If you're an employee who has suffered a work-related injury or illness, you may be entitled to workers' compensation benefits. Unfortunately, employers or their insurance companies routinely deny workers' comp claims, even when they’re legitimate—which leaves injured employees to face a complex system of appeals. At that point, many applicants simply give up, while others try their best to navigate the system on their own.
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 medical evidence that supports your claim, 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.
Insufficient medical evidence is probably the most common reason workers' comp claims are denied. Even if your claim is approved, you’re more likely to receive all of the medical treatment you need—and all of the other benefits you deserve—if you have strong medical evidence that supports your case. An attorney can help develop the medical evidence by:
There are several other types of evidence that could bolster your case, including:
An experienced workers' comp attorney will understand, based on the strengths and weaknesses of your case, what evidence is needed to maximize the chances of a good outcome.
When it’s time to negotiate with your employer’s insurance company to reach a settlement, a workers’ comp attorney has the advantage of being able to estimate how much your case is worth—that is, the amount of benefits you should receive, based on a number of factors, including:
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 properly written to avoid negative consequences down the road. For instance, if you're receiving or applying for Social Security disability benefits, an improperly designed settlement agreement could cost you hundreds of dollars every month in benefits due to the workers' compensation offset. An attorney can also help you come up with a reasonable estimate of your future medical expenses, so that the settlement agreement can take that into account.
While it's true that workers’ comp judges must approve settlements, it wouldn’t be wise to rely on the judge to protect your interests adequately. In settlement negotiations, a lawyer is essential.
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” (or investigation) process, your attorney may take depositions of witnesses, request your medical records, perform legal research, write your “pleadings” (petitions, motions, and responses to the insurance company), and make sure that everything is submitted on time. At the hearing, your lawyer will present a "theory of the case" (why you should get benefits) to the judge, make opening and closing arguments, examine witnesses, and raise objections when the insurance company does something improper.
If you're not satisfied by the result of your hearing, your attorney can help you appeal the decision.
In addition to a workers' comp claim, you might have a personal injury claim against a third party (someone other than your employer) 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.
A lawyer can also advise you about your potential eligibility for other benefits, including vocational rehabilitation assistance, wage reimbursement, long-term disability insurance benefits, state short-term disability, and Social Security disability.