A high percentage of criminal cases do not make it to a trial because the prosecutor and the defendant’s lawyer agree to a deal in which the defendant pleads guilty to a charge or charges. Likewise, many civil lawsuits – personal injury and employment law cases, for example – settle long before trial as both sides agree to an amount of money that the insurance company will pay the plaintiff to end the case.
It’s the same way in workers’ compensation cases. Frequently, the PA workers’ compensation lawyer for the injured worker, known as the claimant, and the lawyer for the insurance company reach a settlement whereby the insurance company pays the claimant an agreed upon sum of money. The parties may also stipulate to other terms, such as what medical bills of the claimant’s the insurance company will pay.
Not all workers’ comp. cases settle, however; some go to trial. In a criminal case or civil case, this usually means a trial before a jury. But workers’ comp. is different – if there is no settlement, your case will be decided by one person, the Workers’ Compensation Judge presiding over your case.
Why do some cases go to trial and some cases settle? And what does it mean if your case goes to trial? To help answer these questions, we will explain the process that you will go through if you are unlucky enough to hurt yourself at work and your claim is denied.
Your lawyer — and we hope it will be a Pearson Koutcher PA workers’ compensation lawyer – will file a Claim Petition against your employer that will be assigned to a Workers’ Compensation Judge. The Judge will then conduct a number of hearings over the next several months. While Judges differ somewhat in their procedures, it is likely that within 30 days of the first hearing, you will testify by deposition, outside of the presence of the Judge. At your deposition, you will answer questions about all of the issues relevant to your claim, including your job duties for your employer, how you got injured, what medical treatment you have received, and how you have been able to function since your injury. The transcript of your deposition will be submitted to the Judge.
The insurance company is allowed to have you examined by a doctor of its own choosing — this usually takes place within 45 days of your deposition. That doctor will likely provide opinions favorable to the insurance company, such as you have fully recovered from your injury and are able to return to your job. This doctor, as well as one of your treating doctors, will each give a deposition in which they render opinions about your medical condition and your ability to work. Witnesses from your employer may also testify about various issues, such as the circumstances surrounding your injury, and whether light-duty work is available for you.
At the final hearing before the Judge (usually about eight months after the first hearing), you will testify in person or by video about how you have been doing since your deposition – whether your condition has improved or worsened, what additional treatment you have undergone, and if you are able to work. The lawyers will then be given time by the Judge to submit legal briefs, summarizing the evidence and making arguments. The Judge will then issue a decision, ruling on whether you have won or lost your case.
This is the process if there is not a settlement in your case prior to the Judge rendering a decision. However, your case may settle before the Judge decides it because way back at the first hearing, the Judge will likely schedule a mediation, or settlement conference. This will be held by another Judge at which you, your PA workers’ compensation lawyer, and the insurance company lawyer will participate. The mediating Judge will work with both sides in an effort to facilitate a settlement to see if the insurance company will offer an amount of money that you are willing to accept. This is a big decision because once you enter into a settlement and the Judge approves it, there is no turning back; your case is over. A settlement can also be reached without a mediation – it can happen anytime, before mediation or after; sometimes it happens after the final hearing but before the Judge writes the decision.
There are many factors, though, that can prevent a case from settling. Here are a few of the most common factors that can be deal-breakers:
–There is a substantial difference of opinion between the two doctors with regard to your condition. If your doctor thinks your injuries are so serious that you require surgery, but the insurance company doctor believes you sustained a minor injury and no further treatment is necessary, that most likely will cause an impasse. You may be hesitant to sign off on your claim because you need surgery and your ability to work in the future is uncertain. Based on your doctor’s surgery recommendation, your PA workers’ compensation lawyer will probably place a high settlement value on your case, while the insurance company lawyer, taking the position that your injury was minimal, will maintain that the case has low value. If the gap is too big, it will be difficult to reach a settlement.
–Some employers and their insurance companies are hard-nosed and resist settling cases. They may not want to set a precedent by settling your case. Or they may might dig their heels in on your case. They may dispute that you got injured in the course of your employment or that your condition is due to a pre-existing condition, not any injury you suffered at work. You may receive no offer or such a low offer, you won’t consider accepting it.
–Another big impediment to settling is if your employer did not have workers’ comp. insurance when you were injured. While Pennsylvania law requires all employers to carry workers’ comp. insurance, some do not. Under these circumstances, your lawyer will file a claim against the Uninsured Employers Guaranty Fund, which steps into a case if an employer is uninsured. The problem is that the Uninsured Fund is often financially strapped and does not have the means to fund settlements.
Those are just a few things that can stand in the way of you reaching a settlement in your case, which will require your case to go to trial for the Judge to decide it. Here’s the bottom line: If you injure yourself at work, we urge you to contact Pearson Koutcher Law as we specialize in representing injured workers. One of our experienced, highly skilled PA workers’ compensation lawyers will strive to get you the best result possible in your case – either by obtaining a favorable settlement or taking your case to trial and hopefully receiving a favorable decision. Please contact Pearson Koutcher Law today for a free consultation.