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How are workers’ comp disputes resolved?

When filing a workers’ comp claim, you hope you receive a swift approval. However, this is not always the case. In the event of a denied claim, you must take further steps to have the issue rectified.

As explained by the Commonwealth of Massachusetts, there are four steps to resolving a workers’ compensation dispute. Understanding what each step entails can help you navigate the process with as little stress possible.

Conciliation

Conciliation is a meeting between you, your attorney, the insurance company, and a conciliator authorized by the Department of Industrial Accidents. During conciliation, you can present evidence of your injuries, such as medical records. The conciliator reviews the case and makes a decision. If the conciliator cannot reach a decision, you move to the next step.

Conference

Conferences are similar to conciliation when it comes to whom is present. The primary difference is that conferences are overseen by an administrative judge and not a conciliator. The judge will decide whether you receive benefits. If so, they can issue an order obligating the insurance company to provide them. If not, you have 14 days to appeal the decision made during the conference.

Hearing

Hearings are very similar to trials, meaning a stenographer records the proceeding and both sides can call witnesses. The judge may ask you and the insurance company to submit new evidence and testimony supporting your claims. If you are unhappy with the decision, you have 30 days to appeal.

Reviewing Board

Three administrative judges sit on the reviewing board. They will look over the transcript from the hearing to help their decision. They may send the case back to the previous administrative judge for further review. They may also overturn the previous decision.

The more prepared you are for the appeals process, the better your chance of receiving a favorable outcome. Make sure you have access to your medical records and other documents supporting your case.