![]() If your case is not settled at the MSC, you will need to prepare documents that outline the dispute, identify the items each party will present at trial and the names of the witnesses that each party will ask to testify. The judge will discuss the case with both of you and try to assist in reaching a settlement. You and your claims administrator or their attorney will appear before a judge. Your case will be scheduled for a hearing called a mandatory settlement conference (MSC). You must file a Declaration of Readiness to Proceed to request a hearing. Keep the notice and use the assigned case number on all documents and correspondence relating to your case. The notice will include your assigned case number, which will begin with the letters “ADJ” followed by a sequence of numbers. The DWC office where you filed the application will send you a notice confirming that it has been filed. ![]() You must serve the application on all other parties, which is generally the claims administrator. The application must be filed at the DWC office in the county where you live or in the county where you were injured. In order to have your case heard by a judge, you must first file an Application for Adjudication of Claim. Each DWC office is a trial court where disputes that arise from workers’ compensation claims are decided by a judge without a jury. If you want to object to the denial of your claim, you will need to file a case at one the division’s 24 offices located around the state. I want to object to the denial of my claim 1, 2013, and as of Jfor all dates of injury, disagreements about a specific course of medical treatment recommended by the treating physician can only be resolved through a process called independent medical review (IMR). This doctor is called an agreed medical evaluator (AME).įor injuries on or after Jan. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. They must also pass a test and participate in ongoing education on the workers' compensation evaluation process. To qualify as a QME, a physician must meet additional educational and licensing requirements. When there is a disagreement about whether your claim is covered by workers’ compensation, you may be evaluated by a qualified medical evaluator (QME). What if I have a disagreement about my benefits?Īt some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury or treatment. If you contest the denial of your claim, your case will be heard by a workers’ compensation administrative law judge (WCJ) at one of the division's 23 local offices plus satellites. You may represent yourself or hire an attorney. If you need help with your workers’ compensation claim, you can contact the Information and Assistance Unit. Don’t delay, because there are deadlines for filing the necessary papers. If the claims administrator sends you a letter denying your claim, you have a right to challenge the decision. When a claim is denied, it means the claims administrator believes your injury is not covered by workers’ compensation.
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