Proving Your Claim

19. What happens if my employer contests my claim for benefits?

You will have a right to a hearing before an impartial administrative law judge who will determine your rights to benefits. If the worker or employer is not satisfied with the judge's determination, either one may appeal that determination to a panel of the Board, consisting of three Board members. Therefore, either you or your employer can appeal the panel's decision to court.

20. Will I receive benefits if my employer contests my claim?

If the employer or carrier contests your right to benefits on the ground that your condition is not work-related, you will not be entitled to benefits while the case is being heard before the Board, but you can apply to the Board for non-occupational disability benefits during this period, which will be repaid out of any workers' compensation award you may ultimately receive. After the Board has finally decided a claim in your favor, you are entitled to be paid within 10 days of the award, even if the employer or carrier appeals the decision to the courts. If the employer or insurance carrier concedes your right to some benefits but contests the amount, you are entitled to receive the uncontested portion of the benefits while your case is being heard.

21. Will I need representation?

You may represent yourself. However, occupational disease cases are complex and your employer may contest your right to benefits. You may want an attorney's help to file your claim, represent you before the Board and find medical experts to support your case. If you belong to a union, your union representative may be able to prove the names of attorneys who specialize in workers' compensation law. In addition to attorneys, the Workers' Compensation Board licenses individuals to represent employees making claims in workers' compensation cases. Some unions have licensed representatives on their staffs who represent union members without charge. You can obtain the names of attorneys and licensed representatives from your local Board office, or you may contact your local bar association. If you do retain an attorney or representative, do not pay him or her directly, since the fee will be fixed by the Board and deducted from your award.

22. What type of proof or medical evidence will I need to establish my claim that I contracted an occupational disease from exposure to a toxic substance?

Occupational disease claims usually require two types of proof: (1) evidence that you were exposed to a particular substance in the course of employment; and (2) proof that the exposure caused the condition for which you are claiming benefits. The first type of proof may be supplied by your testimony, if you know what substances you worked with, or by employment records. The second type of proof will usually require a medical report indicating that your condition was caused by exposure to the substance. Your doctor should be able to provide you with such a report, or you could utilize one of the occupational disease clinics established recently in this state for that purpose.

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