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What if my workers’ compensation case doesn’t go as planned?

An injured worker might have numerous questions prior to and upon reporting the facts of their injury to an employer. After filing a workers’ compensation claim, he or she might question whether they will be able to promptly obtain workers’ compensation benefits. Unfortunately, however, that is not always the case and there may be bumps along the road.

What if my workers’ compensation case doesn’t go as planned? A Connecticut worker may wonder what to do if his claim is contested. He may know he was injured on the job and is racking up medical expenses, but an employer might still contest his claim for benefits. In the event an employer contests an employee’s claim, the employee can request an Informal Hearing.

At an Informal Hearing, the injured worker will want to present proof that the injury or illness is work-related. Testimony of witnesses and medical reports are often sufficient to establish the connection between the ailment and the workplace.

If a claim is denied, an injured worker will need to contact the District Office of the town where the worker was injured and request an Informal Hearing. If a case advances to an Informal, Formal or Appellate hearing, a Commissioner will act as a mediator. The Commissioner, whose role is similar to that of a judge, will try to resolve any disputes in the workers’ compensation case before him or her.

Of course an employer may not contest a claim, but instead offer what is called a Voluntary Agreement. Under a Voluntary Agreement, an employer agrees that the worker’s claim is deserving of benefits and agrees to provide those benefits. It is important to review a Voluntary Agreement carefully as it contains information about an injured worker’s claim.

A claimant has the right to have an attorney with him throughout this entire process, and it may be helpful, particularly as a claimant navigates what is often unfamiliar territory. It will benefit the worker to be as prepared and thorough as possible as he pursues workers’ compensation benefits.

Source: State of Connecticut Workers Compensation Commission, “What to do if your claim is contested“, accessed April 25, 2015

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36-year-old laborer for landscaping company fractured wrist when fellow employee hit him with truck. Claimant received in excess of $30,000 in workers’ compensation benefits for total disability and medical expenses and settled with automobile insurance company for fellow employee for $95,000.

1989 workers’ compensation claim settled for $125,000. Claimant originally sustained a low back injury when she slipped and fell at local grocery store resulting in low back surgery in 1989. Several years later, claimant exacerbated her low back injury. Claim was reopened and settled with carrier for $125,000 in 2006.

47-year-old deli clerk sustained low back injuries at work for local supermarket. Carrier originally denied claim on the grounds that the injury was pre-existing. After formal workers’ compensation hearing carrier accepted claim and paid all total disability benefits and medical expenses in excess of $100,000. Case then settled for an additional $100,000 after injured person received a permanent disability rating.

34-year-old male roofer sustained multiple injuries to his shoulder, neck, back and hip when he fell from roof during work. Claimant was provided workers’ compensation benefits in excess of $100,000 and settled remaining claims for an additional $55,000.

40-year-old male working for cleaning company sustained neck and low back injuries when he fell on defective staircase while cleaning local museum. Claimant recovered over $95,000 in workers’ compensation benefits and resolved claim against museum for $85,000.

26-year-old laborer sustained fractured foot when a cast iron pipe was dropped on his foot. Employer and workers’ compensation carrier denied claim on basis that injured worker was an independent contractor. After a series of informal and formal workers’ compensation hearings, carrier conceded that claimant was an employee and settled case for $85,000.

24-year-old waitress sustained back injury while working at Outback Steak House. Workers’ compensation insurance company initially denied the claim. After a series of informal hearings, carrier accepted claim paying medical expenses and total disability benefits. In addition to those benefits paid, claim settled for an additional $75,000.

Delivery truck driver sustained right wrist fracture in rear-end motor vehicle accident while in the course of his employment. Claimant recovered in excess of $40,000 in workers’ compensation benefits for medical expenses and total disability benefits. Claimant settled case against at-fault driver for $105,000.

22-year-old male working as stocking clerk at “big box” retailer sustained herniated disc in low back. Workers’ compensation carrier refused to accept the claim. After formal workers’ compensation, hearing commissioner ordered carrier to pay over $35,000 in past total disability benefits and pay for surgery and all related medical expenses. Case settled for an additional $35,000 for a total recovery in excess of $100,000.

Rear-end collision on entrance ramp to Merritt Parkway resulting in 49-year-old woman sustaining mid-back injury. Case settled at mediation after filing suit for $300,000.

28-year-old passenger sustained multiple herniated discs in automobile accident in New York state. New York no-fault carrier paid for extended period of disability from work and medical expenses, including expenses for surgery. Case settled against driver of vehicle for $300,000 policy limits shortly after filing suit.

54-year-old man sustains shoulder injury when hit from behind by uninsured motorist on New Jersey Turnpike. Case settled for $135,000 prior to trial.

CT Transit bus driver sustained torn meniscus in collision with another vehicle. Claims made against at-fault driver, workers’ compensation carrier and client’s underinsured motorist policy. All claims settle for a recovery in excess of $100,000.

68-year-old woman sustained neck and back injuries in rear-end collision and required extended course physical therapy, but was not a surgical candidate. Case settled for $100,000 prior to filing suit.

34-year-old woman sustained concussion and neck and back injuries in hit-and-run accident on a New York highway. Claimant settled uninsured motorist claim for her $100,000 policy limits.

80-year-old woman sustained right foot fracture when her foot was run over in a parking lot. Case settled for at-fault driver’s policy limit of $100,000 prior to filing suit.

38-year-old nanny sustained right femur fracture when she fell down defective stairs in home of her employer’s neighbor. All medical expenses and lost wages reimbursed and case settled for an additional $150,000.

Claim against landlord for defective staircase in multi-family rental house. Claimant sustained a right femur fracture. Case settled for $125,000 prior to filing suit.

$95,000 judgment obtained against bar and nightclub for assault by one of its patrons against another patron.

47-year-old woman sustained a broken left wrist when she fell from porch stairs at house she was renting. Case settled for $95,000 shortly before trial.

26-year-old male bitten on leg by German shepherd. Claim against dog owner settled for $65,000 plus payment of all medical expenses.