If the employer or insurance company decides to contest an injured worker’s compensation case, there are rules and time limits that must be followed. One rule is that that they must file a timely “notice of controversy,” and another is that they must file a timely “pre-hearing conference statement” explaining the reason for the dispute and what proof they plan to submit.
If the employer or insurance company fails to follow the rules, it gives the injured worker an advantage in winning the case. However, in most cases the injured worker must still submit a medical report showing that the injury was due to their work. This is called “prima facie medical evidence.”
In this case, the WCL Judge found that there was prima facie medical evidence and that the employer had not filed a timely notice of controversy. As a result, the WCL Judge decided the case in favor of our client. The employer appealed the decision, and on appeal the Workers’ Compensation Board disallowed the claim on the grounds that the medical evidence was inadequate.
We appealed to the Appellate Division, Third Department, arguing that where the WCL Judge had already found prima facie medical evidence, the Board could not dismiss the case due to lack of evidence without at least giving the worker an opportunity to submit a better medical report. The Court agreed, writing that the Board could not preclude “claimant from submitting further medical evidence of a causal relationship between her injury and employment.”