to determine “the good, the bad, and the ugly” of their case. Usually, a Judge not assigned to the case will mediate the case and help the parties move toward settlement. If the case does not settle at the mediation, the parties will continue to proceed through the litigation.

Evidence

Once all evidence is complete, the parties will submit the evidence and the Judge will issue a briefing schedule, giving the parties time to submit briefs in support of their positions. The briefs contain a summary of the evidence and a legal argument. Once the Judge receives both parties’ briefs, His or Her Honor will review the briefs in conjunction with the evidence submitted and issue a written Decision. There is no timeline for when Decisions will be circulated, but it commonly takes Judges about one to three months after briefs are submitted to circulate a Decision.

Decision time

If a Judge issues a Decision and grants the Claim Petition in full, this means that the Judge awarded wage loss and medical bills on an ongoing basis. The only way for the insurance company to stop benefits after a Decision such as this one is circulated is with a Judge’s Decision. If a Claim Petition is granted in part, this could mean the Judge awarded benefits for a limited or closed period or the Judge limited medical treatment to a certain body part or diagnosis. If a Claim Petition is denied, the Judge denied the allegations that you sustained a work injury and were disabled as a result.

If you disagree with a Judge’s Decision, you can appeal it. Head over to our blog about appeals HERE to learn more!

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Understanding the flow of a Workers’ Compensation case is extremely helpful in successfully litigating a Claim Petition, and that is why it is important to obtain an experienced Workers’ Compensation lawyer as early as possible following a work injury.

 

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