If you're an employee who has suffered a work-related injury or illness, you may be entitled to workers' compensation benefits. Unfortunately, legitimate workers' comp claims are routinely denied by employers or their insurance carriers, leaving workers' comp applicants to face a complex system of appeals. At that point, many applicants simply give up, while others try their best to navigate the system themselves.
Hiring a dedicated workers' compensation attorney will give you a much better chance of obtaining the benefits you deserve. An attorney will communicate with the workers' comp insurer on your behalf, gather and develop medical evidence, negotiate a good settlement, and represent you at your workers' comp hearing.
The claims adjusters and attorneys working for the insurance company are not looking out for you, and they won't hesitate to reject your bona fide claim for dubious reasons. Fortunately, there are several things a knowledgeable and experienced workers' comp attorney can do to tilt the scales in your favor.
Developing Medical, Vocational, and Other Evidence
Insufficient medical evidence is probably the most common reason workers' comp claims are denied. An attorney can help develop the medical evidence by gathering medical records, arranging or recommending treatment with certain physicians, obtaining medical opinions, and conducting depositions of medical experts. A properly developed medical record is more likely to lead to a permanent disability rating that reflects the true extent of any lasting impairments you have.
There are several other types of evidence that could bolster your case: vocational expert testimony about your job's physical requirements, statements from friends and family members about your daily activities, or evidence showing a history of poor workplace safety or lack of training. An experienced workers' comp attorney will understand, based on the strengths and weaknesses of your case, what evidence is needed to maximize your chances of recovery.
Negotiating and Structuring Settlement Agreements
Workers' comp attorneys tend to have a much better idea of the value of a claim than the workers they represent. A lawyer will understand how the following factors impact how much your case is worth:
- the extent of your injuries and your resulting functional limitations
- your disability rating
- whether the disability is partial or total
- whether the disability is temporary or permanent
- your previous wages, and
- the costs of past and future medical treatment.
Moreover, lawyers understand the negotiating tricks and tactics used by insurance companies, from low-ball offers to bogus "final offers" that really aren't. With few exceptions, workers' comp attorneys are more likely to engage in productive negotiations with insurers than applicants acting alone.
Your attorney can also ensure that your settlement agreement is structured properly. If you're receiving or applying for Social Security disability benefits, an improperly drafted settlement agreement can cost you hundreds of dollars per month in benefits due to the workers' compensation offset. Your settlement should also take into account the medical bills you've already incurred and those you expect to incur in the future. An attorney can help you decide on a reasonable estimate of your future medical expenses.
While it's true that settlements must be approved by a workers' comp judge, unrepresented claimants would be unwise to rely on the judge to adequately safeguard their interests. In settlement negotiations, a lawyer is essential.
Representing You in a Workers' Comp Hearing or Trial
If you're unable to reach a settlement, your case proceeds to an administrative hearing or trial before a workers' comp judge. During the discovery process, your attorney may take depositions of witnesses, request your medical records, perform legal research, and prepare pleadings and motions. At the hearing, your lawyer will present his "theory of the case" (why you should get benefits) to the judge, make opening and closing arguments, examine witnesses, and offer objections.
If you're not satisfied by the result of your hearing, your attorney can help you appeal the decision, typically to a panel of workers' comp judges.
Advising You on Third-Party Claims and Other Potential Benefits
In addition to a workers' comp claim, an injured worker may have a personal injury claim against a third party whose negligence caused or contributed to the injury. Drivers and manufacturers of faulty equipment are frequent targets of third-party suits. A personal injury claim may be much more valuable than a workers' comp claim because damages can include pain and suffering and loss of potential earnings. Read more about when you can sue outside of workers' comp.
Attorneys can also advise claimants on their potential eligibility for other benefits, including vocational rehabilitation assistance, wage reimbursement, long-term disability insurance benefits, state short-term disability, and Social Security disability.