Step 1
When a conflict arises regarding workers compensation claims and / or benefit payments, employees and employers need to understand what steps should be taken to appropriately deal with the situation. Typically speaking, these disputes rarely involve the employer directly, since workers compensation insurance is the tool in and of itself that companies utilize to avoid being sued in the event of an on-the-job accident or injury. In most cases, if an issue arises, it is between the insurance company and the injured worker.
Although there are different groups and agencies available in each state who have the responsibility to assist in the process, as a general rule, most organizations involved in this type of conflict resolution routinely follow a general, three step process, regardless of whether the intermediary is state sanctioned or not.
The first step in the process is generally referred to as advocacy. In some states, this first phase is called the Ombudsman stage, although, not in all cases. The term Ombudsman is a Scandinavian word meaning an individual who investigates complaints and issues, reports findings, and helps to achieve a fair settlement.
If there is a dispute, one party or the other may seek the services of an advocate. The advocate’s primary function is to serve as an intermediary between the two parties to reach a fair and equitable solution, perhaps compromise, to the dispute. It is in the best interest of both parties to resolve their differences during this stage, as it is the fastest, and most inexpensive alternative to allow relief to a disagreement.
Step 2
In some instances, disputes over workers compensation can not be solved through the use of an advocate, or Ombudsman. If this is the case, both parties move into the second step of the system, often referred to as mediation. Mediation usually does not occur unless the advocate is unable to resolve the dispute in Step 1.
Mediation is a non-litigation situation, although occasionally people who serve as mediators have legal experience, especially in relation to workers compensation claims and cases. In some cases, a retired workers compensation judge will serve as the mediator between the disputing parties.
Generally speaking, the mediation process comprises informal communication, usually by way of telephone conversations. Both parties engaging in mediation are typically required to use good faith efforts in an honest attempt to resolve their disagreement through the use of a mediator.
Step 3
If mediation is unsuccessful and does not result in a fair and equitable resolution to the dispute between the two parties, the next step is Arbitration.
Arbitration is the litigation phase of the conflict resolution process, and is usually only available if the Mediator is not able to resolve the dispute during Step 2, that was first presented by the Advocate in Step 1. During this stage of the process, both parties can, and often do, retain the services of legal counsel to serve as their representation in a legal suit of one kind or another.
Attorneys for both parties appear at an Arbitration hearing or trial, and are allowed to be directly involved, and present the case to an acting judge, who then hears and decides, the case. Generally speaking, both parties of the dispute must agree, usually in writing, prior to the hearing, to accept the decision handed down by the judge at the conclusion of the arbitration hearing.
This step, as can be expected, is the most costly, and time consuming, for both parties, and in many cases, the disputing parties will attempt to solve their dispute before the case gets to the arbitration stage.
