The 4 steps in the dispute resolution process

When you, or your attorney, files a claim for workers’ compensation benefits, or the insurer files a complaint to stop or modify your benefits, a conciliation is scheduled.

A conciliation is an informal meeting between you, your attorney, the insurer's attorney, and a conciliator from the DIA.

• Bring medical documentation with you
• It is recommended you hire an attorney
• Find out tips on how to prepare for a conciliation

The conciliator will try to help the parties reach an agreement. If an agreement can’t be reached, the claim is referred to an administrative judge for the next step — a conference. 

It is strongly advised you hire an attorney for a conference.

A conference, (also known as a proceeding), is also an informal discussion between you, your attorney if you have one, the insurer, and the administrative judge. The DIA has tips on preparing for a workers’ compensation conference.

If the issues are resolved, the administrative judge will issue a temporary order that states if the workers’ compensation insurer must pay you benefits.

• If the insurer is asking to modify or stop benefits, the order will address those issues

You, and/or the insurer, can file an appeal of a workers’ compensation conference order within 14 days if you don’t agree with the administrative judge’s order.  

If the conference order is appealed, the case will go to a full evidentiary hearing.

The hearing is the “trial” phase of the case. Massachusetts rules of evidence apply, witnesses are called, and a stenographer records testimony. The DIA offers tips on preparing for a workers’ compensation hearing.

The administrative judge may require both sides to new submit evidence and oral testimony before issuing a hearing decision.

You and/or the insurer must file an appeal of a workers’ compensation hearing decision to the Reviewing Board within 30 days.

The DIA’s Reviewing Board hears appeals of hearing decisions. The DIA offers tips on preparing for a workers’ compensation Reviewing Board case.

Three administrative law judges will examine the hearing transcripts. The reviewing board:

• Can ask for legal arguments, called oral arguments
• Will require legal briefs
• Can affirm the hearing decision with no discussion
• Can send a decision back to the administrative judge for further findings of fact

The Reviewing Board will only reverse the hearing decision if they find it was:

• Beyond the scope of the administrative judge’s authority
• Arbitrary or capricious
• Contrary to law

If you and/or the insurer wants to appeal the Reviewing Board decision, it is heard by the Massachusetts Court of Appeals.