Workers’ compensation hearings are a crucial part of the claim process. They occur when the details of the claim are under dispute, such as the validity of the injuries sustained or the amount of compensation expected to be paid out. Either the injured worker or the insurance company can file a request for a hearing. Once a request for a hearing is filed, the Board then decides whether the issue can be resolved administratively, without the need for a hearing.
What Happens at a Workers’ Compensation Hearing?
Before the COVID-19 pandemic, hearings were conducted in front of an administrative law judge (ALJ) across multiple sites around New York State. Now, all hearings are conducted virtually, and claimants can either appear by phone or using the Board’s virtual system.
The ALJ makes decisions regarding all issues that may arise in workers’ compensation cases, such as compensability of a claim, reduced earnings, degree of disability, medical treatment, and permanency. Once the ALJ determines the ongoing lost time benefits based on the medical evidence, the insurance carrier is under an obligation to issue timely payments for the amount reflected in the Judge’s Notice of Decision for the period of lost time from work.
Are Workers’ Compensation Hearings Required?
Without a hearing and decision from the ALJ, the workers’ compensation carrier can make any determination in a claim that suits them. For example, without a hearing that directs what the carrier is to pay for lost time benefits, the carrier can pay whatever they choose.
To reduce the number of hearings, the Board also issues Proposed Decisions which can be objected to by either side. For the most part, however, hearings are necessary so all the facts can be presented to the law judge, which often requires claimant or employer testimony and/or further litigation and discovery to resolve the issue. Once the judge makes a decision, either side may then appeal the judge’s finding by requesting further review by the Board panel.
What Questions Are Asked at a Worker’s Compensation Hearing?
General Background: Information about the injured worker, including marital status, living situations, and children or other dependents. These answers are used to calculate weekly compensation rates.
Education and Training: Information concerning the injured worker’s education and training, including courses or certifications. These answers will gauge the worker’s level of expertise.
Job Role: Information about job duties held, how the injured worker was hired, how many hours they worked, and their salary.
Incident: Details about when and how the incident happened, what injuries were sustained, how and when it was reported, when the injured worker sought out medical attention, and what treatment was prescribed.
Medical History: Details about previous injuries, doctors the injured worker has seen throughout the years, and side effects from the work injury.
Miscellaneous: Information about job applications, if a new job has been offered, and what hobbies or activities the injured worker is participating in.
How Often Do Workers’ Compensation Cases Go To Trial?
Most workers’ compensation cases are resolved out of court. Only a handful require a trial. If a case does go to trial, it’s because the injured worker did not receive a fair or satisfactory compensation award, or the insurance company is appealing the decision made about how much they owe in benefits.
Get Help With Your Workers’ Compensation Case
Workers’ compensation hearings are integral to the resolution of many issues that arise in one’s case. It is important to have attorney representation going into a workers’ compensation hearing so that the appropriate evidence can be presented to the judge and the necessary benefits pursued. Having a skilled workers’ compensation attorney who is well versed in the law and process may be able to push toward a more favorable resolution.
