Why is My Workers’ Comp Case Going to Trial?

Very few job injury victims ask this question. Over 95 percent of civil claims, including workers’ compensation claims, settle out of court. In fact, in many cases, a trial setting is simply a negotiating tool. Once the insurance company knows the victim is determined to go all the way, insurance company lawyers are more willing to wheel and deal. However, as outlined below, sometimes the two sides are simply too far apart on a key issue, so an Administrative Law Judge must resolve the dispute.


Many victims believe making an out-of-court settlement is like raising the white flag and giving up. However, these resolutions are usually better for victims than trials. Primarily, these settlements end cases sooner, which means victims get their checks sooner. Moreover, settlements give the parties more control over the outcome. Finally, these settlements reduce bad feelings, so when workers get back on the job, a cloud doesn’t linger over them.


Issues in Workers’ Compensation Cases


Usually, insurance company lawyers cannot dispute fault. However, they can and do dispute teh work-related connection and the amount of damages.


Most work-related injuries occur at work while the victim is on the clock, so the connection is clear. But what about injuries during “optional” company events, work from home injuries, and commuting-related injuries?


The first two examples are clearly work related. Charity softball games, team-building retreats, and other such events clearly benefit employers. If the employer benefits, the injury is work related, at least in most states. WFH injuries are also work related. Employers have a legal duty to provide safe work environments. Simply providing equipment and watching remote employees doesn’t come close to fulfilling this duty of care.


You’d think the third above example is a work related injury as well. However, courts have consistently held that commuting injuries aren’t work related injuries. That position might change in the remote work era, but we shall see.


The Trial Process


An Administrative Law Judge hearing is a bit like a bench trial, in which the judge serves as both legal referee and factfinder.


Privacy is one big difference. Court reporters record everything that anyone says at a bench trial. ALJ hearings don’t have official records. If questions about the ALJ’s decision arise, a reviewing body must piece things together based on the paperwork in the file and the participant’s recollections. These recollections might or might not be accurate.


Additionally, ALJs have limited powers. For example, they usually cannot issue subpoenas. ALJs cannot compel reluctant witnesses to appear and testify and/or produce documents. On a related note, ALJs are usually insurance company-paid independent contractors. So, ALJs are usually, but not always, completely neutral.


Procedurally, ALJ hearings and trials are almost identical. Lawyers make arguments, question and cross-examine witnesses, and introduce and challenge evidence. That’s much more complete than a Claims Examiner review, which is normally a paper review. Insurance company arguments often don’t withstand the additional scrutiny, which is why so few workers’ compensation cases go to trial.

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