When a Workers’ Compensation claim is disputed, mediation can help resolve it. Our lawyers can explain how mediation might work in your case and additional steps to recover benefits.
While any party can request mediation during a claim dispute, they are not mandatory. In Massachusetts, a conciliation meeting is the first step of the dispute process, which functions much like a mediation. During conciliation, your attorney will negotiate with the insurer under the guidance of an impartial conciliator. You can reject any offers and schedule a conference with an administrative judge. From there, we move to a hearing.
Call the Law Office of John J. Sheehan today at (617) 925-6407 for free case review with our Boston, MA Workers’ Compensation lawyers.
How Mediations Are Used in Massachusetts Workers’ Compensation Claims
Mediation is a tool used in many legal cases where opposing parties come together to negotiate a settlement.
In Massachusetts, mediations are available when disputing a Workers’ Compensation claim, but they are not an official step in the dispute resolution process. Instead, injured workers can request mediation at any level of the dispute resolution process if they are close to resolving their claim with the insurer.
Filing for Workers’ Comp
When most employees get injured, they can file for Workers’ Compensation benefits to help them while they are out of work. If an employer’s insurance provider denies a claim or disputes the qualifying benefits, an injured worker can file with the DIA (Department of Industrial Accidents) to help settle the dispute.
Conciliation vs. Mediation
The dispute process starts with a conciliation, followed by a conference, both of which work much like a mediation in that they are informal and non-binding on the parties. If no resolution has been reached, the claim will move to a formal legal hearing with an administrative judge. Workers can then appeal to the DIA Reviewing Board if the administrative judge decides against them.
Either party can request a mediation during any of these phases of the dispute process, which the DIA holds virtually. While a mediation is informal and you do not have to accept the outcome, we strongly recommend working with our Massachusetts Workers’ Compensation lawyers. They can counsel you on when to reject an offer and move to a formal hearing.
Requesting a Conciliation in a Massachusetts Workers’ Compensation Case
The Workers’ Compensation dispute resolution process starts with conciliation when an insurer denies a claim or files a complaint to modify or stop an injured worker’s benefits. Like mediation, conciliation is an informal meeting between the parties overseen by a DIA conciliator.
The conciliator is not on either party’s side but is there to guide them to a voluntary agreement. You will need your most recent medical records and any other documents crucial to settling the dispute.
However, you do not have to accept the conciliator’s findings or final settlement offer.
Massachusetts Workers’ Comp Conferences
If conciliation cannot resolve the claim, it will be assigned for a conference. Like conciliations, conferences are informal and not governed by evidentiary rules. Medical reports, wage statements, and other documents must be submitted to the presiding administrative judge but no witnesses are called.
Instead of guiding the parties to a negotiated settlement, the administrative judge will decide whether to pay the claim based on the evidence.
Unlike conciliation, the judge’s determination is a final decision. However, you have 14 days to file an appeal with the DIA.
Appealing a Conference Order for a Formal Workers’ Compensation Hearing in Massachusetts
Appealing a conference order will take the claim to the next step of the resolution process, which is a formal hearing. Hearings are essentially the “trial” phase of a disputed Workers’ Compensation claim. Like a trial, the rules of evidence apply, and witnesses must testify under oath.
Hearing Process
During a hearing, administrative judges can make any necessary inquiries and investigations under Mass. Gen. Laws Ch. 152 § 11. They can also admit documentary evidence and oral testimony previously unobtained to decide the issues.
Pre-Hearing Medical Exams
Before the hearing, an impartial physician will likely need to conduct an independent medical exam. They will use this report to help make their decision. However, we can file motions to introduce your own reports from medical providers you choose. We can also arrange for experts with direct personal knowledge of your injuries, such as your doctor, to testify at the hearing.
Pre-Hearing Conferences
A pre-hearing conference will also be scheduled before the hearing to identify the important issues and the remedy sought. The pre-hearing conference will typically occur between five to 10 business days before your hearing date.
Decisions
Administrative judges generally have 28 days from the hearing’s close to issue a decision on the claim. However, the actual time is typically longer.
Unlike the steps discussed above, the final decision from a hearing is fully binding on the parties. If the administrative judge denies your claim, you have 30 days to file an appeal to the DIA Reviewing Board.
Appealing Workers’ Compensation Hearing Decisions to the Massachusetts DIA Reviewing Board
A hearing before the DIA Reviewing Board is the final step in the dispute resolution process. Here, you claim is presented to up to two panels of three administrative law judges, but they do not conduct a new “trial.” Instead, they review evidence already in the record and the previous judge’s hearing decision.
However, the Reviewing Board can only reverse an administrative judge’s decision in limited circumstances. Reversals are only allowed if the decision went beyond the scope of the judge’s authority or it was arbitrary or capricious. The Reviewing Board can also reverse if the decision is contrary to the law.
Before this hearing, we can file a “brief” that states the issue for review and legal arguments for compensation. Our team can also make oral arguments to the board during the hearing if permitted.
Call Our Massachusetts Workers’ Compensation Attorneys Today for Help
Call the Law Office of John J. Sheehan at (617) 925-6407 for free case assessment with our Lynnfield, MA Workers’ Compensation attorneys.