Worker’s compensation is a specialized area of law that focuses on the rights and benefits of employees who have been injured or fallen ill as a result of their jobs.
In most cases, when you are injured, you cannot sue your employer due to state laws that limit or eliminate personal injury claims against your employer. So worker’s compensation lawyer is an attorney who specializes in this field, representing either the injured worker or the employer during compensation claims processes. The core of what a comp lawyer does revolves around ensuring that an injured worker receives all of the benefits that the law will allow.
Our law firm only focuses on severe injury or wrongful death workers’ compensation claims. So, for most of you, thankfully, our workers’ compensation lawyers will not be able to represent you. But the information here applies to anyone who has a workers’ compensation claim and wants to better understand the process and what their workers’ compensation lawyer will do for them.
Initial Case Evaluation
Understanding the Incident: The first step a lawyer undertakes is to meet with the client to understand the details of the incident. This involves scrutinizing the circumstances leading up to the injury, including workplace conditions, equipment used, and actions taken by the worker and others around them.
Determining Validity: With the incident details in hand, the lawyer then assesses the viability of the claim. This means checking if the injury or illness is indeed work-related and if the victim is entitled to compensation under local laws and regulations.
Gathering Essential Evidence
Medical Records: Lawyers liaise with medical professionals to obtain detailed medical records that shed light on the severity and longevity of the injury. This can include diagnostic reports, treatment plans, and doctor’s prognostic notes.
Witness Statements: If there were any eyewitnesses to the accident, their testimonies can be invaluable. The lawyer will interview these witnesses and gather formal statements to support the case.
Workplace Data: This involves obtaining information about workplace safety measures, equipment maintenance logs, training records, and any other documentation that can provide context about the working environment and practices.
Filing and Managing Claims:
Paperwork Mastery: The worker’s compensation claim process involves a myriad of forms, deadlines, and protocols. The lawyer ensures that all necessary paperwork is accurately filled out and submitted on time, safeguarding against administrative blunders that could jeopardize the claim.
Liaising with the Worker’s Compensation Board: Lawyers frequently interact with the local Worker’s Compensation Board (or its equivalent). This body usually oversees and adjudicates worker’s compensation claims, and the lawyer ensures that they remain compliant with its guidelines and mandates.
Negotiation and Settlement
Few workers compensation lawsuits go to a hearing. In most workers’ compensation claims, the way to maximize settlement amounts is at the
Dealing with Insurance Companies: Insurance adjusters are trained to minimize payouts. A worker’s compensation lawyer levels the playing field, using their expertise to negotiate with these adjusters and fight for a settlement that truly reflects the injured worker’s needs and rights.
Evaluating Settlement Offers: If an insurance company extends a settlement offer, the lawyer meticulously evaluates its fairness. The best workers compensation lawyers will break down the offer’s components, assessing aspects like medical costs, lost wages, and potential future treatments, ensuring the worker is neither short-changed nor unduly influenced to accept a lowball offer.
Advocacy in Trials
If negotiations fail or if there’s a dispute regarding the claim, the matter might proceed to a formal hearing or trial. Here, the lawyer’s role becomes even more pivotal:
Presenting the Case: Using gathered evidence, the lawyer presents a coherent and persuasive narrative, demonstrating the legitimacy of the worker’s claim and the extent of their suffering.
Cross-examination: Lawyers specializing in workers compensation rigorously question opposing witnesses, challenging inconsistencies in testimonies or any attempts to downplay the worker’s injury.
Legal Arguments: Drawing on our knowledge of worker’s compensation law, lawyers present legal arguments that support their client’s case, often citing previous case law, regulations, and statutes.
Appeals: If the verdict is unsatisfactory, the lawyer might pursue an appeal. This involves presenting the case to a higher authority, highlighting any legal errors or oversights that occurred during the initial trial.
Disbursement: Once settlement compensation for your comp claim is secured, your lawyer ensures that the funds are correctly disbursed, ensuring that medical providers are paid and that the injured worker receives their due.
Continuous Support and Counseling
Injured workers often find themselves overwhelmed not just by their physical ailments, but by the psychological toll of the accident and the ensuing legal battles. When you are in the midst of battling an injury, especially for people who have children or other obligations, it can be a brutal ordeal that can just wear you down. The best workers’ compensation lawyers are also, in a sense, friends. It is a part of the job description. A worker’s compensation lawyer often provides emotional and moral support, ensuring that their client remains informed, reassured, and empowered throughout the process.
When Do You Need a Workers Comp Lawyer?
If your employer’s workers comp insurance carrier is reasonable and accepts your claim for workers comp benefits, then you really don’t need to hire a workers comp attorney. However, if the insurance company or your employer start getting adversarial at any point during the claim process, you should immediately retain a workers compensation lawyer. Below are a few situations that you may encounter during the claim process which should prompt you to seek an attorney:
- Your employer claims that your accident did not happen at work or occurred outside the scope of your employment. If the injury did not occur at work, it means that you won’t be entitled to workers’ comp benefits. Employers will often make this claim in cases where the workplace injury took some time to flare up, or had a long latency period (such as disease from occupational exposure to chemicals).
- If your injury results in permanent disabilities and you are going to claim that you can never return to work, you should get a lawyer right from the start. These are high value claims that insurance companies are always going to dispute.
- Your claim should normally take no more than 30 days to complete, if your employer is stalling call lawyer.
- If your initial claim get formally denied you will need to hire a lawyer to fight for your rights.
How Can a Workers’ Comp Lawyer Help If Your Claim Is Denied?
If your initial claim for workers’ compensation benefits is formally denied by the insurance company, you should hire a workers’ compensation attorney immediately. A workers’ comp lawyer can represent you in the difficult process of appealing the initial denial of your workers’ comp claim. Workers’ comp claims get denied very frequently and there can be a number of different grounds for the denial. An experienced workers’ compensation lawyer will be very familiar with the legal basis for these denials and how best to attack them during the appeal process. The success rate for appeals in workers’ compensation claims is much higher than the success rate of appeals in civil court cases.
Common Workers’ Comp Claim Denial and How to Appeal Them
Below is a brief list of some of the more common grounds for denials of workers’ compensation claims. We also discuss how a workers’ comp attorney can challenge these effectively on appeal.
One common reason for denial of a workers’ comp claim is that your injury is “non-compensable.” This basically means that the type of injury you are claiming doesn’t meet the legal requirements for workers’ comp coverage. This is often a very ambiguous basis for a denial and can easily be challenged by an experienced comp lawyer. A workers’ compensation lawyer can review the applicable law and make a determination as to whether the denial is valid or not.
Another common basis for denial is that the insurance company claims that your alleged injuries were pre-existing and not something you actually suffered on the job. This is probably the most frequently cited grounds for denial of a workers’ comp claim and it is an effort by the insurance company to shift blame for the injury onto the employee.
A workers’ comp lawyer can help you appeal this denial and establish record proof that your injury was not pre-existing, but rather something that you suffered while on the job. If your injury was an aggravation of a pre-existing condition, a workers’ comp lawyer can help you get benefits for that also.
Lack of Supporting Documentation
Sometimes, your claim might get denied because the insurance company says that you failed to provide the required supporting documentation. A workers’ compensation lawyer can help you appeal this by collecting and presenting all of the required supporting proof necessary to document your workers’ comp claim. A workers’ compensation attorney will be able to help fight for proper acknowledgment from your employer’s insurance company. They can also assist you in gathering and sending this documentation if any paperwork is missing.