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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:
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.