Hearings and Appeals
Most employees with work-related injuries or illnesses will have undisputed cases in which their medical treatment, wage replacement benefits, and other benefits proceed smoothly and expeditiously. These employees will not need a workers' compensation hearing, because there will be no dispute to settle; all parties agree on the compensability of the accident or illness and on the medical treatment and benefits due the employee as a result. However, for those cases in which there is some level of difference of opinion, disagreement, or misunderstanding, the Workers' Compensation Act provides for several levels of hearings in which to resolve disputes.
Of all disputed cases, over 95% are settled in Informal Hearings. In a very small number of cases, usually involving very complex issues or matters of law, disputes are taken to Formal Hearings for resolution. Decisions rendered at Formal Hearings may be appealed to the Compensation Review Board (CRB). [Cases may also be appealed past the CRB to the Appellate Court and to the State Supreme Court, but this is very rare indeed.] Sec. 31-290a cases, involving Discharge and Discrimination, do not get appealed to the CRB, but directly to the Appellate Court.
Hearings may also be held for reasons other than disputes. For instance, a claimant must request an Informal Hearing before an Administrative Law Judge to request discretionary “308a” wage differential benefits or to have a scar or disfigurement evaluation.
An Informal Hearing is an informal conference held at a Workers’ Compensation Commission District Office and presided over by an Administrative Law Judge. The purpose of the conference, which usually lasts about 15 minutes, is to resolve disputes in workers’ compensation cases, or to make appropriate awards of benefits such as “308a” or scar and disfigurement benefits. An Administrative Law Judge presiding over an Informal Hearing will not “represent” either party in a case, but will serve as an impartial fact finder and mediator between the two parties.
Either party—claimant or respondent—may request an Informal Hearing by contacting the District Office having jurisdiction. However, an effort must be made to resolve the dispute prior to requesting the hearing.
Both the claimant and the employer or its workers’ compensation insurance carrier attend the Informal Hearing. (An Informal Hearing will not be postponed if one party fails to attend, unless both parties have agreed ahead of time to such a postponement.) A claimant may come alone to an Informal Hearing or may come with an interpreter (if needed) and may also be represented by an attorney, union official, or other workers’ compensation representative. Employers and insurers often have an insurance adjuster and/or attorney as their representative(s). As a claimant, you have the right to attend hearings involving your case, including when represented by counsel. The Informal Hearing is informal in nature, simply including a discussion of the issues and evidence, and most often a recommendation by an Administrative Law Judge as to how to resolve the dispute. There are no stenographic records of such hearings.
The party requesting the hearing should clearly explain to the Administrative Law Judge any issues that are in dispute. Evidence (such as medical reports, test results, evaluations, or any documents supporting the request) should have been attached to the Hearing Request so that the Administrative Law Judge will have them in the file.
After reviewing evidence presented and discussing the issues, the Administrative Law Judge will usually make a recommendation to resolve the dispute. If both parties agree, the recommendation(s) will be binding upon the parties as an award made by the Administrative Law Judge.
When a resolution cannot be determined and agreed upon in one Informal Hearing, another one is usually scheduled for more discussion, presentation of evidence, or for whatever other reason(s) the Administrative Law Judge deems necessary. In cases where the parties cannot reach agreement after one or more Informal Hearing(s), it may be necessary to request a Formal Hearing.
If an Administrative Law Judge determines that a dispute cannot be resolved informally, or one of the parties requests a Formal Hearing, a Pre-Formal Hearing may be held prior to the scheduling of the Formal Hearing. Where possible, a party who has not been represented by an attorney during the Informal Hearings may wish to consider retaining counsel, as discussed in the section on Formal Hearings (below).
The purpose of the Pre-Formal Hearing is to help the settlement of claims and to prepare a case for trial at a Formal Hearing by clarifying the issues in dispute. At the Pre-Formal Hearing, the parties should cover the issues to be decided at the Formal Hearing, the evidence that they expect to submit, the particular testimony to be addressed, and the names of persons being deposed. Once the hearing is concluded, the parties should know what the Administrative Law Judge expects of them for the Formal Hearing. They should not expect the Administrative Law Judge to consider issues or evidence, including testimony, that goes beyond the matters addressed at the Pre-Formal Hearing.
At the Pre-Formal Hearing, the parties should also agree to a timetable for preparing their respective cases. This timetable will be given to the Administrative Law Judge, who may either schedule a second Pre-Formal Hearing to confirm that the parties have followed the schedule, or proceed to schedule the Formal Hearing. The goal of a Pre-Formal Hearing is to streamline the overall process.
Unlike Informal Hearings, a “Formal Hearing” is a formal legal proceeding presided over by an Administrative Law Judge which may last up to several hours and may involve more than one session.
The purpose of Formal Hearings, like that of the Informal Hearings, is to resolve differences and disagreements. It is the second level of hearing available to adverse parties in a workers’ compensation case, although perhaps only about 3% or 4% of disputed cases ever reach this level. (NOTE: A Formal Hearing is scheduled ONLY when disputes are not resolved by an Administrative Law Judge at one or more Informal Hearings; they are NOT scheduled without previous attempts to reach agreement at the Informal Hearing level.)
Like the Informal Hearing, either party—claimant or respondent—may request a Formal Hearing, if earlier Informal Hearings have failed to produce an agreement between the adverse parties. Both the claimant and the respondent attend the hearing. Although a claimant may represent himself or herself (called “pro se”) at a Formal Hearing and they are not legally required to retain an attorney, it is almost always recommended that the claimant be represented at this level by legal counsel.
In Formal Hearings, which resemble court trials, evidence is submitted as exhibits, witnesses may be produced and provide testimony under oath, and a stenographic record of the proceedings is taken. Unlike regular court trials, however, an Administrative Law Judge is not as restricted by statutory rules of evidence or procedure. It is the Administrative Law Judge’s duty in a Formal Hearing to make inquiry (through oral testimony, deposition testimony, or through written or printed records) in a manner designed to ascertain each of the parties’ substantial rights and carry out the provisions of the Workers’ Compensation Act, as well as its intent.
Following a Formal Hearing the presiding Administrative Law Judge reviews the evidence presented, as well as any briefs filed with the Administrative Law Judge after the actual hearing, and renders a written decision called a “Finding and Award” or a “Finding and Dismissal” in which he or she issues any findings of fact and conclusions regarding the disputed issue(s) in the case. It must be delivered to both parties within 120 days after the conclusion of the hearing. This written decision is binding on all parties, unless appealed by either party to the Workers’ Compensation Commission’s Compensation Review Board (CRB).
A small number of disputed workers’ compensation cases are appealed to the Workers’ Compensation Commission’s Compensation Review Board (CRB), which is a panel of two (2) Administrative Law Judges and the Workers’ Compensation Commission Chairman that regularly meets to review such appeals of decisions from lower level workers’ compensation hearings. The CRB may affirm, modify or reverse the decision of the Administrative Law Judge, subject to appeal to the Appellate Court.
After an Administrative Law Judge has rendered a Formal Hearing decision, either party to the claim has twenty (20) days in which to appeal the Administrative Law Judge’s decision to the CRB, which does NOT try the case again, but hears the appeal on the record of the earlier hearing. The CRB will not change an Administrative Law Judge’s decision from the earlier hearing, if that decision was based on the evidence presented. New evidence or testimony will be allowed ONLY if the CRB determines that such evidence or testimony is material and there were good reasons for failure to present it at the Formal Hearing.