Take Action: Regain Control of Your Life
If your benefits are not paid correctly, for whatever reason, take action. You have the right to file a claim with the Labor Commission to ask for a mediator to help you resolve the case or to ask for a Judge to order benefits to be paid.
Before you decide to file a claim, take a close look at your case. You must be able to prove two things in order to prevail at a hearing.
1. Legal Causation. Is your employer (and therefore their workers compensation insurance company) legally responsible for your injury? Were you injured at work? Did you report the injury within 180 days as required by law? If you had a preexisting injury to the injured body part, were you involved in an accident or doing something unusual to re-injure the body part? Please note: if you had no prior injury to that body part, anything that causes an injury is sufficient, but if there was a prior injury to that body part, no matter how long ago, a sudden or unexpected occurrence or an unusual exertion is required to make the employer responsible. (See: Preexisting Conditions for more information.)
2. Medical Causation. Was your injury medically caused by the accident or exposure at work? This question is simple to answer - just ask your doctor. You must have a medical opinion saying it is at least more likely than not that your injury was caused by your employment. Many people make the mistake of saying “of course it happened at work I never had this problem before.” However, this is NOT sufficient to prove your case in court. You must have a written medical opinion. If your doctor has not written that your medical condition was caused by work, a Summary of Medical Record Form can be obtained from the Labor Commission. The Summary of Medical Record Form allows your doctor to provide the medical evidence you need in a simple, fill in the blank form. You can dowload the Summary of Medical Record Form here.
To file a claim, you must complete the appropriate forms which include: Application for Hearing, Medical Authorization, and Health Care Provider List. You can get the forms online or contact the Labor Commission at (801)530-6800 or (800) 530-5090. Once completed the forms are returned to the Labor Commission.
At the Labor Commission , file the forms listed above along with the medical record which shows a doctor's opinion that your injury is a result of your work.
After filing, you will receive an Order for Answer which requires your employer (through their insurance company) to respond to your claims. They have thirty days to respond with an Answer. You will receive a copy. It should explain all the reasons they denied your claim. If it does not, be sure to write to the person who signed the Answer asking for a complete explanation of the denial as required by the Request for Answer. Once the Answer has been filed, the Labor Commission will set a hearing date.
You will receive notice of your hearing date by mail. Although it takes some time for a hearing to be scheduled. Use this time to prepare for your hearing. Prepare your opening statement (a short summary of what you are requesting the judge to do) and your closing argument (a summary of your case including the evidence that supports your claim and a final short statement of what you want the judge to order.) Gather witnesses and medical reports. Don't forget you are your own best witness. Prepare your testimony carefully to be sure to cover all the important information the judge will need to know to understand your case.
The workers compensation insurance company will also be preparing their case. They may ask you to answer Interrogatories (written questions) attend a Deposition (oral questions) or attend an IME (medical evaluation). Refusal to cooperate will delay your hearing. If you feel they are being unreasonable or asking questions they should not ask, contact an attorney for legal advice.
Hearings at the Labor Commission involve an Administrative Law Judge, the employer's (or their insurance company's) attorney with their witnesses as well as you and your witnesses. The judge will get the hearing started with basic information such as names, address and what benefits you want the insurance to pay. The judge will then ask for testimony. You should testify first. Start with the accident and tell your story slowly and clearly from start to finish. Be sure to discuss your side of the story on anything the employer (or their insurance company) used as a reason to deny your claim in their Answer. After you have testified, the attorney for the employer has a chance to ask you questions. Answer them as truthfully as you can. If you do not feel you are allowed to explain completely, you can explain after they are done with their questions. Sometimes, the judge may have a few questions as well.
Once your turn is done, call each of your witnesses, if any. (Witnesses are not required). After all your witnesses have testified, the employer's attorney can call his witnesses. After each witness testifies, you can ask the witness questions. The employer's attorney can follow up with additional questions after you are done. After all the employer's witnesses are done, you can take the stand again to address any issues the witnesses introduced. This is not necessary, but should be done if you disagree with anything they say. After all testimony is presented, closing arguments are presented. After closing arguments, the judge will close the hearing.
Judges do not normally make decisions at the hearing. The matter is taken under advisement and a written decision is mailed to you later. If the judge needs medical advice he will send the matter to a medical panel for medical decisions.
Medical Panels are required in cases in which there is a disagreement among the doctors about what is wrong with you or the cause of the injury. A Medical Panel consists if neutral doctors who work for the judge. If the judge sends the case to a medical panel, the doctors will contact you to make an appointment for an examination. Only you attend the examination. No insurance company employees, case workers, etc. should attend. The medical panel will examine you and issue their decision in writing. You will receive a copy of that decision. If you feel it is wrong, you must write the judge with specific reasons why you feel it is wrong within 15 days. Be sure to include support for your objections, such as medical reports. The Judge will then mail you a copy of the Judge’s Order.
An Order is a binding decision. It will include the amounts the workers compensation insurance company is required to pay and the injuries for which they are responsible. Unless the decision is appealed, the workers compensation insurance company must pay the benefits outlined in the Order within 30 days.
If either side disagrees with an Order they must file a Request for Review with the Labor Commission within 30 days. Include the reasons you disagree and support for your opinion. If nothing is filed within 30 days, the Order becomes final and cannot be changed. This applies to the insurance company as well. If you have not received payment as required by the Order within 30 days and no appeal was filed, contact the Labor Commission.
After the Review is completed at the Labor Commission, an appeal can be filed with the Utah Court of Appeals if you disagree with decisions of the Labor Commission, but be sure to meet the required time limits.
This page was written by Atkin & Associates.
Contact attorney Marsha S. Atkin for more information.
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(Chartered April 1, 1988)
The Injured Workers Association of Utah (IWAU) is a Utah non-profit corporation concerned with over 70,000 injured, disabled and displaced workers each year who suffer the financial and personal hardships occasioned by industrial injuries and occupational diseases in Utah. It is neither union nor non-union, and represents all members of the workforce. Its membership is open to all injured workers regardless of race, creed, color, age, sex, national origin, religious persuasion or political affiliation
copyright 1999 - updated March 2005
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