The Best Laid Plans: A 60-Second Seminar in Workers’ Compensation Claims Handling

For those who supervise or manage a claims department we ask that you take an informal survey of your staff to determine how many of them have ever attended a WCAB hearing.  We believe you will be surprised to learn that very few have ever ventured to the appeals board, and that consequently, most claims professionals have relatively little understanding of WCAB operations, and don’t understand why their best laid litigation plans often go awry.  The purpose of today’s blog is to explain why strategies developed by claims adjusters don’t always go as planned at the WCAB.

A definitive plan of action is usually formulated and in place prior to appearing before a judge.  However, sometimes before a single word is uttered by any participant, the WCJ makes it exceptionally clear that the case will proceed in a totally different direction.  The judge for example, may be running late with no time to entertain arguments.  In addition, there are times when a judge is upset or disappointed with the parties beforehand for not informally settling their differences.  As a result, instead of listening to arguments the WCJ will send the parties out into the hall to resolve disputes between themselves without judicial intervention/assistance.

As there is no way to dictate what will happen at the Board until the parties are standing before a judge, everyone should be prepared to alter their planned strategies.  For this reason, it is imperative for the claims adjuster to be available telephonically whenever a hearing is held to address a last moment change of plans.  It is exceptionally frustrating to the judge when defense counsel is unable to contact the claims adjuster to discuss developments and obtain new authorization.  It might even lead to a contempt citation.

Unfortunately, some adjusters and stakeholders fail to understand why planned strategies don’t come to fruition.  Because of unfamiliarity with board procedures, many adjusters find it hard to accept that there are times when a judge will simply not entertain arguments.  As a result, any pre-developed defense strategies may be dead on arrival. For this reason, all plans must be flexible, as the employer, applicant attorney, injured worker and judge may all have different ideas in mind on how the case is to proceed.

We at F+B are prepared with alternatives in the event a primary objective becomes improbable.  The trick is not to be caught off-guard but to be prepared for the unexpected.  When we partner with our clients, we discuss alternative, back up plans so as not to be caught off-guard!