California has the largest workers’ compensation market in the U.S. The approximately 600,000 claims filed yearly prompted Risk Placement Services to dub the state the center of the workers’ compensation world.
The majority of these are paid or settled through negotiation. However, a small percentage are not and go to trial.
Trials often occur when attempts to resolve issues through negotiation or mediation fail.
This article examines the key factors that lead to a workers’ comp trial and how best to navigate the legal process.
Understanding Workers’ Compensations Trials
A workers’ compensation trial is an administrative hearing before a judge where an injured worker and their employer resolve disputes regarding a work-related injury claim. Trials typically occur when a settlement cannot be reached and provide an opportunity for the parties involved to present:
- Evidence including medical records
- Witness testimony
- Documentation to support their case
The process in California is less formal and takes place before an Administrative Law Judge who decides the appropriate level of workers’ compensation benefits owed to the injured employee.
Why Is My Workers’ Comp Case Going to Trial?
There is usually an attempt at settling before a workers’ comp claim goes to trial. When settlement negotiations fail, it becomes necessary to have a judge decide the outcome of the case. The reasons for workers’ comp disagreements include:
- Disputes Over Injury Claims
An employer or insurance company may deny your claim based on the belief that the injury did not happen on the job. If you dispute this assertion and neither party cannot agree on the claim’s validity, your case will go to trial.
Disagreements may also occur if the employer or insurance company is disputing:
- The extent or severity of the injury
- The need for and cost of medical treatment
- The amount and duration of wage replacement benefits
Disputes can occur between the initial filing and the final settlement. Hiring a workers’ comp attorney increases the chances of successful settlement negotiations.
- Permanent Disability Assessments
Maximum medical improvement (MMI) is a term used when a medical condition is unlikely to improve with more treatment. At this stage, a physician conducts a permanent disability assessment, based on guidelines set by the American Medical Association. If the parties involved disagree on the extent of the disability, a workers’ compensation trial can occur.
The issue becomes exacerbated when medical opinions differ regarding the impairment rating or the injury’s impact on the individual’s ability to work. In both cases, determining the appropriate level of compensation becomes difficult making court proceedings for compensation necessary. If so, following a few trial preparation tips can ensure you thoroughly understand your case and your jurisdiction’s specific laws and procedures.
- Insurance Company Denials
A workers’ comp case can often go to trial when the insurance company denies your claim. Insurance companies are more likely to deny a workers’ comp claim if:
- They can prove the injury happened outside of work duties
- A prior injury contributed significantly to the current one
- The injured worker does not seek timely medical treatment
- The injured worker does not provide enough medical documentation to support the claim
- Risky behavior or intentional actions led to the injury
- The exact cause of the injury is ambiguous or not well-documented
- Claims are not filed within a reasonable time frame
Claim denials can have significant implications for injured workers including delayed medical treatment and financial hardship. Appealing the denial could lead to a potential legal battle.
- Medical Treatment Disputes
Workers’ compensation legal challenges can occur due to medical treatment disputes. In these cases, the doctors representing each party disagree on the necessity or appropriateness of medical treatments.
Medical evaluations and reports can be the proof needed to support a worker’s compensation claim. They can provide crucial information about the injury’s nature, severity, and work-relatedness. By establishing a clear connection between the workplace incident and the employee’s medical condition, they ultimately determine the validity and extent of a claim.
- Settlement Negotiations Failures
Any of the reasons outlined above can lead to failure of workers’ compensation settlement negotiations. Failed settlement negotiations can also occur due to:
- Differing opinions on future medical costs
- Unrealistic expectations from either party
- Poor communication
- Pressure tactics from the insurance company
- Lack of legal representation
A trial may be inevitable if both parties cannot agree on specific issues associated with a claim. However, this could change during the pretrial conference.
Pretrial conferences can help parties settle before a full hearing, potentially saving time and money. Even if this does not occur, the process allows the judge to understand the complexities of the case and guide the parties toward a resolution.
- Employer Non-Compliance
Employer non-compliance in workers’ comp cases occurs when an employer knowingly fails to fulfill their legal obligations regarding a claim. The employer can be subject to penalties and legal action as a result. Some cases of non-compliance can include:
- Refusing to provide the necessary medical treatment
- Denying a legitimate claim
- Not reporting work-related injuries properly
- Failing to carry proper workers’ comp insurance
What happens if an employee sustains a work-related injury, and an employer does not have workers’ comp insurance? The employee can sue the employer for damages related to the injury in civil court.
- Complexity of Cases
Workers’ comp claim complications are usually more likely when the case has many parties or legal issues. Complex cases can be intricate and tend to escalate to trial due to:
- Unclear policy language on treatment coverage
- Multiple procedures that may be expensive or experimental
- Any non-typical circumstances
Cases with significant financial implications also tend to be more complex.
Don’t Face Your Workers’ Comp Trial Alone – Get Expert Help Now!
If you’re facing a workers’ compensation case in Pomona, CA that may be heading to trial, don’t navigate this complex process alone. The experienced attorneys at Solimon Rodgers are here to guide you every step of the way. With our deep understanding of California’s workers’ comp laws and our commitment to fighting for your rights, we can help you achieve the best possible outcome. Whether you’re dealing with claim denials, disputes over medical treatment, or complex case issues, our workers’ compensation attorneys are ready to provide the expert legal representation you need.
Don’t let the uncertainty of a trial overwhelm you – contact Kings of Workers’ Compensation today and let us champion your cause in the courtroom. Your rights and your future are worth fighting for, and we’re here to ensure you get the compensation you deserve.
Schedule a FREE consultation here or call us at (844) 774-3577.
To learn more about us, please visit www.KingsofWC.com.
