A workers' compensation trial is an administrative hearing before a judge to resolve disputes between an injured worker and his or her employer related to a work injury claim. At the trial, each side will present evidence in the form of documents and witness testimony.
The judge will issue a decision within thirty days of the trial's completion. A decision that awards benefits to an injured worker is called a Findings and Award. A decision that does not award benefits is called a Findings and Order.
Generally, evidence presented at trial will include:
- testimony of the injured worker
- medical reports evaluating the injured worker's condition
- medical records of the injured worker's prior medical treatment
- employment records
The most common issue at a California worker's compensation trial is permanent disability.
The payment of an award of permanent disability is made on a biweekly basis up to the amount of the award. The injured worker can request that the payments be made sooner through a process called “commutation.”
It is extremely unlikely that an employer or insurance company will not pay an award. California has procedures in place to protect an injured worker's award when there is an uninsured employer or a bankrupt insurance company.
There is no limit on the number of trials that can take place in one workers' compensation case.
In this article, our California personal injury attorneys will explain:
- 1. What is a workers' compensation trial?
- 2. How a California workers' compensation trial proceeds
- 3. Evidence in a workers' compensation case
- 4. The findings of the judge
- 5. After the Award
- 6. Collecting an award
- 7. The purpose of trial in workers' compensation
A California workers' compensation trial is a hearing at the Workers' Compensation Appeals Board that resolves a dispute between two parties in a workers' compensation case. The most common trial is between the injured worker and the employer's insurance company.
To obtain a trial date, there must first be a Mandatory Settlement Conference or other specialized hearing.
Example: Jose files a claim for a workplace injury in California, but it is denied by his employer. As Jose is not receiving any benefits, he requests a trial to prove that he was injured at work.
Jose testifies at trial and submits a medical report finding that he does have a work injury. The insurance company questions Jose about his injury and submits a medical report finding that he does not have a work injury.
The judge finds the medical report submitted by Jose to be more persuasive than the report submitted by the insurance company. The judge rules that Jose was injured at work and is currently temporarily disabled.
The insurance company now has to pay Jose's temporary disability benefits and provide medical treatment for the injury. There may be a trial at a later date if the insurance company and Jose do not agree on other issues, such as his level of permanent disability.
There can also be trials in a workers' compensation cases on issues that do not involve the injured worker. There can be a trial between the insurance company and a medical provider on payment of a medical bill or between insurance companies on whether one paid more than its fair share of a claim.
A trial in a workers' compensation case takes place in a hearing room. This is not a “courtroom.” It is usually a regular room in a government office building.
The judge will sit at a table, and the insurance company representative and injured worker will sit at tables opposite each other across from the judge. There will be a court reporter to take down everything that is said in the trial.
The Appeals Board is not bound by the rules of evidence.1 The rules of evidence are a formal set of rules as to how evidence must be collected and presented in a court case. The judge has the discretion to hear any evidence that will help him or her make a decision. This lack of formality often benefits the injured worker, who does not have as much legal knowledge as the insurance company.
At the beginning of a workers' compensation trial, the judge will clarify the issues that the injured worker and the insurance company agree on. These are called “stipulations,” and they are read into the record.
The stipulations come from the Pretrial Conference Statement that was filled out at the Mandatory Settlement Conference. These are issues the judge will not have to decide because there is no dispute. By narrowing the issues, the trial goes faster.
Once an injured worker and insurance company agree, neither will be able to withdraw from the stipulations.2 But the judge can make a different finding if he or she believes the stipulation is incorrect.3
Example: At Olivia's trial the judge reads the following into the record:
“Olivia Smith, born 12-5-77, while employed on 5-17-17 as a fitness instructor at Los Angeles, California by ABC Fitness, sustained an injury to her left knee. At the time, the employer's workers' compensation insurance carrier was XYZ Insurance.”
These are facts Olivia and the insurance company agree on.
After the stipulations are read, the judge will go over the issues the parties do not agree on. If an issue is not raised, there is nothing for the judge to decide.
Example: In Olivia's trial, the judge reads the following:
“Issues are parts of body injured, injured worker claims left elbow, temporary disability from 5-21-17 to 7-21-17, permanent disability, and whether out-of-state medical treatment for this workers comp case anf mileage reimbursement are warranted.”
The insurance company and Olivia disagree on whether she had a work injury to her left elbow, temporary disability for two months, her permanent disability level, and her need for the out-of-state medical treatment.
The issues come from the Pretrial Conference Statement. The judge's decision will address each of the issues raised at trial.
The last item the judge will review at trial are the exhibits the insurance company and injured worker was listed on the pretrial conference statement.
Each side can object to any exhibit they believe should not be admitted into evidence. Parties can object that an exhibit is inadmissible based on the exhibit itself being incomplete or the exhibit is complete but was not obtained or given to the other side before trial.
An exhibit that is not admitted cannot be used as the basis for a decision.
Evidence will include:
- medical evaluation reports
- medical deposition transcripts
- medical treatment reports
- hospital records
- employment records
- surveillance video
Medical reports are the most common and important form of evidence. As the California workers' compensation system deals with compensating employees for injuries on the job, medical reporting is highly relevant.
Medical reports should include:
- the date of the examination
- the history of the injury
- the patient's complaints
- a listing of all information received or relied upon for the formulation of the physician's opinion
- the patient's medical history, including previous injuries and conditions
- findings on examination
- a diagnosis
- opinion as to the nature, extent, and duration of disability and work limitations
- cause of the disability
- treatment, including future medical care
- whether permanent disability has resulted from the injury and whether or not it is permanent and stationary i.e. unlikely to improve. If stationary, the report should include a description of the disability with a complete evaluation
- apportionment of disability, meaning any non-work related disability
- percent of the total causation resulting from actual events of employment, if the injury is alleged to be a psychiatric injury
- the reasons for the opinion
- the signature of the physician.4
After the stipulations and issues and exhibits are reviewed, the case can be submitted for a decision. This means the judge will go over all the material and issue a written decision within 30 days.5
But often the injured worker will want to testify to his or her injury. The insurance company will also want to question the injured worker regarding the injury.
In many cases, the injured worker will be the only person to testify. Other testimony might come from a co-worker or supervisor who may or may not back up the injured worker's claim.
No matter who testifies for either side, the opposing party will also have a chance to question them.
At the end of the witness testimony, the case is submitted for a decision.
Before the decision is issued, both sides will receive a summary of events that took place at the trial, a document called a Summary of Evidence.6
This includes the stipulations and issues and summary of the testimony of any witnesses and any video that was shown.7 The actual transcript of the trial will not be released.
If the judge's decision awards anything to the injured worker, it is called a Findings and Award. If it denies benefits to the injured worker, it is called a Findings and Order.
A California Workers' Compensation Appeals Board judge has a duty to develop the record at trial.8 If a judge does not have sufficient facts to issue a decision, he or she can develop the record, meaning request additional evidence. The trial will be delayed until the information is obtained.
Example: Laura's case goes to trial. She testifies, and all the evidence is submitted. Instead of a decision, the judge says she wants Laura's doctor to answer specific questions in a supplemental report.
The doctor issues the report four weeks later. The report is entered into evidence. With the report, the judge will issue a decision.
If any money is payable, interest begins at the time of the decision. Interest is at the same rate as in civil cases.9 Interest is currently 10%.10
Any award of permanent disability is paid on a biweekly basis and is based on the percentage of disability. 11 Depending on the facts of the case, the amount of permanent disability benefits will be due at the time of the award or paid out into the future.
The insurance company is required to pay a reasonable amount of permanent disability when it stops paying temporary disability.12 Often the insurance company will dispute the permanent disability or pay very little. The trial may take place long after the permanent disability payments should have been made.
Example: Ryan's trial is on April 6, 2017. On May 5, 2017, he is awarded 32% permanent disability, with a value of $42,050.13 The insurance company has not paid Ryan any permanent disability to date.
The judge finds that Ryan should receive permanent disability beginning on April 6, 2016, payable at $290 a week. Since the permanent disability should have started a year earlier, the insurance company already owes Ryan for that period.
The insurance company must pay Ryan approximately $16,240 ($290 x 56 weeks) for one year and one month of payments. The insurance company must then pay Ryan $580 every two weeks until the total amount reaches $42,050.
If the payment of the award to the injured worker is late, penalties may apply.
Even though payments are made every two weeks, the injured worker can ask that the payments be “commuted.”14 Commutation means that future payments are moved to the present. This is often done if the injured worker has a financial hardship and the biweekly payments are not enough for his or her living needs.15
Example: Cody is awarded $74,000 in permanent disability. However, it is all due in the future in payments at $290 a week. Cody asks and receives a commutation for $25,000 to use to repair his home, which needs significant repairs to be habitable.
Commutations are rarely granted. If an injured worker wants to receive a lump sum payment for his or her injury, the only option is a settlement by way of a Compromise and Release.
If an injured worker dies after receiving an award while permanent disability is still due, the payments will stop.16 The injured worker's heirs will not receive the remainder of the payments.
If the injured worker or insurance company do not agree with the decision, it can be appealed through a Petition for Reconsideration.
If there are any medical providers in the injured worker's case that have not been fully paid, those payments will not come out of the injured worker's award. The payments are the responsibility of the insurance company. 17
There will rarely be any difficulty in collecting an award. All employers are required to have insurance. The insurance company will usually have sufficient funds to pay an award. Even if the insurance company goes bankrupt during the time it is required to make payments, a state agency, California Insurance Guarantee Association (CIGA), will take over and make the payments.
If the employer did not have workers' compensation insurance, a state agency, Uninsured Employers Benefits Trust Fund, will make the payments.
The workers' compensation system was set up to provide benefits to injured workers. It was not set up to make the injured worker prove he or she was injured at work.
Therefore, a trial in a workers' compensation case tends to favor the injured worker.
The insurance company will have a much more difficult time proving its case than the injured worker.
However, by understanding the trial process an injured worker can present his or her best case and maximize an award.
Moreover, an injured worker who loses at trial can always appeal a denial of workers compensation benefits in California.
Call us for help...
For help with filing a workers compensation claim in Calfornia or completing workers comp forms, contact us at (855) LAW-FIRM. Our firm helps police officers, firefighters and other workers to get compensation for their job-related injuries.
Huston v. Workers' Comp. Appeals Bd. (1979) 95 Cal. App. 3d 856.
Cal. Lab. Code § 5702.
Cal. Code Regs., tit. 8, § 10606.
Cal. Lab. Code § 5313 & § 5800.5.
Cal. Lab. Code § 5313.
Cal. Code Regs., tit. 8, § 10566.
Cal. Lab. Code § 5701 & 5906.
Cal. Lab. Code § 5800.
Cal. Code Civ. Pro. § 685.010.
Cal. Lab. Code § 4650.
Cal. Lab. Codd § 4650(b).
Cal. Lab. Code § 4658.
Cal. Lab. Code § 5100.
Auburn Volkswagen-Mazda and Insurance Company of North America v. WCAB (1989) 54 Cal. Comp. Cases 1.
Cal. Lab. Code § 4700.
Cal. Lab. Code § 4600 & § 4621.