When your workers' compensation claim is denied or you disagree with the benefits you're receiving, you have the right to request a hearing before a workers' compensation judge. Presenting your case effectively at a hearing can mean the difference between receiving benefits and having your claim denied. Understanding the process helps you prepare for this important proceeding.
When to Request a Hearing
You may request a hearing when: your claim has been denied, your benefits have been terminated or reduced, you disagree with your permanent disability rating, the insurance company refuses to authorize treatment, or you have any other dispute with the insurance carrier that hasn't been resolved through informal channels.
Most states require you to first attempt informal resolution through mediation, settlement conferences, or administrative processes before proceeding to a formal hearing. Check your state's requirements—failing to follow proper procedures can delay your case.
Filing Your Hearing Request
To request a hearing, file an application or petition with your state's workers' compensation board or industrial commission. Your request must identify the specific issues you want the judge to decide—be precise about what benefits you're seeking and why you believe you're entitled to them.
Time limits apply to hearing requests. Most states require filing within one to two years of a denial, though deadlines vary. Missing your deadline can permanently bar your claim.
Preparing Your Evidence
Hearings are won or lost on evidence. Gather all documentation supporting your claim:
Medical evidence is crucial. Obtain records from all treating physicians, diagnostic tests, specialist reports, and any independent medical examinations. If your doctor disagrees with the insurance company's doctor, get a written statement explaining why your condition is work-related and what treatment you need.
Employment records document your job duties, date of injury, and wages for calculating benefits.
Witness statements from coworkers who saw the accident or can describe your job duties strengthen your case.
Incident reports and employer records of your injury create a timeline of events.
Pre-Hearing Procedures
Before the hearing, you'll typically participate in discovery—exchanging evidence and information with the insurance company. Review everything the insurance company provides—their medical reports, investigator findings, and legal arguments help you understand their defense and prepare responses.
Many states hold pre-hearing conferences where the judge identifies disputed issues, discusses potential settlement, and establishes deadlines for submitting evidence. Take these conferences seriously—positions you take may limit your options at the hearing.
The Hearing Process
Workers' comp hearings are less formal than court trials but still follow legal procedures. The hearing typically includes opening statements summarizing each side's position, presentation of documents and medical records, testimony from you and any witnesses, cross-examination by the insurance company's attorney, and closing arguments.
You'll testify about how your injury occurred, your symptoms and limitations, the treatment you've received, and how the injury affects your ability to work. Be honest and thorough—inconsistencies can damage your credibility.
Presenting Medical Evidence
Medical evidence often decides workers' comp cases. If possible, have your treating physician testify (in person, by video, or through deposition) about your diagnosis, work-relatedness, and treatment needs. Written medical reports alone may be less persuasive than live testimony your attorney can use to emphasize key points.
Be prepared for the insurance company to present competing medical opinions from their doctors. Your attorney should cross-examine their experts about biases, methodological flaws, and assumptions.
The Judge's Decision
After the hearing, the judge issues a written decision—which may take weeks to months. The decision addresses each disputed issue and explains the judge's reasoning. If you disagree with the decision, you typically have the right to appeal to a workers' compensation appeals board or court.
Should You Have an Attorney?
Having legal representation significantly improves your chances of success. Workers' comp hearings involve complex medical and legal issues. Insurance companies always have experienced attorneys—you should too. Most workers' comp attorneys work on contingency, taking a percentage of benefits recovered only if you win.
An attorney can help gather evidence, prepare you for testimony, cross-examine insurance company witnesses, and make legal arguments that protect your rights.