In workers compensation in Rhode Island, we have, fortunately, one of the most efficient and fastest-moving, fastest-working courts in the nation—we’re really, um, sort of the gold standard in that regard. Now, things still take time; there is a turnaround time for everything. But let’s say, um, really whatever the issue is—it can be anything from are you entitled to workers comp or not in the first place, or it can be a situation where you’re on workers comp, that’s not disputed, but there’s a dispute over whether you should be paid, uh, a certain amount for your scarring, or whether you’re entitled to a form of medical treatment, or any issue—when you get to that point and you have to file a petition, the turnaround time, uh, kind of looks like this essentially: um, for many things like medical treatment, you first have to ask for it, and legally you have to ask for it in writing, and if the insurance company, uh, receives your request in writing for something, uh, you typically have to give them 21 days to respond before you can file that petition. So you have the first period of time you’re looking at in terms of turnaround time—21 days from when you ask for what you want to when the insurance company has to pay it or approve it or deny it. Once you get to that 21-day point, you can file a petition. Um, obviously, you don’t go into court the same day you file the petition—you file the petition on that 22nd day, let’s say, and now the court schedules a hearing so you can talk to the judge and make your case for what you want. That hearing, from the point you file it, is typically 21 days as well away. So you’ve got 42 days in terms of a typical turnaround time. And this all assumes that the parties can’t work it out in the interim—or, or once—sometimes once you file that petition, the insurance company will see it and retreat or say, “You know, here’s the authorization, go ahead and get that treatment, we don’t even have to bother going to court.” But worst-case scenario, if we’re going to have a judge decide a petition or an issue, you’re looking at 21 days for a hearing from when you file the petition. And more times than not, most disputes are resolved at that first hearing at the pretrial level, um, after 21 days. So that’s, um, a good turnaround time compared to other systems and other courts and other legal disputes that can come up.

When you file—or when we file—a petition in Workers Compensation Court in Rhode Island on behalf of an injured worker, it can mean, uh, or can be about any number of things. Basically, every issue that comes up in the course of your workers compensation case, uh, can be the subject of a petition. What do I mean by that? Well, let’s say your weekly check all of a sudden stops, uh, let’s say for no reason—uh, what do you do? You would file a petition called a Petition to Enforce, uh, in the Workers Compensation Court and ask for a court order to pay you what they owe you retroactive to when they stopped, and to potentially pay you a penalty on top of that, or to pay your lawyer a fee. Um, but petitions can take the form or be regarding other issues as well. Pretty much any issue—for example, if you need an MRI or you need a surgery or some form of treatment and the insurance company just will not voluntarily approve it or pay for it or they outright deny it—that’s an issue that you need the Workers Compensation Court to address. And in Rhode Island, fortunately, we have one of the fastest working Workers Compensation Courts in the country—it’s a fairly quick system—and so you can file a petition called a Petition to Review, uh, over whether or not you should be entitled to and have the insurance company pay for that form of treatment that they’re denying. So there’s a lot of other issues that can come up in workers compensation that cause a petition to be filed on your behalf by your lawyer in the Workers Compensation Court—which, unfortunately for our firm, is right across the street—and have a court decide it and decide it promptly so that you can move on with the treatment you need or get the money that you’re entitled to, and these petitions are filed every day over myriad issues in Workers Compensation Court no matter really what they are.

So, appeals in the workers compensation context typically look like this: if, uh, you hired a lawyer or you attempted to bring a petition on your own to recognize your injuries, and the judge at the pretrial hearing decided that, for whatever reason, uh, they weren’t prepared to grant your petition, uh, then and there, but rather they need to hear more evidence—they need a full hearing with testimony and witnesses and the like—then that, in itself, is a form of an appeal that we typically see in workers compensation. Um, your claim is denied at the pretrial level, and by claiming a trial—claim for trial is another word for, uh, another word for appeal—you get to a level of the, um, review process by the court where, like a trial, uh, a full trial, you can depose doctors, you can call witnesses, you can have testimony under oath, and the judge receives and hears and considers all of the evidence and then makes a final, um, determination about whether or not your claim is compensable or not. Now, if it’s not, you still have appellate rights beyond, um, the hearing judge or the, or the trial judge, to the Appellate Division of the Workers Compensation Court or potentially even the Supreme Court. But typically, an appeal, um, indicates that a judge either needs to hear more robust forms of evidence or that perhaps there’s some problem with the, with the claim legally, uh, or evidentiary, uh, that requires an appeal, and, you know, it’s a very difficult thing to handle on your own. That’s a—that’s something a lawyer would almost always have to be involved in.

If your claim is denied, uh, you would file a petition in Workers Compensation Court to have a judge hear and decide whether the denial was appropriate or, on the other hand, if you are entitled to workers compensation benefits and the claim shouldn’t have been denied. If you promptly consult with a workers compensation lawyer, that lawyer will file that petition the first second they can so that there’s no unnecessary delays in getting you what you’re entitled to and, and getting your rights recognized. So when they do deny your claim—and they often do—it doesn’t mean your claim doesn’t have merit, it just means that they’re not gonna voluntarily give you what you’re entitled to. So you need a lawyer to file what they have to file to legally get you what you’re entitled to.

A lot of reasons can result in delay of your claim. Uh, sometimes the insurance company or the employer refuses to, uh, allow you the claim because they don’t want to pay. Uh, they may have nothing to do with the merits of your claim—they can just deny it. Or perhaps they have some question or they legitimately dispute the validity of the claim. Doesn’t mean you’re not entitled to benefits, but you’re going to have to fight them to get it, and, and of course, you will be wise to hire a lawyer to do that for you. Uh, other reasons for delay—and perhaps one of the most important reasons or things to know about why claims get delayed—is, under the system, if the insurer wants to, they can delay or put it off or start paying you but not, not properly, uh, grant your claim, and that’s something you want to avoid. And the way to avoid it is to promptly consult with a workers comp lawyer who knows exactly how quickly they can memorialize your claim so that your rights are officially protected and written in stone, so that they can’t pull the rug out from under you when you least expect it. Because again, what workers comp insurance companies can do is start paying you right away and make you feel as if everything is well and your claim must, of course, be approved if you’re getting paid—and it turns out that’s not the case legally. The law gives them a certain window of time, which they don’t really tell you about, to pay you without really accepting the claim, and they can decide at any time up to 13 weeks after your injury to stop paying you, to deny the claim, to pull the rug out from underneath you, and leave you scrambling with this interruption in your income stream, uh, as well as a—now a delay in getting medical treatment that you may be entitled to.

Approval of a workers compensation claim can be instant—as soon as you’ve missed more than three days from work. Or, um, sometimes the insurance company can delay or deny or put off, uh, memorializing your claim in the way that they should. If this happens, then, uh, again, consult with a workers compensation lawyer about that, and we’ll do what we have to do to get your claim approved. If we’re talking about filing a petition in Workers Compensation Court to officially establish and recognize your claim, then the, um, pertinent laws that apply are, first, that you can’t file that petition until the earliest, uh, 21 days after the injury. And typically, we don’t file these petitions in cases where you haven’t lost any time from work—you do need to be incapacitated or lose time to officially have your claim mature and before you can seek to recognize it or memorialize it. So, um, while an insurance company or the employer can do the right thing instantly and recognize your claim and open it and process it and start paying you, you can imagine that in many, uh, instances that doesn’t happen, or it doesn’t happen in a timely way, or it happens, uh, and you start getting paid but it’s not, uh, properly documented. You really haven’t been given any rights that you can exercise if they stop paying you. And again, this all goes back to one of the most important things to do in a workers compensation case, or in the case of a workplace injury, which is have it legally memorialized the right way—which is what your workers comp lawyer is—one of the chief reasons you hire them and one of the first things they do.

The filing of a workers comp claim typically gets initiated, uh, in the first instance by the employer and/or their insurance company. Employers are obligated to report all workplace injuries; they should be communicating that to their workers comp carrier, and that carrier should be opening up a claim—a claim number, assigning you an adjuster, and sending you certain information. That’s the typical way that the claim is, uh, opened up or initiated. But if we’re talking about your right officially to be on workers comp, then the—the first step or the necessary step, oftentimes if the employer doesn’t do it or the insurer doesn’t do it the right way, is to file a petition in the Workers Compensation Court called an Original Petition, seeking to establish that you did officially have a work-related injury and that you are disabled, whether it’s for a limited period of time or into the future. That’s something that’s an important step in the process—namely, memorializing your claim and getting your right to workers compensation benefits etched in stone, essentially legally. And that’s something—it’s the first thing, uh, we look to do when we, uh, take on a new client.

Uh, if you are requested to come back light duty, then refusal to do that, uh, can have consequences if the light duty position, quote unquote, is offered to you under what’s called Suitable Alternative Employment. The Suitable Alternative Employment provisions of the Act are very specific in terms of how it has to be done and offered, but it can sound a lot like a light duty position. Now, if you refuse an offer of Suitable Alternative Employment, then there can be consequences to your workers compensation weekly check and your benefits. But oftentimes, uh, you do not have to, or you’re not required to, go back light duty as a condition of being able to stay out and receive your weekly check.

Um, light duty is, um, not a required thing for you to submit to, but it—it can be something that is good for both sides if it’s done through a process in the Workers’ Compensation Act known as Suitable Alternative Employment. That’s—that’s different than light duty, but sometimes it is confused with light duty. You want to make sure, if you’re going to go back to work for the same employer but it’s something different than you were doing at the time of your injury, that you’re protected, and the Suitable Alternative Employment provisions of the Workers Compensation Act do offer protections to you that you otherwise wouldn’t have if you simply went back light duty. Sometimes employers will tell employees, “We’re sorry, we don’t have any light duty employment for you,” in which case, um, you don’t go back. But there’s many cases where your employer may say, “Well, we want you to come back light duty,” and depending on the circumstances, legally you’re not obligated to do that and you can remain out on workers comp until you resume your full duty capabilities. Um, so the mere fact that your employer wants to assign you to light duty or wants you to do light duty doesn’t mean necessarily that you have to do that or sacrifice your rights. Um, it can depend on the circumstances, of course, and you’re well advised to consult with your lawyer about the implications of working in, um, a light duty capacity. But, um, generally speaking, you don’t have to, um, submit to light duty and you can continue to remain out until you’re better and go back to full duty, and you can collect your weekly checks until that point.

If your employer does not report your claim, um, you can again figure out through your lawyer, typically, who their insurance company—their workers comp insurance company—is as of the date of your injury and make your claim directly, uh, that way or by filing a petition in the Rhode Island Workers Compensation Court to document your case and your claim. Uh, and, um, despite your employer not reporting it like they should, your rights will still be protected.