The Longshore and Harbor Workers’ Compensation Act (LHWCA) is in place to provide certain types of maritime workers with a workers’ compensation plan. If you qualify under this law as a longshore or harbor worker you have access to compensation in the event that you are injured or become ill because of your time on the job. There is no need to prove negligence, you are simply entitled to this compensation as long as your illness or injury happened at work or resulted from work duties.
In many cases, injured or ill workers do not have to fight for this right to compensation; the employer’s workers’ compensation insurer simply pays what is owed. However, you may find yourself being denied these benefits by your employer or employer’s insurer. In this case you can file a claim with LHWCA. The ultimate decision as to whether you get benefits, and how you receive, is determined at an official hearing in front of a federal Administrative Law Judge, or ALJ.
If you are denied benefits by your employer’s insurer, they are claiming either that you are not ill or injured or that your injury or illness did not result from being on the job. Another situation in which you may be in dispute over benefits is when your employer offers compensation, but you disagree with the amount or extent. Regardless of what the dispute is, if you and your employer are in disagreement about your benefits, your claim goes to the Office of Workers’ Compensation (OWCP) within the Department of Labor. The OWCP will try to resolve the dispute through an informal conference or an official hearing.
The Informal Conference
The first step in an LHWCA claims dispute is to go through an informal conference through the OWCP. You can request this step if you believe that your claim is valid and that your employer is not providing adequate compensation for your injury or illness. You must complete the appropriate form and submit it to the OWCP to be given an informal conference.
The purpose of the informal conference is for the OWCP to review your case and give a recommendation to you and your employer’s insurer. It is an attempt to settle the dispute informally and to avoid the need for a hearing. Once you and your lawyer have requested an informal conference, you will have a couple of months to gather your medical records, accident reports, wage records, and any other documents you need to make your case.
You do not have to attend the informal conference, only your lawyer does. A lawyer with experience working on these kinds of claims should be able to represent you and your best interests. During the conference, a claims examiner from the OWCP will review your case and look at evidence from both you and your employer. This examiner will end the conference with a recommendation. If the recommendation is that you should receive your benefits, your employer’s insurer may decide to abide by the decision, but they do not have to do so. If they disagree, you can take your case to a formal hearing with an ALJ.
The Pre-Hearing Phase
If you decide to continue your claims process, the next step is to submit a request for a formal hearing. You or your lawyer must submit a Pre-Hearing Statement to the OWCP and to all other parties involved. The OWCP will refer your case to an ALJ, but it can take several months to go from an informal conference recommendation to a hearing.
During this time, called the pre-hearing, or the discovery period, you and your lawyer will put together all the information needed to make your case in front of the ALJ. Your employer and their insurer will be doing the same during this period. This may mean gathering all your records, taking depositions, interviewing witnesses, or making requests to your employer for documents or answers to necessary questions.
The formal hearing with an ALJ is a chance for you and your lawyer and your employer’s representation to make a case to the judge. There is no jury and the judge makes the final decision about your claim based on the evidence heard from both sides. The judge must consider several factors when coming to a decision, such as whether or not your injury or illness resulted from your work, whether you were injured prior to a work incident, the seriousness of your injury or illness, whether you received proper medical care, and how much you earned before the incident.
In most cases the hearing is the final decision in how and whether you get benefits under the LHWCA. However, if you are denied benefits and you feel as if the decision is wrong, you can have it reviewed by the Benefits Review Board of the Department of Labor. You can also appeal the decision in the U.S. Court of Appeals or even in the U.S. Supreme Court.
The hearing process for denied LHWCA claims is one that most workers don’t have to experience. If you are not receiving the benefits you believe you are entitled to because of your work-related injury or illness, an experienced lawyer can take you through the process and give you the best chances of getting the decision you want.