Accepted Vs Contested

Most workers’ compensation cases are not seriously contested by the employer. This means that in the typical workers’ compensation case, your employer will “accept” your claim. In an accepted claim, the employer will not question that you were injured while on the job, nor will your employer challenge the nature and extent of your injuries. The sole focus of your workers’ compensation case will be to get you medical treatment, replace your pay while you are out of work, and get you back to work as soon as possible. This is the ideal situation for both you and your employer.

Contested Cases

Things don’t always go according to plan. In some matters, the employer disputes, or “contests,” whether the employee is entitled to benefits for their injuries. Consider these situations:

1. The employee has experienced prior back pain and then severely injured their back by lifting heavy boxes while at work.
2. The employee falls in the parking lot while walking from their motor vehicle into the employer’s factory.
3. The employee develops mesothelioma, a type of cancer caused by exposure to asbestos.
4. The employee files their workers’ compensation claim more than one year after the injury.

Workers’ compensation benefits are based on the fact that the employee’s injury occurred at the workplace or, in the case of disease or illness, was caused by occupational conditions. In each situation discussed above, the employer may decide to contest the employee’s eligibility to receive workers’ compensation benefits.

In the first example, the employee had prior back pain. The employer may challenge whether the claimed workplace injury was the root cause of the employee’s present condition. Likewise, in the second example, the employee’s work shift had ended. The employer may challenge whether the injury took place at the workplace. In the third example, the employee claims that their cancer was caused by workplace conditions. The employer will no doubt contest whether the workplace conditions caused the illness. Finally, in the last example, the employee may raise the one-year statute of limitations in order to refute the employee’s belated claim.

Disputing Claims With File 43

Regardless of the reason, if the employer wants to contest an employee’s workers’ compensation claim, they must act quickly in response to the employee’s claim. If your employer wants to dispute your claim, they must file an official written notice of denial, known as a “Form 43.” This official form requires an employer that disputes a workers’ compensation claim to provide information about themselves, the employee, their workers’ compensation insurer, the claimed injury, and the employer’s reasons for disputing the employee’s claim for workers’ compensation benefits.

If your employer disputes the claim for workers’ compensation, they must file the Form 43 within twenty-eight (28) days of receipt of your official notice of claim (the Form 30C). This is another reason why it is important to timely file your Form 30C and have your claim on the record. Once you file, you start the timeline for your employer to either accept your claim or to dispute your right to receive benefits.

If your employer files a Form 43 to contest your claim for workers’ compensation benefits, you have the absolute right to continue forward with your case. If your employer has disputed your claim for workers’ compensation benefits by filing a Form 43, you must prove that the disease or injury is work-related. You can do this by objecting to the Form 43 and producing evidence at an Informal Hearing. The evidence you might want to produce could include medical reports and witness statements to show that your injury or illness is work-related.

Hearings

For example, a written statement from a co-worker which says that they observed your injury while you were both on the job would likely carry the day towards proving that your injury was work-related. If your employer has filed a Form 43 against you, you should file a written request for an Informal Hearing to dispute the Form 43. You can get this hearing request form at any District Office, or through the Workers’ Compensation Commission website, or your attorney can prepare and file the form for you. An Informal Hearing is a preliminary hearing with an Administrative Law Judge (formerly called “Commissioner”), where you will have the opportunity to resolve the Form 43.

In the meantime, while your claim remains contested, you should continue forward with your medical care and treatment, using your health insurance and/or any available disability insurance benefits. Your insurance carrier will provide benefits, according to what it covers, until the Administrative Law Judge resolves the issue of workers’ compensation.

Get Help

If your employer has contested your workers’ compensation claim, you must obtain legal counsel to handle this battle for you. Don’t jeopardize your eligibility to receive valuable workers’ compensation benefits. Contact the lawyers at our firm if you have received a Form 43 from your employer.