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Claims Process Disagreements

If your employer’s workers’ compensation insurance company is disputing your claim, you are probably feeling stressed and discouraged. Contact an experienced Massachusetts workers’ comp attorney today to protect your rights and get the reimbursement you deserve. Here is some important information on claims process disagreements.

Claims Process Disagreements | Conciliation

Conciliation consists of an informal meeting between the worker, the worker’s attorney (if he or she has one), an attorney for the workers’ compensation insurance company and the DIA conciliator. The conciliator serves as a neutral third party to try and help negotiate a settlement. Conciliation meetings take place at the closest DIA regional office to the employee. If the worker is out-of-state, the conciliation will automatically take place in Boston. In some circumstances, the location of the conciliation meeting can be changed.

Before the conciliation, the worker should gather necessary medical documentation to support his or her position. It’s not required that the worker have an attorney for the conciliation process, but it’s a good idea that they have one. If the parties cannot resolve their disagreement during conciliation, the conference process is the next step.

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Claims Process Disagreements | Conference

The second step is the conference (sometimes referred to as a proceeding). And while the worker still isn’t required to have an attorney, it’s strongly recommended they have one for this process. This is because even though a conference is an informal meeting between the workers’ compensation insurance company and the worker, instead of being before a conciliator, it’s in front of an Administrative Judge.

This Administrative Judge has much more power than the conciliator because the Administrative Judge can make a decision as to whether the workers’ compensation insurance company must pay benefits to the worker. If the worker or the workers’ compensation insurance company disagrees with the Administrative Judge’s order, they must file an appeal within 14 days. Appeals are decided at a hearing.

Claims Process Disagreements | Hearing

A hearing is a formal legal proceeding and is a lot like a trial. A hearing is held before an Administrative Judge and many rules from a regular courtroom apply, such as the Massachusetts rules of evidence.

At the hearing, both sides present evidence in support of their position and may call witnesses to testify. In certain situations, either side may be required to submit new evidence before the Administrative Judge issues a decision. If either side is unhappy with the Administrative Judge’s decision, they can appeal it to the Reviewing Board.

Claims Process Disagreements | Reviewing Board

t this level of the workers’ compensation settlement process, the parties may only present legal arguments in support of their position. Generally speaking, no new evidence may be presented to the Reviewing Board. If the Reviewing Board feels additional evidence is necessary, they will usually remand the case back to the Administrative Judge for further consideration of additional evidence.

No matter what, the parties must present legal briefs to the Reviewing Board. These legal briefs will explain the basis for their legal position. The Reviewing Board will sometimes ask for more from the parties, such as coming before the Reviewing Board to present their legal arguments in person. If either side is still unhappy with the Reviewing Board’s decision, they may file another appeal with the Massachusetts Court of Appeals. A workers’ compensation appeal to the Massachusetts Court of Appeals is a fairly rare occurrence.

While Massachusetts workers’ compensation laws are designed to help protect injured workers, insurance companies want to make a profit. It’s important that injured workers talk with an experienced workers’ compensation lawyer to make sure that their rights are protected and that they are treated fairly.

Don’t Wait. Insurers only have 14 days to pay or deny your claim. Learn how to improve your chances of having your claim approved.