Workers’ Compensation Conferences in Massachusetts
In Boston workers’ compensation cases, the conference occurs after the parties are unable to reach an agreement or settlement at the conciliation. Conferences are required by Chapter 152, Section 10A of the Massachusetts Workers’ Compensation Act (WCA).
After a conciliation, a case is referred to the division of administration and an administrative judge (AJ), is assigned to the case. An AJ is a neutral judge who works for the Department of Industrial Accidents (DIA) and is assigned to oversee and facilitate conferences. At the conference, the AJ will listen to arguments and evidence presented by both the claimant and insurer. The judge will then ask any questions he or she has before concluding the proceeding. Typically, the AJ renders an opinion within a week of the Conference.
Unlike how a conciliator can only make suggestions, the AJ has the authority to issue a binding ruling on a case. At this stage, the ruling results in a temporary order. It becomes permanent if the parties do not request a hearing in a timely manner.
The conference is less formal than a hearing, but the DIA strongly recommends you have a workers’ compensation attorney representing you during this process. The reason for this is because the workers’ compensation insurance company will surely have their own attorney at the conference, and this will put an unrepresented claimant at a significant disadvantage.
In an ideal world, if you were injured at work, your employer would submit a timely claim to his or her workers’ compensation insurance company so that you can promptly obtain medical treatment, and the workers’ compensation company would provide you with benefits for your Boston on-the-job accident. Unfortunately, we do not always live in an ideal world, and workers’ compensation companies are often far more concerned about making money than they are about paying people the workers’ compensation benefits to which they are rightfully entitled.
For example, you could be seriously injured while working at a garment factory sewing fabric. If your hand were to get caught in the sewing machine you could sustain serious injuries. In some cases, a needle could stitch your hand, causing significant damage. If you were using a heavy gauge needle that is designed to go through leather or vinyl, the needle could actually puncture a bone. Accidents like this happen all too frequently.
If this were to happen at work, it would be fairly obvious that you were injured on-the-job, and your employer would typically call an ambulance or send you to the emergency room with another employee. You may not have to worry about an injury report being generated. It would be difficult for your employer’s workers’ compensation insurance company to deny your claim for benefits. However, if you had been working at that same factory for years and developed carpal tunnel syndrome (CTS), it might be more difficult to prove that this was a work-related injury. In such a situation, the process of obtaining workers’ compensation benefits might be more involved and could require a conciliation, conference, and eventually even a hearing.Workers’ Compensation Conference Process
If your employer’s workers’ compensation insurance company has denied your claim, as discussed above, you or your attorney can file a workers’ compensation claim with the DIA. The first thing that will be required is a conciliation. If an agreement or settlement is not reached, the case will then be assigned to an AJ for a Conference. As outlined on the DIA’s website, this conference is a proceeding where the claimant must show the following three things:
- The injured worker is/was disabled;
- The injury or illness causing the disability was work-related; and
- That any medical treatment is reasonable, necessary, and related to the work injury.
At the conference, the insurance company will have a lawyer that has handled many conferences before. They are experienced experts in fighting against claimants who are applying for workers’ compensation benefits. If you do not have an experienced workers’ compensation lawyer on your side fighting for your rights, you are at a significant disadvantage. For this reason, even the DIA strongly recommends you speak with a workers’ compensation attorney before going to the conference at the DIA.Appealing a Workers’ Compensation Conference Decision
At the conclusion of the workers’ compensation conference with an AJ, a temporary order is issued. The decision can be appealed by completing the appropriate DIA forms. You should do this with the assistance of your attorney. If an appeal is not filed within 14 days, the order will become permanent. Either party can appeal a conference order. If appealed, the case will be sent forward for a hearing before an AJ. This will be a formal hearing akin to a normal trial in a court of law. The main difference here is that since there is an AJ, it is still considered an administrative hearing.
In between the conference and the hearing, the injured worker will be examined by an impartial physician, pursuant to M.G.L. c. 152, section 11A. The impartial physician will draft an impartial report, which is later used by the judge in making his or her decision.
It is critical to have an experienced legal team on your side throughout this process to ensure your interests are looked after and protected.