When a work injury occurs and a Workers’ Compensation claim is filed, the insurance company must file a form in response either accepting or controverting (denying or contesting) the claim. These controverted claims can be for a variety of reasons; the injury did not arise out of or in the course of employment, the injury was a result of “horseplay,” the injury did not occur to the extent claimed, did not occur or was made up entirely, or improper notice for the injury was given (not reported within 30 days), among other things.

Once a claim is controverted, the Board will schedule a Pre-Hearing Conference to allow the injured worker and insurance company to present evidence to support their claim. The injured worker needs to present medical reports at that time that constitute prima facie medical evidence ("PFME”). By this time, it is extremely helpful for an injured worker to have an attorney to represent them in their case.

In order to demonstrate PFME and begin the process to establishing a valid Workers’ Compensation claim, the injured worker will need medical evidence from a doctor which includes the following:

  1. a history of your work activities;
  2. a diagnosis of your injury or condition;
  3. a statement that the injury is causally related to your work activity.

At the Pre-Hearing Conference, the Workers’ Compensation Law Judge will review any medical evidence and likely direct the parties to take testimony of any medical providers and schedule a trial for any testimony from the injured worker and witnesses regarding the injury. Medical testimony is taken via telephone deposition by the claimant’s and insurance carrier’s attorneys, and the transcript is entered into evidence on the Workers’ Compensation Board’s electronic file. After all testimony is taken, the Judge will either direct the attorneys to submit Memoranda of Law or schedule oral arguments to present their cases.

This process takes place over the course of several months in most instances.  If you have a controverted claim or are scheduled for a Workers’ Compensation hearing, please call our Rochester location at 585-423-9444, our Canandaigua location at 315-853-9444, or email us through our secure contact form.