When to Hire a Workers Compensation Lawyer

You can decide for yourself if it’s time to hire a workers compensation lawyer by reading the examples below. Or, you can ask an attorney for their expert opinion with a free consultation.

Assume you’re at work and need to move a stack of boxes. Your boss shoots you with a bow and arrow halfway through lifting one.

He doesn’t, but the pain shooting through your shoulder and neck makes you believe he does.

You’ll need medical attention whether it’s a pulled muscle or a slipped disc. That means you’re about to enter the maze of workers’ compensation.

Who are you going to call?

Some people’s first call is to a workers’ compensation lawyer. That’s a fantastic idea, except when it isn’t.

Allow us to explain the distinction and assist you in determining when to seek legal counsel.

Signs You Should Hire a Workers’ Compensation Attorney

The way your company, or, more importantly, its insurance carrier, handles your case will determine whether or not you should hire a lawyer. Here are ten signs that you need a workers’ compensation attorney on your side.

1. Your employer or insurance company denies it happened at work – This is common when a minor injury occurs at work and goes unreported. That injury worsens at work, becomes serious, and the employer/carrier claims the original injury did not occur at work. This also occurs when the long-term effects of a workplace exposure result in a disease.

• Your employer is dragging its feet with your claim – If you are injured on the job, you should notify your employer immediately and begin the reporting process. The company must provide you with the necessary paperwork, file a claim with its insurance carrier, and report your case to the state workers’ compensation board. Reporting regulations and deadlines vary by state, but this process should typically take no more than 30 days to complete.

• If you suffer a permanent disability, either partial or total, that prevents you from ever fully returning to work – Insurance companies are more likely to contest such claims because they are the most costly.

• Your doctor recommends treatment, but the insurance company refuses to pay for it – This is also a common practice when an injured worker’s recovery necessitates rehabilitation visits that the insurance company deems unnecessary.

• If the insurance company denies your claim – and you should if you believe your claim is legitimate – this is where things can get complicated and expert advice is required. “If it becomes contentious, if there is a disagreement,” Branham said, “it’s time to get a lawyer.”

• If the settlement offer does not cover all lost wages and medical bills – The majority of worker compensation settlements are for permanent disability benefits, which are determined by examining doctors using a rating system. If the insurance company disagrees with the rating, it may order an independent medical examination (IME) by a doctor of its choosing. That doctor is likely to give you a lower rating than you (and your sore neck) believe you deserve. A lawyer can help you persuade a judge that you are deserving of a higher rating.

• You have a preexisting condition – If you had neck pain before lifting that heavy box, the insurance company will almost certainly blame your new pain on that. You’ll need evidence to back up your claim.

• You intend to apply for Social Security Disability Insurance (SSDI) benefits – These benefits, known as SSDI, may be reduced by workers’ compensation benefits. A lawyer can help you structure your settlement so that the offset is reduced or eliminated.

• Your employer retaliates against you – If you are fired, demoted, have your hours reduced, or are forced to return to work too soon, a lawyer can argue that the penalties are unjustified.

1. If you have a third-party claim – If someone other than your employer contributed to your injury, you can file a workers comp lawsuit outside of the workers comp system. For example, if you are hit by a negligent driver while driving for work, you can sue that person for damages.

Signs You Shouldn’t Hire a Workers’ Compensation Attorney

• Your injury is minor and does not necessitate extensive medical treatment – the workers’ compensation system is specifically designed to handle cases like yours.
• You don’t have a pre-existing condition that the accident aggravated – Preexisting conditions, such as a neck injury sustained in a car accident and exacerbated by a workplace fall, can complicate your claim.
• You miss little to no work – This type of claim should be simple.

Should I Hire a Lawyer for Workers’ Compensation?

A workers’ compensation lawyer has been hired to assist an injured worker.

Hiring a lawyer for a workers’ compensation claim is a question that every injured worker faces, and the truth is that most situations – injured ankle, cut on the arm, sore back – are easily treated and will only require a bag of ice, a trip to the doctor, a few aspirins, and some rest.

However, if your workplace injury is serious and things become contentious between you and your employer or the insurance carrier handling the case, it is unquestionably in your best interests to consult with a workers compensation lawyer. A twisted knee or strained back can lead to knee or back surgery, and things can quickly become serious.

“You don’t have to hire an attorney every time you have a claim,” said Tom Holder, an Atlanta-based workers’ compensation lawyer, “but you should at least call one and let them explain how the process works and what benefits you are entitled to receive.”

Just don’t assume that your case will devolve into a legal slugfest.

“Too many claimants hire a lawyer the day after the accident,” said Jeff Branham, a Florida workers’ compensation attorney.

In contrast, if you’re concerned about upsetting your boss or the cost of hiring a lawyer, not calling one could end up costing you a lot more.

“The public perception is that I can’t afford a lawyer, or that it will cause unnecessary delays, or that the lawyer will take too much of my award,” said Judge Neal Pitts, a Compensation Claims Judge in Florida. “It’s a no-brainer if the case settles for $100,000 with a lawyer or $10,000 without. And that is what happens.”

Taking Care of a Case on Your Own

We’ve talked about SSDI and IME, but what about AOE/CEO, cumulative trauma, DEU, IIPP, PDRS, and WCAB?

Unless you’re an attorney or enjoy reading workers’ compensation manuals in your spare time, the answer is probably no. Taking on a case on your own is almost always a bad idea, especially since the insurance company will be represented by someone who has probably handled hundreds of cases.

Even when employees win their appeals, the majority of them would have done better if they had a lawyer arguing their case.

“Way more than half, way more,” said Judge Pitts. “I’d say it’s closer to 80%.” It’s unusual to come across a situation in which the employee likes the insurance rep and the insurance rep likes the employee, and everything works out.”

When Should You Hire a Workers’ Compensation Attorney?

As soon as you make the decision to challenge the settlement decision.

Workers’ compensation can quickly devolve into a legal jungle of paperwork, deadlines, depositions, and evidence gathering at that point. If you don’t know what you’re doing, it’s easy to get lost.

How a Good Workers’ Compensation Lawyer Can Help Your Case

Hiring a workers’ compensation attorney will give you the best chance of winning your case. A lawyer can assist you in gathering medical evidence to support your claim, negotiating a settlement, and representing you at your workers’ compensation hearing.

Hiring a dedicated workers’ compensation attorney will greatly improve your chances of receiving the benefits you deserve. An attorney will communicate with the workers’ compensation insurer on your behalf, gather medical evidence to support your claim, attempt to negotiate a favorable settlement and represent you at your workers’ compensation hearing.

The insurance company’s claims adjusters and attorneys are not looking out for you, and they will not hesitate to deny your legitimate claim for questionable reasons. Fortunately, a workers’ compensation attorney can do a number of things to tip the scales in your favor.

Create Medical, Vocational, and Other Proof

Inadequate medical evidence is most likely the most common reason workers’ compensation claims are denied. Even if your claim is approved, you are more likely to receive all of the medical treatment you require—as well as all of the other benefits you are entitled to—if you have solid medical evidence to back up your claim. An attorney can assist in the development of medical evidence by:

• compiling medical documents
• arranging for or recommending treatment with specific doctors
• obtaining medical opinions from your treating doctors and conducting an independent medical examination
• representing you when you are called to appear and answer questions at a deposition, and
• conducting medical expert depositions

There are a variety of other types of evidence that could help your case, such as:

• A vocational expert’s testimony about the physical requirements of your job.
• statements about your daily activities from friends and family members, or
• evidence demonstrating your employer’s track record of poor workplace safety or a lack of training

Based on the strengths and weaknesses of your case, an experienced workers’ compensation attorney will know what evidence is required to maximize the chances of a favorable outcome.

Negotiate Settlement Agreements

When it comes time to negotiate a settlement with your employer’s insurance company, a workers’ comp attorney has the advantage of knowing how much your case is worth—that is, the number of benefits you should receive, based on a number of factors such as:

• The extent of your injuries and the resulting limitations in your ability to do things
• Your previous medical expenses, as well as the cost of future medical treatment
• Whether you have long-term impairments and, if so, how severe your permanent disability is.
• Whether your employer owes you money for past temporary disability (wage loss) benefits and
• Late payment penalties, as well as your previous wages

Lawyers are familiar with insurance companies’ negotiating strategies, which range from low-ball offers to phony “final offers” that aren’t. Workers’ compensation attorneys, with few exceptions, are more likely than applicants acting alone to engage in fruitful negotiations with insurers.

Your attorney can also make certain that your settlement agreement is properly written in order to avoid negative consequences later on. For example, if you are receiving or applying for Social Security disability benefits, and improperly designed settlement agreement could cost you hundreds of dollars in benefits each month due to the workers’ compensation offset. An attorney can also assist you in calculating a reasonable estimate of your future medical expenses so that the settlement agreement can account for them.

While it is true that workers’ compensation judges must approve settlements, it is not prudent to rely on the judge to adequately protect your interests. A lawyer is essential in settlement negotiations.

Represent You at a Workers’ Compensation Hearing or Trial

If you are unable to reach an agreement, your case will be heard in an administrative hearing or at trial before a workers’ compensation judge. During the “discovery” (or investigation) process, your attorney may take witness depositions, obtain your medical records, conduct legal research, draft your “pleadings” (petitions, motions, and responses to the insurance company), and ensure that everything is submitted on time. At the hearing, your lawyer will present the judge with a “theory of the case” (why you should be granted benefits), make opening and closing arguments, cross-examine witnesses, and raise objections when the insurance company does something improper.

If you are dissatisfied with the outcome of your hearing, your attorney can assist you in appealing the decision.

Provide you with information on third-party claims and other potential benefits

You may have a personal injury claim in addition to a workers’ compensation claim against a third party (someone other than your employer) whose negligence caused or contributed to the injury. Third-party lawsuits frequently target drivers and manufacturers of defective equipment. A personal injury claim may be more valuable than a workers’ compensation claim because damages can include pain and suffering as well as lost earnings potential. (Learn more about when you can sue outside of workers’ compensation here.)

A lawyer can also advise you on your eligibility for other benefits such as vocational rehabilitation, wage reimbursement, long-term disability insurance benefits, state short-term disability, and Social Security disability.

Fees for Workers’ Compensation Attorneys

Most workers’ compensation attorneys work on a contingency fee basis, which means they don’t charge you anything upfront and only gets paid if you win your case. Many states strictly limit the amount of money that workers’ compensation lawyers can charge, with fees typically capped at 10 to 20% of your benefits. Attorneys’ fees may also need to be approved by the workers’ compensation judge or appeals board.

When Should You Consult a Workers’ Compensation Lawyer?

You may be able to represent yourself if your workers’ compensation claim is simple, straightforward, and low in value. However, there are a few situations in which hiring a lawyer is essential, such as if:

• You don’t have a lot of medical evidence to back up your claim.
• Your claim is worth a lot of money, or you’ve suffered serious, long-term injuries.
• Your claim is being challenged by your employer.
• You’re undecided about accepting a settlement or.
• Your claim has been denied, and you must file an appeal.

If any of the above apply to you, you should contact an experienced workers’ compensation attorney right away.

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