If you and your employer’s workers’ compensation insurer can’t agree on your claim, the DIA will help settle the dispute. There are 4 steps in the process:
- Reviewing Board
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.