What Is Workers’ Compensation Adjudication?

Workers’ compensation adjudication is the legal process to resolve disputes over workers’ comp claims between injured workers and insurance providers.

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In the US, workers are entitled to compensation for work-related injuries through workers’ compensation insurance. This coverage aids workers with medical expenses, lost wages, and rehabilitation costs. In Missouri, employers with five or more employees must legally provide workers’ compensation insurance.

However, navigating the workers’ compensation landscape can be complex and challenging, primarily when insurers hesitate to fulfill their obligations. This is where workers’ comp adjudication comes into play. It’s the legal process through which issues related to a workers’ comp claim are resolved. 

Workers’ Compensation Adjudication: A Closer Look

Adjudication in the context of workers’ comp is the legal means to address disputes about a claim. The injured worker, employer, or insurance company might file an Adjudication of Claim with the Workers’ Compensation Appeal Board (WCAB). This action prompts the board to review the claim and, if necessary, appoint a judge for adjudication. This judge plays a crucial role in resolving claim-related disagreements.

Why Undergo Workers’ Comp Adjudication?

Several circumstances might push workers or their representatives to seek adjudication:

• Denial of Benefits: If workers believe their workers’ comp insurance has denied them rightful benefits, they can request adjudication. This step prompts the workers’ comp board to reevaluate the claim and determine eligibility for benefits.
• Departing from the Company: If a worker leaves their employer after filing a claim, it can raise suspicions. Questions might arise, such as if the employer dismissed the worker because of the claim or if the injury was falsified. Adjudication sheds light on the reasons behind such departures.
• Disputes Over Medical Treatment: Disagreements might emerge over the medical treatment prescribed by insurer-approved doctors. If there’s suspicion of undue influence or misdiagnosis, adjudication can be sought.

The Adjudication Hearing Explained

An adjudication hearing is the culmination of the adjudication process. It brings together the claimant, judge, and claim administrator to evaluate the evidence. After careful consideration, the judge determines the appropriate compensation due to the injured worker.

St. Louis Workers’ Comp Attorney

Navigating the waters of workers’ comp adjudication can be intricate. While some claims proceed without problems, others, especially those filed without professional help, can encounter hurdles. By engaging a skilled workers’ comp attorney, claimants can streamline their claims process and ensure their rights are protected.If you’re contemplating a workers’ comp adjudication due to an unsettled claim, consider reaching out for experienced legal help. Contact at St. Louis workers compensation attorney at the Law Office of James M. Hoffmann. With over 30 years of experience safeguarding the rights of injured Missouri workers and having handled thousands of cases, we stand ready to help.