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What if there is a dispute in my workers' compensation claim?

When a Massachusetts worker is injured on the job or suffers a condition or illness due to the work they do, they might believe they are entitled to workers' compensation benefits. Sometimes, however, there are issues surrounding workers' compensation claims that cause problems for the person to get the benefits. There are four steps in settling a workers' compensation dispute. They are: conciliation, conference, hearing, and reviewing board. The Department of Industrial Accidents (DIA) helps to settle these disputes.

Conciliation is when the claim for workers' compensation is filed and the insurer tries to stop or modify the benefits. This is an informal meeting between the claimant, his or her legal representation, and a DIA conciliator. The claimant should have the medical documentation regarding the issue and bring it to the meeting. The conciliator's role is to help the sides come to an agreement. If this is not possible, it will go to a conference.

A conference is also referred to as a proceeding. An administrative judge will hear the arguments both sides. Should the issues in the case be resolved in the conference, the administrative judge issues a temporary order stating that the insurer is required to pay the benefits. In some instances, the insurer is told to modify or cease providing benefits. The order will deal with that if it is the case. There can be an appeal of the order within 14 days.

With an appeal, the case will move to a full evidentiary hearing. The rules of evidence in the state will apply, there will be witnesses and a court reporter. The administrative judge can ask for new evidence and testimony prior to giving a decision. If either side disagrees with the result of the hearing, there will be 30 days to appeal to the Reviewing Board. The Reviewing Board can do the following: ask for legal - or oral - arguments; require there be legal briefs; affirm the decision from the hearing without a discussion; or return the decision to the administrative judge for further findings of fact.

The Reviewing Board will only reverse a decision from the hearing if they find: that it was beyond the authority of the administrative judge; it was capricious or arbitrary; or it was contrary to law. Any further appeal will be heard by the Massachusetts Court of Appeals. People who are seeking workers' compensation benefits should know that they have recourse if there is a problem of any kind. Having legal assistance from an attorney who is experienced in assisting an injured worker with a dispute is essential.

Source: pilot.mass.gov, "The 4 steps in the dispute resolution process," accessed on Sept. 3, 2017

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