If an employee believes that he/she has not received all benefits due to them or has issues relating to the benefits that are owed, there are several different options available to resolve the issues. Both the employee and the employer/insurer may wish to consider these options:
- Take advantage of the dispute management services provided by the Division;
- Have a conference;
- The employee may end up filing a claim for compensation.
Dispute Management Services
The Division’s Dispute Management Unit offers a voluntary alternative dispute resolution process to assist parties in attempting to resolve a dispute without resorting to formal litigation. The process offered by the unit’s mediator begins with informational telephone consultations with the interested parties. If a more formalized process is desired by the parties, true mediations are available-if all interested parties agree to participate.
Mediation is a process in which a neutral person facilitates communication between the parties. The mediator does not decide issues or impose a solution upon the parties, the mediator simply helps the parties understand and work toward an agreed upon resolution of their dispute.
A conference is a proceeding held before an administrative law judge in cases where no claim for compensation has been filed. A conference is an opportunity for the injured worker to meet with the lawyer for the employer/insurer, discuss the case, and attempt to resolve the case by settlement, if appropriate. A conference may be set by written request of a party by completing a Request for Conference, or it may be set at the discretion of the Division. A Notice of Conference is sent to the parties, notifying the parties of the date, time and place of the conference.
Conferences will be set within 120 days after the local adjudication office receives the request. If the request is received too late to be set on a docket scheduled within 120 days or if no dockets are scheduled in that docket location for 120 days, the case shall be set on the next available docket.
What Happens If an Employee Files a Claim for Compensation
- A pre-hearing is a proceeding before an administrative law judge to discuss issues in a case in which a Claim for Compensation or claim has been filed. A pre-hearing may be requested by completing Request for Pre-Hearing. A “Notice of Pre-hearing” is sent to all parties.
A party may request a pre-hearing when:
- The parties want to present a settlement agreement for approval; or
- Disputes or other issues arise that must be resolved in order for the case to proceed; or
- The parties have a good faith belief that a brief meeting with an administrative law judge will help in moving the case more expeditiously to settlement or final hearing.
- A mediation is a setting in which the parties and their lawyers, if represented, meet with an administrative law judge to discuss issues in a confidential manner and identify areas of agreement and facilitate a compromise settlement of a claim to avoid proceeding to a hearing.
- A mediation may be set upon the written request of a party by completing the Request for Mediation, provided that an administrative law judge finds that the issues have been sufficiently developed to make the mediation meaningful.
A party may request a mediation when:
- There are issues that need to be resolved to move the case forward.
- One party has a final rating report and the opposing party has not, within a reasonable time frame, obtained a final rating report;
- Both parties have exchanged final reports, but the parties have been unable to reach a settlement agreement;
- Initial or additional medical treatment has been:
- Requested by the employee;
- Refused by the employer; and
- The employee has written medical evidence establishing the need for treatment and the relation between the alleged job-related injury and treatment prescribed. This type of request is automatically considered a hardship request; or
- Parties have been unable to resolve a Second Injury Fund claim and the employee possesses written medical reports or other records or reports relating to the claim.
- A hardship hearing is an evidentiary hearing held before an administrative law judge when the employee alleges that he or she is not at maximum medical improvement, is in need of medical treatment or entitled to temporary total disability benefits, and the employer is not providing such treatment or benefits. The hearing may be based on the termination of benefits under Section 287.203, RSMo. A hardship hearing is a hearing in which the employee is requesting the issuance of a temporary or partial award. A temporary or partial award addresses issues of medical treatment and payment of temporary disability benefits. If a party requests the issuance of a final award and makes it an issue at the hearing, and the evidence presented so merits, a final award may be issued. An employee may file a Request for Hardship Hearing to request the hearing.
- A final hearing may be requested when the employee has reached maximum medical improvement or the case is otherwise ready for final resolution. This is an evidentiary hearing on the record, and a verbatim record will be made for the reviewing tribunal. To request a final hearing, any party may file a Request for Hearing-Final Award and simultaneously send a copy thereof to all other parties.
- There are three types of awards that can be made in a workers’ compensation case.
- Award (final). This is the final determination by an administrative law judge after a hearing
- Temporary or Partial Award. This is made by an administrative law judge after a hearing in cases where the claimant is not receive medical treatment or lost wage benefits. In these situations, the award is made before issues such as the extent of disability are addressed by the judge. The case is kept open until a final award can be made.
- Award on Agreed Statement of Facts. Such an award may be issued without an evidentiary hearing in cases where the parties are in complete agreement on the facts of the case, and the only issues to be decided by the administrative law judge are issues of law.