In most circumstances it is the injured worker’s responsibility to report the injury to the employer. Often, however, in a war environment, the worker does not have time to report the accident right away. Or even if reported timely, the person or supervisor who was told about the accident fails to provide the information to his superior. Litigation is often necessary to conduct discovery in order to establish that an injury was timely reported.
The Employee’s responsibility is to report the accident as soon as possible. It is also the Employee’s responsibility to request medical care from the Employer.
Once the Employer knows about the accident, it is its responsibility to report the injury to the Department of Insurance within 10 days. The Employer will also notify its insurance carrier.
Often, the Employer or its insurance carrier does not have sufficient information when the claim is filed. In that case, they will often deny the claim, pending further investigation.
The Department of Labor (“DOL”) governs Defense Base Act, and several other types of federally regulated workers’ compensation programs. The DOL maintains the Office of Workers’ Compensation Programs, to help administer claims. The Department of Labor does not represent either party. The DOL helps keep the parties on track, and monitors the case. However, because of the DOL’s high case load, legal representation is often necessary to ensure that their case is being handled timely and properly.
If necessary, the parties will attend an Informal Conference before the DOL. This conference is usually attended by phone by all parties. The conference often resembles a brief mediation, for each side to present their position, including why benefits should or should not be paid. Many times the insurance carrier attends the Informal Conference without having previously paid benefits. After the Informal Conference, the insurance carrier will decide to either pay or deny benefits, conduct an investigation, or to move the file toward a Formal Hearing.
Formal Hearings are conducted before an Administrative Law Judge, who works for the Department of Labor. There is no jury trial, and the Judge serves as both the finder of fact and adjudicator. Trials are becoming less common, because of the downsizing of the Office of Administrative Law Judges, resulting in fewer judges to adjudication claims. Parties often make use of private mediators to reach settlement. These mediators are usually highly skilled, with years of experience handling DBA cases.
Appeals are rare, and are handled before the Department of Labor’s Benefits Review Board. This is a paper appeal with no oral argument or jury. In very rare instances, the case will be appealed from the BRB to the Federal Circuit Court. Appeals under the DBA are extremely slow, and often several years go by before the BRB or the Court make a decision.
Our San Diego Defense Base Act attorneys can help represent you throughout all steps of the DOL claims and adjudication process. Please call us if you have any legal questions.