When a worker in Massachusetts is injured on the job and the injury prevents them from working, they are entitled to certain benefits from their employer’s workers' compensation insurance carrier. If the insurance company denies the claim or does not respond within the specific timeframe following the accident or first date of disability, the injured employee can file a claim.
Once the claim is filed, the employee’s claim for benefits will follow the usual process of a Massachusetts workers’ compensation case. The first step after filing the claim is the scheduled Conciliation.
What is a Conciliation?
A conciliation is the first meeting or hearing that is scheduled when an injured employee files a claim for workers' compensation benefits. A conciliation is a form of alternative dispute resolution. It is defined as a formality to which intending litigants are convened in an attempt to reconcile the dispute. More plainly stated, it is an informal meeting between the injured employee’s attorney, the workers’ compensation insurer's attorney, and a conciliator from the Department of Industrial Accidents (DIA). Due to the COVID pandemic, the Massachusetts Department of Industrial Accidents has ordered that all conciliations are now to be held virtually and will continue this way for the foreseeable future. Previously, the conciliations were held in-person at the conciliation unit within the Department of Industrial Accients handling the claim or complaint. Although the conciliations are now held virtually, all requirments of the conciliations remain the same.
At this meeting, the conciliator will hear from both attorneys in an effort to clarify the issues of each case or claim. The conciliator will then try to get the parties to agree to a voluntary agreement. If the conciliator is unable to get the parties to come to some agreement, the claim is then referred to an administrative judge for a conference.
Does the Injured Worker Need to Appear at the Conciliation?
The general answer is, no, the injured worker does not need to attend the conciliation if he or she has an attorney. Although their appearance is not required, they may attend the conciliation if they desire. Since the conciliations are now being held virtually, if an injured worker is pro se or has a workers' comp lawyer and chooses to attend the conciliation, they must do it virtually. Thus, the injured worker must have the link and access code to attend the virutal conciliation.
In some situations, the injured employee must attend the conciliation. The injured worker must attend the conciliation on an employee’s claim(s) for scarring and disfigurement under Section 36. This is so the conciliator can evaluate the scar or disfigurement in order to determine the proper amount of compensation the employee should be entitled to.
What Needs to be Filed at a Conciliation?
When an employee or his or her attorney appears at a conciliation on the employee’s claim for benefits, there are certain documents that must be presented or filed. In cases where the workers’ compensation insurer has denied or is contesting liability and the employee has filed a claim for benefits, the injured employee or his or her counsel must present relevant medical records to the DIA or conciliator.
Generally, the injured employee or his or her counsel must present relevant medical records that establish the history of the injury, the nature and causation of the injury and the injured employee’s ability to work. When a claim is filed soon after the work accident and injury, there is typically not a lot of medical records. In situations where an employee was transported to an emergency room by ambulance after a work-related accident, the ambulance report and emergency room records are usually sufficient for the purposes of a conciliation.
What Happens After a Conciliation?
As stated above, the conciliator will hear from both sides and try to help the parties come to some sort of a voluntary agreement. If the conciliator is unable to get the parties to agree, the issues of the claim are clarified and the case will be referred to an administrative judge for the purposes of a conference.
The conciliator will provide the administrative judge with a report that outlines the issues in dispute and recommendations on whether weekly compensation or other benefits should be paid or not. This is why conciliations are important even if they are not able to get the parties to some agreement on the claim.
Have you Been Hurt on the Job and the Insurer Denied your Claim?
If you have been injured at work and you are not receiving workers’ compensation benefits or the insurer has denied your claim, feel free to contact us today either on-line or call us at (508) 879-3500. We focus our legal practice on representing injured workers in workers' compensation cases in Massachusetts. We will explain what benefits you are entitled to and help you get the benefits you deserve.