Within 2-3 weeks of filing your claim, your case will be assigned for a conciliation. A conciliation is a meeting between you, your lawyer, a representative of the insurance company, and a Department of Industrial Accidents conciliator. The conciliator will encourage everyone involved to resolve the matter voluntarily. They will try to avoid bringing the case before a judge. The conciliator listens to all parties and reviews. He or she then files all relevant documentation provided by both you and the insurer. If there is a disagreement regarding the extent of your injury or illness, both sides will submit documentation. The documentation notes the “last best offer” of compensation for the conciliator to consider.
Conciliations are the first stage of the Dispute Resolution process. This process begins when the DIA receives either an Employee’s Claim (Form 110) or an Insurer’s Complaint for Modification, Discontinuance, or Recoupment of Compensation (Form 108). An Employee’s Claim (Form 110) is filed by an injured employee or their legal advocate against the workers’ compensation insurance carrier. On the other hand, the Insurer’s Complaint for Modification, Discontinuance, or Recoupment of Compensation (Form 108) is filed when an insurance company seeks approval to stop or alter your benefits. If you receive either of these forms then a conciliation will be scheduled. This meeting normally takes place within 12 business days of submitting either form.
A conciliator will stand in on these meetings to mediate the discussion and ensure critical information is discussed. These meetings are an alternative out-of-court dispute resolution process and are entirely voluntary and confidential. The conciliator operates as a neutral third party.
Advantages of a Conciliation
- Establishes self-determination
- Each party determines the timing, language, location, and content of the meetings
- Ensures the proficiency of the decision-maker
- Each party picks their own conciliator. A conciliator doesn’t need to have a specific professional background.
- Time and cost-efficient
- Since these meetings are informal and flexible, they can take place in a time and cost-efficient manner
- Disputes can be resolved discreetly
The conciliator doesn’t have the power to order or deny compensation if you and the insurer are not able to come to an agreement during the conciliation meeting. Instead, he or she is responsible for reviewing all of the information presented and making a recommendation to a Department of Industrial Accidents judge for an informal proceeding called a conference. Per workers’ compensation law, once the recommendation is filed, a judge will be assigned and scheduled for a conference “immediately.” Realistically, the time from conciliation to a conference is based on the number of cases ahead of yours and can range from a few weeks to as long as six months.
Once the conference date arrives, the judge will have full authority to order (Order of Payment) or deny (Denial of Compensation) benefits. If the “last best offer” procedure was used at the conciliation, the judge will choose between the offer made by the insurer and the offer made by the employee. However, the judge has the power to choose another figure altogether as long as there is a reason given for doing so.
Both parties can appeal the conference judge’s decision. They can also request a hearing. During a hearing, there is a formal trial at which witnesses testify under oath and are cross-examined. The fee for filing an appeal is $350 and is paid by the requesting party. This fee pays for a medical exam performed by an “impartial physician.” Once the doctor’s report is sent to the judge, other medical evidence can only be admissible if the judge deems it necessary. If the conference judge orders the insurance company to compensate the employee and the insurance company appeals, the employee will continue to receive benefits while the appeal is pending.