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Workers Comp Dispute Resolution

Resolving Workers Compensation Claims Through Mediation and Arbitration

Workers’ compensation disputes arise from injuries that occur as a consequence of a workplace accident. They usually involve issues regarding the causal relationship of an injury to work, the ability to continue working, payment for being out of work, the right to treatment, the right to obtain doctors in a particular specialty, impairment benefits for a permanent impairment, permanent total disability, and allegations of misrepresentation or fraudulent behavior.

The parties in a workers compensation dispute are an injured worker as a claimant the injured worker’s employer and the insurance company for the employer. The employer and the insurance company are usually represented by an adjuster and an attorney representing both of them. The employer does not usually participate directly because the workers’ compensation insurance company covers the employer’s financial interests. In this way, an injured worker is usually not suing his or her employer directly.

Although not obligatory, in most disputes the worker should hire an experienced attorney knowledgeable about various workers’ compensation insurance laws and legal procedures and rules.

The insurance carrier and the injured worker are interested in resolving these disputes in a timely and cost-effective manner. For that reason, they often seek resolution mechanisms other than traditional court litigation. In most cases, alternative dispute resolution methods such as mediation and arbitration are the most suitable solution. Some jurisdictions recommend or even mandate mediation and arbitration before bringing the issue to the workers’ compensation court. Florida requires mediation after the filing of every claim in a workers’ compensation case.

It is also important to understand that an injured worker cannot obtain a lump sum payment for his or her injuries except through a settlement of the claim and only mediation facilitates such an outcome.

Mediation is an effective and mutually beneficial method of settling workers’ compensation disputes. Compared to litigation, which often takes years, mediation enables the parties to resolve their conflict quickly, even in a matter of a few months or even weeks.

As an informal and confidential process, mediation enables the parties to present their claims to a neutral third person. The mediator is chosen voluntarily by agreement of the parties or by the court if the parties can not agree. It is usually a retired judge or an attorney experienced in workers’ compensation claims.

Regardless of the informal nature of the mediation procedure, the workers and their attorneys should show up prepared for the session. The worker should be clear about his compensation claim, so that mediator can easily facilitate the negotiations and foster a settlement both parties agree upon. That includes calculating amounts of unpaid medical bills and wage loss benefits. Supporting the claim with copies of medical bills and other evidence is also vital.

An experienced attorney will help determine the best time for initiating the mediation in a workers’ compensation claim, but the court will set a deadline by which mediation must occur. While the state court system offers state hired mediators, most parties prefer to hire private mediators and the Florida law requires the insurance carrier to cover the cost of mediation. Therefore, there is no additional cost to the injured worker to hire an experienced private mediator.

Through a series of talks with each side separately, the parties can present their positions regarding the dispute. That enables the mediator to estimate the possibility of settling and then hold the joint sessions attempting to find common ground that leads to an agreement. Such agreement, when signed, is binding for both parties.

It is important to note that when the claimant is not represented by an attorney, the insurance carrier is not permitted to have an attorney present at mediation. Because of this it may be more difficult to reach an agreement.

Arbitration

Arbitration is another alternative dispute resolution method, which is highly effective in resolving compensation claims. Unlike court litigation, there is no judge or a jury in arbitration. Workers present compensation claims to an arbitrator or “Private Judge” chosen by the parties who are almost always former judges or experienced attorneys.

The arbitration ruling is mandatory and enforceable in the same way as court judgments.

Arbitration is less formal than litigation. There are no strict rules of evidence like in a court trial. The arbitrator can even resolve the dispute based on his sense of fairness, regardless of any procedure. That enables the parties to resolve the workplace compensation dispute in a timely and cost-effective manner.

Conclusion

Both mediation and arbitration are informal, confidential, and far less expensive than litigation. For these reasons, mediation and arbitration are important mechanisms for resolving compensation claims related to workplace accidents.