A Workers’ Compensation hearing is a formal legal proceeding that occurs if your claim is denied or the insurance company wants to modify or terminate your existing benefits. How the hearing proceeds, what evidence is presented, and how the judge makes a decision vary depending on the issues being disputed.
The Massachusetts Rules of Evidence typically govern what evidence may be presented. Medical records, reports regarding your accident and injuries, wage statements, and witness testimony may be presented. You might have to be evaluated by a doctor appointed by the court or selected by the insurance company. While it is possible to also submit reports from a doctor of your choosing, you may only do so if additional reports are necessary due to the complexity of the medical issues in the case.
Get an initial free case review from our Boston Workers’ Compensation attorneys at the Law Office of John J. Sheehan by calling (617) 925-6407.
When a Workers’ Compensation Hearing in Massachusetts May Be Scheduled
Not every Workers’ Compensation claim requires a formal hearing. Your case should begin when your employer files a report of your accident and injuries with their insurance provider. Once you become eligible for benefits – usually after being unable to work for at least 5 non-consecutive days – the insurance company may approve or deny you for benefits.
If you are approved, you may begin receiving benefits without the need for a hearing. Factual hearings are also unnecessary if you accept a settlement; there may just be a short hearing to ensure you understand your settlement. If you are denied, our Massachusetts Workers’ Compensation lawyers can arrange a hearing on the matter.
Another possibility is that you were previously approved for benefits, but the insurance provider now wishes to modify or terminate them. Generally, an insurance company cannot modify or terminate your Workers’ Compensation benefits without a legal proceeding.
Evidence Permitted in a Workers’ Comp Hearing
A Workers’ Compensation hearing is a very formal legal proceeding where various forms of evidence may be presented.
Rules of Evidence
The Massachusetts Rules of Evidence control what can and cannot be presented. These are the same rules that apply in most civil and criminal trials in the state. If evidence meets these rules, it may be admissible. This may make for a wide variety of evidence in your case.
How Cases Are Presented
Your attorney and the insurance company’s legal counsel may present opening and closing statements addressing the heart of the matter being decided. If you were denied benefits, the focus should be on why that denial was incorrect. If the insurance company wants to reduce or terminate existing benefits, the focus should be on why your benefits should remain unaltered.
The court also allows the parties to file legal briefs and call witnesses to provide sworn testimony. Just like in almost any civil or criminal case, witnesses who testify may be cross-examined by the opposing party. As such, witnesses should be adequately prepared for the hearing.
Medical Evaluations and Workers’ Compensation Hearings in Massachusetts
According to Mass. Gen. Laws Ch. 152 § 11A(2), you might have to submit to a medical evaluation. The court may appoint an impartial medical examiner to conduct an evaluation. Alternatively, you and the opposing party may agree on someone from the list of impartial examiners to conduct the evaluation. It is also possible that the insurance company will choose an independent medical examiner to evaluate you.
If you refuse to submit to an evaluation, the court may suspend your benefits. These examinations are more common in cases where the insurance company is unsure whether the injured employee has a qualifying disability or if their disability actually prevents them from working.
The medical report should explain whether the injured employee is disabled, whether the disability is partial, total, temporary, or permanent, and whether the employee’s injuries are work-related. Either party may have the impartial medical examiner deposed for cross-examination purposes.
Reports From Your Own Doctor for a Workers’ Comp Hearing
You might be uncomfortable with the idea of a doctor you do not know evaluating you. Depending on the circumstances, you and your attorney may convince the court to allow you to be evaluated by another doctor in addition to the impartial one from the court and the independent one chosen by the insurance company.
Reports from other medical professionals usually may not be presented at the hearing by any party. However, under very specific circumstances, either party may file a motion to submit additional medical reports or testimony. This does not include reports from the doctor who treated your injuries.
You may submit additional medical reports or testimony from a different doctor if you believe it is necessary due to the complex nature of the medical issues or if the existing medical reports are inadequate.
For example, if your injuries are highly complex, you might need a specialist to review your case in addition to the court-appointed doctor. You might also file a motion to have another medical evaluation if the first doctor’s reports are incomplete or lack important details needed to decide the case.
How to Prepare for a Massachusetts Workers’ Compensation Hearing
If you are going to have a hearing on your Workers’ Compensation case, you should begin by calling a lawyer for help. Your attorney can help you determine if medical evaluations are necessary and who will perform them.
If the insurance company appoints an independent medical examiner, you must submit to the evaluation or risk losing your case. Similarly, you must submit to an examination by an impartial medical examiner from the court if required. You may consider finding your own doctor, other than the one who initially treated your injuries, to conduct an examination.
Begin gathering evidence to build your case. We should talk to witnesses from work who can testify about the accident. Photos of your injuries, security camera footage of the accident, medical reports, and more should be collected as soon as possible.
Our Massachusetts Workers’ Comp Lawyers Are Prepared to Assist You
Get an initial free case review from our Massachusetts personal injury attorneys at the Law Office of John J. Sheehan by calling (617) 925-6407.