I have a very strong work comp case with the designated doctor in my corner, strong causation evidence (semi to semi collision), and two matching MRI interpretations from the two ortho doctors I have been treated by. My current treating ortho doctor has recommended surgery, now all of a sudden the IC had a peer review done and is limiting my compensable injuries to a claim.
Typical, I know. My question is, what does a worker comp consultation meeting consist of? Would it be over the phone or in person? Would I just have to explain my case or would I bring evidence. Would an attorney tell me if my case is manageable in my own of it was?
I have a BRC coming up and have an ombudsmen. If I can't resolve anything with the IC at the first BRC, then I am going to retain a lawyer before the second one.
The consultation really depends on the lawyer. Some spend the time trying to convince you that you need a lawyer (you really do). It could be on the phone limiting travel time for each party. On a consult I would make sure you understand the Ombudsman does not represent you but assists you. I would want to tell you that once the door is closed for the hearing to commence you are in the hearing on your own. Look around the room; everyone in that room makes a living on workers compensation except for one, YOU! At times it will seem as though everyone is speaking a different language because of all the acronyms used. You will no doubt hear terms you are not familiar with like HOs, BROs, BRC, CCH, AWW, DD, MMI/IR, TIBs, IIBs SIB, LIBs, IRO, MDR, course and scope of employment, and many others.
Many of Ombudsman are very good, (I know because back when God was a kid, I trained a few), unfortunately I have seen some whose entire closing statement was like this, "The claimant has proven his case". The Ombudsman are only required to spend 15 minutes with you before the hearing and they only "assist" you. They are not lawyers, but hey they are free!
I would explain the purpose of a BRC and what you should expect and not expect and that you may have
to take the next step and have a CCH. I would explain the CCH and that it is more formal than a BRC. However a BRC can be extremely important for the simple reason the parties define the issues and the particular wording of the issues to be proven at the CCH as well as who has the burden of proof on the issues. I have seen cases where the injured worker lost because of the wording of the issue. Also I would explain the evidence you will need and how to prove your case. I hope you find my answer useful. Best of luck to you.
I am hopeful my answer is "HELPFUL" and/or is a good answer?" If so, I would appreciate you for noting same. Thank you. The information contained herein is not to be construed as legal advice. The questioner should seek independent legal advice from a qualified attorney after establishing a proper business relationship. My answer is not intended to answer specific details on a particular claim, but rather give a general outline of some of the procedures a person may encounter. The information is only for education and not intended to create legal representative of anyone.
In addition to Mr. Warren’s answer, we would want to take a look at the documents you described. You may think your causation evidence is awesome, but legally it might not be. We just need to check it out and make sure it doesn’t need to get beefed up a little. Just because the DD is in your corner doesn’t mean you will win. Sometimes it’s easier to beat the DD opinion than to defend it. Part of a consultation should be making an assessment about your evidence and coming up with a game plan to move the case forward with the best chance to win.
I agree with Mr. Warren about the need for a lawyer. It’s all good to deal with the case on your own. I don’t like to take cases and charge people money for no reason. But when you are entering the hearings process, anything can happen and you have to know the law. If you are ever going to get a lawyer, that’s the time to do it. And before the BRC while they can still make tactical decisions with enough time to carry them out. If that first BRC does not resolve the dispute, don’t set a Contested case hearing. Ask them to schedule another BRC and give you time to get a lawyer.
Both Roy and Matt have set out the basic process. I agree you need a lawyer to have your best chance for success. Basically a lawyer wants to give you an over-the-phone interview to see if your claim has merit and if the lawyer would be able to assist you. If you don't want assistance from a lawyer, then I usually try to point the person in the right direction. You can go to the first BRC on your own to see if the Carrier will accept the extent of your injury. They won't. They will have a peer review report and/or an RME report indicating that all your conditions are ordinary diseases of life and didn't happen at work. This is the typical and customary tactics and results of a BRC. As soon as you get a lawyer, the lawyer can get to work on getting what you need to give you the best chance for success. We can't do this over the phone. We can't do it until we have made a thorough review of all the potential evidence consisting of the medical records, witness statements, or other relevant evidence. Finally, if you hire an attorney, make sure they do a significant amount of administrative hearings. The attorney needs to be very familiar with this area of the law for your best chance.
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