The Life Cycle of a Claim

The Life Cycle of a Claim

The Informal Conference

Multiple Parties?

Burdens of Proof & Presumptions....

True Doubt Rule

Treating Physician Preference

Effective Deposition Techniques

Discovery and Evidentiary Issues

Effective preparation and use of experts

The Prototypical New England

claim for Permanent Total Disability

Progressive Injury Claims, Aggravations,

Natural Progression and Multi-Employer

Litigation

When the Record Closes..

• The decision - proper service
• Timely Payment... 20%
• Post-Decision remedies
• Reconsideration, modification, settlement...

What is the BRB....

Cases appropriate for

appeal...

Time

Limitations

Final Decision.. Interlocutory

Appeals

Miscellaneous Concepts....

• 8i settlements
• Medicare Set-Asides, prohibition against 'loose ends'
• Special Fund Relief.... uniformity in application.. absolute defense.. actual cost
• Cost of Living Increases
• Section 33
• Failure to repay lien

INJURY

• Employee must report injury w/in 30 days - § 12
• Employee may use Form LS-201 for this purpose

JURISDICTION

• Situs
• Status
• Concurrent jurisdiction

APPEAL TO UNITED STATES SUPREME COURT

• Members appointed by President with advice and consent of Senate
• Court must agree to hear case (cert. petition) Split among circuits or novel issue
• All decisions published and are law of the land.

EMPLOYER’S FIRST REPORT OF INJURY

• Form LS-202
• Only filed if injury results in lost time/self-retained if medical only
• Must be filed w/in 10 days of notice of injury – 20 C.F.R. § 702.201
• If not filed statute of limitations on claim tolled - § 13(a)
• Form filed with District Director who sends letter to Claimant outlining LHWCA rights

APPEAL TO CIRCUIT COURTS OF APPEAL

• Appeal is to Court of Appeals in which injury occurred
• Judges are appointed for life
• Review of BRB decision is de novo based on “substantial evidence” standard of review.
• Appeals rare due to expense & risk/benefits of making new law
• Most decisions based on pleadings – oral argument sometimes granted
• No time limit on time to make decision
• Published decisions binding precedent within that circuit
• Unpublished decisions may be binding depending on local rules

TO PAY OR NOT TO PAY?

• May voluntarily commence payment – Form LS-206
• May “controvert claim” – Form LS-207
• Fourteen days to do either one - § 14(b) and (d)
• 10% penalty on all late payments made w/o award - § 14(e)

con·tro·vert (kntr-vûrt, kntr-vûrt)

tr.v. con·tro·vert·ed, con·tro·vert·ing, con·tro·verts

To raise arguments against; voice opposition to.

To pay....

FORMAL HEARING

• Held at request of either party before Administrative Law Judge
• ALJ is non-political, appointed position (must be attorney to get job)
• Hearing is on the record and de novo
• Written decision issued by ALJ and “served” by District Director
• Any award must be made w/in 10 days or pay 20% penalty - § 14(f)
• Reconsideration request must me made within 10 days
• Appeal to BRB must be filed in 30 days

INFORMAL CONFERENCE

• Held at request of parties or District Director
• District Director is career civil-servant (usually not an attorney)
• May be held in-person or by telephone depending on case
• No formal record made except for Memorandum of Informal Conference
• Decision non-binding (with some limited exceptions)

... or not to pay...

Conflicts over medical treatment

THE ALJ TRIAL PROCESS

the IME process

OWCP Vocational Rehabilitation

Effect on the Claim Process