Filing for workers’ compensation can be a confusing process as each state has its own set of rules and guidelines to follow. When it comes to filing a formal legal claim for workers’ compensation, it can be unclear where to file. Does it matter which court an injured employee uses to file for workers’ compensation? We have asked lawyer, Alaina Sullivan, and here is what she had to say: What Is Workers’ Compensation? Workers’ compensation is a form of insurance available to employees who are injured while on the job. Every state has its own set of laws governing how these claims are submitted and handled. Workers’ compensation compensates the injured employee regardless of who caused the injury, whether it be because of the worker’s negligence, employer’s negligence or all of the above, so long as the injury occurred at work. Most states require that workers’ compensation claims go through the state’s system, while federal employees are required to go through the federal workers’ compensation system for claims, also known as the Federal Employees’ Compensation Act (FECA). Appeals Process After the claim is submitted and the workers’ compensation insurance provider gives an offer, if the injured employee is not satisfied with the amount given or if he or she is denied benefits, the employee can appeal. In fact, the notice of denial given by the insurance company will detail what the employee needs to do to file a formal claim or appeal. Each state has strict deadlines when it comes to appeals so it is important that these instructions be carefully followed. Every state also has its own requirements for sending an appeal. Some states require certain forms while others only require sending a letter to the state’s workers’ compensation agency. Not following the proper protocol, however, can result in the employee being barred from benefits completely. Some states require mediation before any hearing takes place, including North Carolina and Pennsylvania. Formal Administrative Hearing Before the injured employee goes before an actual judge in a court hearing, the first step is usually a workers’ compensation hearing. These hearings are less formal than a trial and are normally before an administrative law judge. However, the hearings can be similar in that both sides are allowed to submit evidence and testimony on their own behalf. The key with these hearings is the injured employee will need to convince the judge that the board’s denial was wrong. A lawyer is not needed at these hearings, but to ensure that evidence is properly submitted in the event a later court hearing needs to happen, having a lawyer can be quite helpful. If the injured employee’s efforts fall short at this first administrative hearing, the next step would be to make a second administrative appeal through the workers’ compensation appeals board. This is usually just in the form of the person explaining why the first officer’s ruling was wrong, based on the evidence that was given at that hearing. The injured employee does not have a second hearing. This second hearing would happen via the court system after the second officer gives an unfavorable decision. Appeals through the Court System If the injured employee is not successful, only then does that person need to appeal through the legal system. In most situations, this is done in the state court system, which normally involves the lowest court in the state court system. In most states, these matters are processed and assigned to courts just like any other lawsuit filed in that county. The case can be decided before a jury or a judge, depending on the case. Also, just like any other law suit, the client will need to follow proper legal procedures and rules of evidence, which can be easier with the assistance of a lawyer. If the employee is a federal employee, the legal claim will need to go through the federal court system, usually starting with the lowest court. Like a state legal proceeding, these law suits are typically handled just like any other law suit and will be assigned to the courts accordingly. Contact a Lawyer Today If you are in the process of pursuing workers’ compensation and have questions about the best venue where you can file your claim, a workers’ compensation lawyer can help review your case and discuss your options. A lawyer can listen to the facts of the case and can best advise you on how to proceed. Contact a lawyer experienced in workers’ compensation law to schedule a consultation today. Additional Resources When is it a Good Time to Settle My Workers' Comp Claim? What Do I Need Prepared For My Workers' Compensation Claim? Can I Settle a Workers' Compensation Claim Out of Court?
