Worker's Compensation

V. OVERVIEW OF DENIED CLAIM PROCEDURE

Should the employer or insurance company refuse to provide benefits for which an employee may be entitled, the injured employee should contact an attorney to perform the following steps:

1. Request the desired benefit to the employer/carrier. If they do not provide the benefits requested within a timely manner (i.e. 5-10 days), you may then proceed with the filing of a Request for Assistance (RFA) through your attorney or if unrepresented, contact the Ombudsmen office 1-800-342-1741.

2. If the dispute cannot be resolved by the Ombudsmen's office within thirty days from the date the Request for Assistance is filed, you may then file a Petition for Benefits.

3. Within thirty days from the filing of the Petition for Benefits, you will receive a docketing order indicating the approval or denial of the Petition for Benefits. If the Petition is denied, an amended Petition must be filed which meets the court's specifications. If approved, the following hearings will be scheduled concerning the issues set forth in the Petition for Benefits.

A. Mediation Conference - negotiation or settlement conference supervised by an impartial individual (mediator) who cannot render a final decision, but who assists the parties in communicating and reaching a mutually agreeable settlement of their dispute. Mediation conferences are mandatory under the Workers' Compensation Law.

B. Pretrial Conference - if a resolution of the matters was not met at the mediation conference, a pretrial conference will then be held. The employee/claimant and employer/carrier meet at office of the Judge of Compensation Claims to complete a pretrial stipulation which outlines the issues which are in dispute and will be presented/argued at the final hearing.

C. Final Hearing - This is where the employee/claimant and the employer (insurance carrier) go before the Judge of Compensation Claims and present their evidence. The Judge will rule on the dispute within 14 days after the final hearing unless the parties agree on a later date.
Due to the volume of claims in this area and the limited number of judges, the final hearing may not be put on the court's calendar for approximately six to nine months from the date of the filing of the Petition for Benefits.