Arbitration in a Workers' Comp Case FAQs

10 December 2015 by Jonathan Phillips

Depending on the state in which you live, if you and your employer's insurance company are unable to reach an agreement on workers' compensation benefits, it is possible that the state's workforce agency could require both parties to attend arbitration. What occurs in arbitration could have a lasting impact on your case. If your claim has been denied by the insurance company and arbitration seems imminent, here is what you need to know.

What Happens During Arbitration?

During arbitration, you and the insurance company have an opportunity to present your cases to an arbitrator. The arbitrator acts in a manner similar to a judge. Once all of the evidence is presented, the arbitrator will determine what the outcome of your claim should be.  

Before agreeing to arbitration, it is advisable to discuss your case with an experienced workers' compensation attorney. The attorney can help you assess your case and determine whether or not it is likely that you can win in arbitration. The attorney can also try to negotiate on your behalf with the insurance company. 

What If You Lose?

If the arbitrator sides with the insurance company, what happens next depends on your state's laws. If you live in a state in which the decision of the arbitrator is considered non-binding, you can file an appeal with the state's workforce agency and request a review of the decision of the arbitrator. 

In some states though, the decision is considered to be binding. If the decision is binding, then the decision stands. 

What If the Workforce Sides With the Arbitrator?

If you appeal the arbitrator's decision and the state's workforce agency reviews your claim and agrees with the decision, you can file an appeal with the state's courts. 

During the appeal, the court might not allow you to introduce any new evidence in your case. The court reviews the actions of the state's workforce agency and the proceedings leading up to that point to determine if there were any legal mistakes that were made that led to an incorrect decision in your case. 

The court can decide to affirm the decision of the agency, make changes to it, or send the case back to the agency for further review. 

Due to the complexities of workers' compensation laws, it is important that you involve an attorney in your case as soon as possible. A workers' compensation lawyer can help guide your case and ensure that you are pursuing the right options when it comes to your case. 

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