June 18, 2020 | Workers' Compensation
The workers’ compensation system should be a straightforward process in which workers receive medical treatment and benefits for a workplace injury. However, disputed claims are common.
When a workers’ compensation dispute cannot be settled between the injured worker and the insurance provider for the employer, the matter may proceed to a workers’ compensation hearing. Only a small percent of cases go to a hearing. Most workers’ comp disputes settle without court intervention.
Filing a Workers’ Compensation Claim in Oklahoma
The first step in receiving workers’ compensation benefits is to file a claim. Workers’ compensation is a no-fault system. Covered workers generally only need to prove that the injury occurred while performing work-related duties to receive benefits.
The process typically begins when an employee reports an injury to the employer. It is usually best to report injuries immediately so that you can begin receiving medical care and workers’ comp benefits as soon as possible. However, Oklahoma’s statute of limitations for workers’ compensation claims is two years, in many cases.
If the workers’ comp claim is approved, the employer’s insurance provider pays for reasonable and necessary medical care. Employees who are unable to work receive wage benefits.
In some cases, a worker may receive vocational rehabilitation and permanent disability benefits. The type of benefits a worker may receive depends on the severity and type of injury.
Why Would My Employer Deny My Workers’ Compensation Claim?
An employer or its insurance provider may deny your claim for workers’ comp benefits. There are several reasons why your claim may be denied. For example, your injury occurred out of the ordinary course of your employment.
An employer may claim that the employee was under the influence of an illegal substance at the time of the injury. An employer may deny a claim if it believes that an employee intentionally caused the injury.
Some employers or insurance providers deny a workers’ compensation claim because the employee failed to report the injury. Employees who fail to follow their doctor’s medical treatment plan may also receive a denial of claim letter.
However, some employers and insurance companies attempt to deny valid workers’ comp claims to avoid paying the claim. For instance, an employer may claim that an employee is an independent contractor. Workers’ compensation insurance does not cover independent contractors.
An employer or insurance company may allege that an employee failed to provide the correct documentation or file the required workers’ comp forms. A claim could be denied based on where the injury occurred. An employer may try to avoid claims involving off-site injuries.
What Happens if My Employer or the Insurance Company Denies My Claim?
If your claim is denied, you have the right to appeal the decision. Requests for hearings of denials are filed with the Oklahoma Workers’ Compensation Commission.
You or your employer may request a pre-hearing conference. Pre-hearing conferences are not trials. They are informal meetings between the parties, their attorneys, and the judge.
During the pre-hearing conference, the parties discuss the issues under appeal. The parties may also discuss potential settlement offers to avoid a full administrative hearing.
Proceeding to a Workers’ Compensation Hearing
If you and your employer cannot settle the dispute, the matter proceeds to a formal hearing. A formal hearing is similar to a non-jury trial. Each party presents evidence and testimony to support the party’s position.
As the injured employee, you have the burden of proof at the hearing. You must prove that your injury is work-related and covered by workers’ compensation laws. Each side can retain expert witnesses to testify at the hearing, present documents, and question witnesses.
Both parties must follow the Rules of Evidence and Rules of Procedure for a workers’ compensation administrative hearing. For instance, both parties have until 20 days before the hearing to provide a list of witnesses and exchange evidence with the other party. Failing to follow procedures could result in evidence being inadmissible at trial.
After all evidence is presented, the judge decides the case based on applicable laws, medical evidence, and witness testimony. If you disagree with the judge’s ruling, you have ten days from the date of the judge’s order to file a Request for Review.
The appeals process can be complicated. You will be going up against attorneys for your employer and the insurance company at the hearing. Additionally, you may be at a disadvantage before the hearing if you are not familiar with the rules of discovery.
You are not required to hire an attorney, but you may want to consider consulting with a workers’ compensation lawyer to protect your right to the benefits you deserve after being injured on the job.