2. 1. How to put your file together
• Left side: • Right Side:
• FROI • Correspondence, Memos and
• Accident report Email
• – Anything to/from claimant or
Hearing notice ER
• BWC/ER medical
• If SI, and not contested, • Medical from treating doctors
allowed conditions – Anything from treating doctors
• Wage information
• Decisions
• Appeals Things to Note on File: AWW, FWW, SOL
• Letters advising of exams
• Questions and documents sent
to ER doctor
3. Why you need to organize your file
• Only way to prepare
• Saves time in preparation
• Ability to find something at
the hearing table
• Ability to answer your
member’s question when
asked
4. 2. Interview the Injured Worker
Find out all you can
• Exactly how did it happen
• Witnesses
• Repetitive motion
What’s different
Weight, frequency, motion
• Injury
• Report it to employer?
• Medical
• What else do I need to prove
• Questionnaire
• Sample
5. 3. Next up: what evidence do I need?
• Get file from SI employer
• If records are on BWC file, copy them
• If exam by employer, get questions
and records from employer or TPA
• Medical from claimant’s doctors
6. 4. What’s next? Hearing Preparation Checklist
• Hearing checklist for each type of hearing:
Allowance—initial or additional
causation, causation, causation
substantial aggravation quicksand
Treatment
Benefits
Temporary Total
Wage Loss
Maximum Medical Improvement (MMI)
Permanent Partial
• These are the most common. Less common—
death benefit, PTD
• Need to go on IC website and make sure your
evidence is in the hearing officer
folder
7. 5. Prepare to argue—Anticipation
• What would you argue if you were the employer?
List the evidence that supports your contrary position
Get ahead of it—don’t wait for rebuttal
Possible mistakes in employer/BWC medical
File Review
failure to review all medical records on file
failure to accept factual findings in medical records
IME
failure to examine all conditions
“slippery” words
range of motion is “adequate”
reflexes are “intact”
strength is “sufficient”
• After reading the IME—do you need something additional from
claimant’s doctor?
• If the doctor scores a significant point, consider getting a rebuttal
8. 6. After hearing—Appeal or Not?
• Appeal even if you are not sure—you can
always withdraw it
• Review decision carefully—is there any
way to obtain further support
• Send out request for additional
information asap before appealing to
give you the maximum time for a
response
9. 1. Appeal to IC? Yes
• Even though this appeal is usually
futile, it buys time
• This is a good time to have claim
reviewed by attorney
