Workers’ Compensation: Coverage Issues & Arbitration

Trial  VS. Arbitration

Workers’ compensation cases can escalate quickly when an employer and an employee do not agree on whether benefits should be granted in a given case. If an employer denies benefits to an employee, the employee may opt to get an attorney to help them obtain benefits. Depending on the individual circumstances, the case could go to trial or to arbitration if there is a coverage issue.

Arbitration

Arbitration generally takes place when there is an issue of coverage. That usually means an insurance company takes the position that they have no liability to defend the case or to pay if the case is lost.  If your insurance company takes that position, it is of utmost importance to have a competent workers compensation defense attorney advocating for you in court.

Arbitration, in other words, is a form of alternative dispute resolution and is available to resolve workers’ compensation disputes. Across the country, there are many states that offer arbitration or mediation to resolve these claims.

Although, arbitration and mediation rarely bind in workers’ compensation. Given there are a few exceptions, if the arbitrator rules in the employer’s favor, the victim is able to appeal the decision to another administrative level in the court system.

During the arbitration, both parties, the employer and the employee present their arguments and evidence to an arbitrator, who acts as a judge. In certain situations, there may be a panel of arbitrators but for workers’ compensation cases, there is usually only one arbitrator. When the arbitrator hears and considers all evidence, they will issue a decision that regards the outcome of the dispute.

As attorneys, we are sometimes called upon to represent employers who dispute a workers’ compensation claim. The reason for the dispute is simple. It all comes back to money. Employers pay premiums to provide workers’ compensation benefits to workers. The premiums are affected whenever an injured employee files a claim for benefits.

Logically speaking, the more workers’ compensation claims that are filed against an employer, the higher the costs for said employer. All workers’ compensation insurance premiums will increase as more employees file for more or have an expensive claim. Due to this fact, employers, as well as insurance companies, investigate agencies in order to better monitor the victim’s daily activities.

As unfortunate as it sounds, there are employers who do not believe some injuries are serious enough or valid for workers’ compensation. Some employers may assume that an employee who files for workers’ compensation benefits is not exactly truthful. On the contrary, this doesn’t mean that every injured worker who has constant pain is dishonest. Employers can enlist help from reputable attorneys to help ease the matter objectively.