Sometimes, employers and workers' compensation insurers don't agree with an employee's claim. They may believe an injury didn't actually take place at work, or that an illness wasn't caused by a workplace hazard. They may try to blame the sick or injured employee. They may even deny the worker was actually an employee and claim he or she is a contractor. Or, they may simply dispute the amount of benefits the worker deserves.
Whatever the reason, if your workers' comp claim was wrongly denied or cut off, the next step is to contact your employer or their insurance company and ask them to reconsider their position. If that doesn't work, you'll need to petition the Pennsylvania Department of Labor & Industry's Office of Adjudication to have a workers' compensation judge resolve the dispute.
If you dread going to court, you'll be pleased to know that the Office of Adjudication provides three alternative dispute resolution options:
- An informal conference with a WC judge
- A formal settlement conference with a WC judge
- Mediation by a WC judge
In fact, mediation is the default option or resolving disputes at this level -- a mediation session will be scheduled automatically unless a WC judge concludes it would be futile.
During mediation, a WC judge will not rule on the dispute. Instead, he or she will act as a neutral but knowledgeable third party in order to facilitate the discussion. A good mediator can help you pinpoint the area of disagreement and discuss it without rancor. Often, keeping a discussion going can be productive because it allows the parties to develop a solution to the dispute that they both can live with. If mediation doesn't resolve the problem, the parties can still head back to a more formal court proceeding, and nothing revealed in the mediation session can be used as evidence in court.
If you prefer a settlement conference, the main difference between the two types is that informal conferences offer a level playing field for workers who can't afford attorneys. In an informal conference, if you don't bring an attorney, the other side doesn't get to, either.
The Department of Labor & Industry urges workers to consider hiring workers' comp lawyers, not only because these cases can be complex but also because the other side will have one. If you're worried you can't afford one, keep in mind that our fee arrangements must be approved by the WC judge.