Afraid of red tape? We are too. When it comes to any issue involving insurance or disputes with a government employer, you can get overwhelmed with the idea of having to cut through mountains of red tape. In fact, the process may seem so daunting that it could even dissuade you from filing a claim altogether. But do not despair.
Having a dispute resolved under the Longshore and Harbor Workers’ Compensation Act (Longshore Act) is a process to be sure, but it is not a process that will consume you. And, in the end, you most likely benefit a great deal from the process.
We at Doolittle Tucker are passionate about advocating for those who are injured, and we specialize in helping injured civilian workers who are working for the U.S. overseas. Whether you ultimately settle or litigate your workers’ compensation claim, you will need expert guidance through the process. That is where the professionals at Doolittle Tucker come in. We can help you understand the dispute resolution process under the Longshore Act. Having litigated such claims many times in our practice, we are poised to give you the best, most experienced guidance in this area. Call us for a free consultation today at 904-396-1734.
What is the Process for Making a Claim Under the Longshore Act?
If you are injured on the job, you should make a claim for compensation and seek medical treatment. Part of your claim will be to alert the Department of Labor’s Division of Longshore and Harbor Workers’ Compensation (DLHWC) of your injury. The DLHWC, which will administer your claim, will make initial recommendations with regard to your eligibility for medical and other benefits.
The DLHWC will also get information from your employer and insurance carrier before making its recommendation. It is typical that both parties will engage in an informal conference before the DLHWC makes a recommendation. The DLHWC will then make a recommendation in a memorandum.
What Happens When a Dispute Arises?
If you or your employer/insurer disagrees with the DLHWC’s recommendation, then you or your employer will file what is called a Form LS-207, which allows the party to explain the disagreement. At that point, either your or your employer may choose to refer the case to the Office of Administrative Law Judges. That is the point at which a formal “adjudication” of your claim has begun.
The adjudication before an Administrative Law Judge (ALJ) will look similar to a typical civil lawsuit. Each party will ask the other for records and documents, and will serve interrogatories (or questions) on the other side. The parties will also likely have depositions so key people can answer questions under oath. It is common to have the injured worker, physicians, defense experts, insurance adjusters, and even someone from your employer come to a deposition.
Once all the information is gathered through that discovery process, the case will be heard before an ALJ. The court rules are not strictly followed before the ALJ. Yet, the proceeding before the ALJ will be similar to a small case before a judge, so it is important that you put your best case forward in front of the ALJ. That is because you will have a burden of proof to show that you are entitled to workers’ compensation benefits.
Typically after the hearing, there is a substantial waiting period before you get a decision from the ALJ. In some cases, the wait can be as long as a year, but hopefully you can get an opinion from the ALJ within a matter of months.
When you receive the ALJ’s decision, you or your employer/insurer can choose to follow the ALJ’s decision, or appeal to a higher court.
Can I Settle a Disputed Claim Instead?
Given that the path through adjudication before an ALJ can be an arduous one, an alternative would be to settle your claim. In fact, most cases do settle at some point during the adjudication process.
The benefit of a settlement, rather than going all the way to an ALJ trial and decision, is that you have more control over the outcome. It makes a very unpredictable ALJ adjudication process predictable and final. What is key when it comes to settlement, however, is knowing when to settle and how to negotiate terms. You do not want to short-change yourself by settling too early or taking less than what you believe you deserve. Your goal should be to get the best deal you can, while getting the finality you need.
Thankfully, the DLHWC provides one helpful safety measure in the settlement process. For any settlement of a Longshore Act claim, the DLHWC reviews the terms to make sure that they are “reasonable.” That said, the standard for reasonableness is not terribly high for the DLHWC, but it is a way in which the DLHWC can make sure that you have not settled for benefits that are woefully inadequate to the injury you suffered.
In determining reasonableness, the DLHWC looks at many factors including:
- Medical records
- Lost earning capacity
- Any disputed factual or legal issues
One thing to note is that the more disputed factual issues there are, such as disputes on weekly wage or whether chronic medical issues are attributable to a work-related injury, the better it is for the employer/insurer. The insurance carrier will try to exercise more leverage in negotiations based on those disputes. That is why your case must be well supported to minimize carriers using such leverage.
The DLHWC has 30 days to review a settlement. Once the DLHWC finds a settlement reasonable, it will issue what is called a Compensation Order. The employer and insurance carrier have 10 days within which to comply with that Compensation Order. There are stiff penalties if the employer/carrier does not comply in those 10 days.
You Should Have the Assistance of an Attorney During the Claim Process
There are many important points along the Longshore Act claims path when an attorney is invaluable. You really need representation during those informal conferences before the DLHWC, during the discovery and trial phase of an adjudication before the ALJ, and during settlement negotiations.
You may think that getting a lawyer to help you with a Longshore Act claim may add further expense, but that is not the case. The attorneys at Doolittle & Tucker do not charge any legal fee unless we get you money for your claim. With the experience and the resources to effectively maximize your Longshore Act claim, Doolittle & Tucker can bring a great deal of value to make sure you get the best outcome for your claim, and it does not cost you anything if you do not recover. Call us to learn more today at 904-396-1734.