What To Expect During a Workers’ Compensation Hearing

Workers’ compensation insurance is designed to provide benefits to employees at any type of job who become ill or are injured while working. The benefits can include paying for medical care, including surgery, physical therapy, permanent disability benefits, lost wages, and death benefits. These programs have been in operation since 1908, when the first worker’s compensation law was passed, and there is definitely an ongoing need for insurance.

According to the U.S. Bureau of Labor Statistics, there were 5,486 workplace injuries in 2022, up 5.7% from the previous year. There were also 2.8 million injuries and illness cases in 2022, a 7.5% increase from 2021. The National Safety Council finds that the average cost for a claim is around $41,757. That makes it clear that despite adherence to safety rules and regulations, accidents can still happen.

Filing a workers’ compensation claim is not a guarantee that the claim will be approved and paid out. Workers’ compensation is a form of dedicated insurance. That means insurance companies administer it with the same goal of maintaining profits, and that can only happen if they don’t pay out benefits. That means they will be looking for ways to generate a denial of your claim.

As such, a workers’ compensation insurance carrier will scrutinize any claim and look for any loophole to deny a claim. Fortunately, an injured worker has a recourse. With the help of an experienced attorney, they can file an appeal.

When an appeal is filed, there needs to be a response in the form of a hearing where the injured worker and the insurance company can present their case before an arbitrator. The following guide details what you could expect during a worker’s compensation hearing.

The Hearing Process

The hearing for a worker’s compensation claim is an opportunity for you and your attorney to present the details of your claim. The representative from the workers’ compensation insurance company will also have a chance to present their reason for denying the claim.

When it comes time for you to present your side, your attorney will have you prepared to present the following types of evidence:

Accident Report

Immediately after your accident, you should have filed a report with your manager or supervisor. That report will provide the details of when and where the accident occurred. It should also detail the immediate aftermath, such as whether you left on your own for medical care or whether an ambulance was called.

Medical Evidence

You will need to present all of the medical reports and relevant documentation related to your injury. That starts with the initial diagnosis and course of treatment. This is also where you would present any receipts for prescriptions, medical supplies, physical therapy, etc.

Physician Testimony

You could present witness testimony from your doctor to back up the written medical reports. They could also support your assertions about any issues you might have with mobility or pain.

Eyewitness Testimony

If there were any witnesses to the accident, you can call them to provide their testimony that supports your case.

Proof of Lost Wages

You will also need to provide documentation about your lost wages caused by the accident. That proof can come in the form of pay stubs or previous direct deposit receipts.

Every piece of evidence that you present can be questioned by the insurance company representative. They can also bring their own medical testimony and witnesses to the accident.

Providing Your Own Testimony

Although the documents you will provide at your hearing are essential, your testimony will carry a lot more weight. Typically, your attorney will be able to ask you questions, and questions from the insurance company will follow that. Here are the questions you can expect to be asked:

How were you injured?

You will describe how you were injured. That will include what happened before and after the accident. You should only present the facts. For instance, if you were injured from a piece of machinery, you wouldn’t say, “I felt like something was off with the machine.” Instead, you should make a direct claim of what you noticed about the machine not operating as it had in the past.

What were the results of your injury?

Here, you will be able to discuss the initial diagnosis, the treatment, and recovery. You will also describe the limitations that resulted from the injury. For instance, was your writing hand injured, which keeps you from signing or writing? Did the injury impact your ability to get around?

What other aspects of the injury have disrupted your life?

You will describe how the injury has caused chronic pain and prevented you from going about your daily routines. Has it disrupted your sleep or caused you to lose or gain weight?

What training did you go through for the job?

You need to explain how you were trained to carry out your assigned task. This is to demonstrate your ability to carry out the task without injury.

You will be able to practice your answers with your attorney. They will also ask you the kind of challenges to your testimony that the insurance company representative might ask. Bottom line: You will be thoroughly prepared to present your case.

At the end of your hearing, the arbitrator will issue a ruling that will either overturn the denial or uphold it. If it is upheld, you might want to discuss with your attorney if you should file a personal injury complaint.

You will probably want to get your workers’ compensation claim approved as quickly as possible. That means involving an experienced attorney as soon as possible. Your attorney can also help you prepare the initial paperwork. You want to make sure your first claim is denial-proof.