A serious injury on the job can leave you dependent on workers’ compensation benefits. When the insurance carrier denies your claim or challenges part of it, you may be uncertain about what happens next. Recognizing when a hearing becomes necessary can help you prepare for the next stage of the process.
Conflicts that require a hearing
A case may proceed to a hearing when a disagreement over your claim remains unresolved and either side files a formal request for a decision. To support your request for disputed benefits, you may offer:
- Whether your injury arose out of and occurred in the course of your employment
- Whether proposed medical treatment is reasonable and necessary
- Whether you qualify for temporary or permanent disability benefits and, if so, how much you are owed
- Whether a closed claim should be reopened
As the injured worker, you generally must present evidence establishing your right to the benefits you request.
Proceedings that narrow the issues
Before a formal hearing, either side may request a prehearing conference to address procedural matters. This step can clarify which questions are ready for a decision and address disputes involving scheduling, evidence exchange or other preparations.
A prehearing administrative law judge may approve agreements between the parties and issue orders concerning discovery, subpoenas, depositions and evidentiary disputes. Handling these matters beforehand can make the later hearing more focused, although the conference does not determine whether you qualify for benefits.
Evidence that guides the decision
At the hearing, you and the insurance carrier rely on witnesses and documents to support your respective positions. To establish your right to disputed benefits, you may offer:
- Your sworn account and statements from other witnesses
- Medical records and opinions from your health care providers
- Wage statements showing your earnings before the injury
- Photographs, written communications or other claim-related documents
The administrative law judge weighs the evidence admitted at the hearing when determining whether you have established your right to the requested benefits. It is important to know that the judge may exclude any document that either you or the insurance carrier failed to disclose properly.
Orders that permit appeals
Once the proceeding concludes, you receive a written order explaining how the administrative law judge resolved the contested issues. If you disagree with a ruling you can challenge, you generally have 20 days from the mailing date to file a petition identifying the errors you believe affected the outcome.
The same judge may issue a supplemental order before sending the matter to the Industrial Claim Appeals Panel. The panel examines the existing record and written arguments rather than taking new evidence or conducting another hearing. If you contest its final decision, you may appeal to the Colorado Court of Appeals.