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What is Adjudication of Claim in a Workers Compensation Case

Suffering a workplace injury can be stressful and even life-altering. Depending on the Adjudication of Claim in a Workers Compensation Casenature of your injury, you may no longer be able to perform the work you previously could, or you may be forced to miss work for an extended period while you heal. If you were injured at work, a workers’ compensation claim can help you to recover medical costs and lost pay.Unfortunately, there are instances where your workers’ compensation claim could face issues that delay your payment or force you to undergo legal proceedings. If your workers’ compensation claim is disputed by either your employer or your employer’s insurance company, your claim may face adjudication. This means that a judge will get involved to help solve your disputed claim. If this happens, a workers’ compensation attorney can guide you through the adjudication process.


Why Would a Claim Be Adjudicated?

If you suffer an injury in the workplace, you may think you have a very straightforward case on your hands. After you file a prompt workers’ compensation claim, the only thing left to do is receive your benefits and heal from your injury. In an ideal world, this would always be the case. However, there are several reasons your claim could be adjudicated.

Your Employer or Their Insurance Company Files a Dispute

Your employer and their insurance company may try to claim that your injuries were sustained outside of the workplace. They could also allege that the time you’re requesting off of work to heal is longer than it actually takes to recover from the injury. If they make either of these assertions, they may dispute your claim and force adjudication.

Sometimes they may simply ask for adjudication to have any outstanding questions answered before providing you with benefits. When this happens, it doesn’t mean you’ll be unable to receive your benefits. It simply means there will likely be a hearing before a judge.

Though this can be a hassle, it’s often just a necessary step for you to prove you’re telling the truth and receive the compensation you’re entitled to. If your claim is disputed, an attorney can help you through the legal process to ensure you are in the best position to receive what you should.

You Left the Company

Quitting, being terminated, or taking a leave of absence are all reasons why your claim could be adjudicated. If you leave your job under any of these circumstances after an injury, then it is likely that your claim will be adjudicated.

By requesting this process, your employer and their insurance company are giving themselves more information about why you left. They and the judge will want to know if you left because of your injury, because you were simply unhappy, or for other reasons.

You File for Adjudication Yourself

It isn’t only the employer or their insurance company who can apply for adjudication. As an employee, you also have the right to request adjudication yourself if you don’t receive the benefits you believe you are entitled to. If your employer or their insurance company refuses to pay you what you are owed, you may need to take legal action. 

In California, the Department of Industrial Relations has an Application for Adjudication of Claim that must be completed to have your case tried before a judge. You must file this application with your county’s Department of Workers’ Compensation office. After your application is filed, you will want to get a hearing before a judge. To do this, you must also file a Declaration of Readiness to Proceed.

It can be stressful to navigate all of this alone, especially if you’ve never had to file a workers’ compensation claim in the past. This is where you could reap the benefits of working with a lawyer who has experience with workers’ compensation claims.


What Happens at an Adjudication Hearing?

At an adjudication hearing, you and your lawyer appear before a judge along with a representative of your claims administrator. At the hearing, the judge will try to help both parties resolve any issues that have not been agreed upon. The judge will work with both sides to help everyone see the legality of the claim and come to an agreement on what type of compensation should be administered.

If your case is not settled at the hearing, you will need to go to trial with another judge. If this happens, you must appear at the trial. At that trial, a determination will be made about how to proceed with your case.

This long and stressful process can be helped by the presence of a workers’ compensation attorney. You will be facing your employer’s legal team if your claim proceeds to trial, so you’ll want a powerful ally backing you as well.


Contact KJT Law Group Today for Help With Your Workers’ Compensation Claim

If you were injured at work and have questions regarding your claim, KJT Law Group can help. Our workers’ compensation lawyers can assist you with every step of the process and represent you if you need to appear before a judge. Handling the process alone can be overwhelming, especially when your employer will have resources at their disposal that could make it more difficult for you to receive your benefits.

Workers’ compensation claims should be straightforward, but for many reasons, it can be difficult to get the benefits you deserve. If your workers’ compensation claim is adjudicated, a lawyer can help. We can guide you through each step, provide counsel on what you should do, and determine the best path forward to pursue the compensation you deserve. When you need a workers’ compensation attorney, contact us online or call KJT Law Group at (818) 507-8525.

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