When To Hire a Workers’ Compensation Lawyer

Workers’ compensation helps protect employees who suffer injuries or illnesses on the job. Nearly 60 billion dollars were paid out in workers’ compensation benefits in 2020.

This state-by-state system provides benefits like medical treatment, wage replacement, and compensation for permanent injuries and impairments. The workers’ compensation system can be extremely complex, however, which means that navigating the claims process isn’t always straightforward.

Knowing when to hire a workers’ compensation lawyer can be a pivotal first step in ensuring that your rights are protected and you get the benefits you’re entitled to.

Let’s talk about when it makes sense to hire a workers’ compensation lawyer and how having a legal representative can make all the difference in your case.

The Basics of Workers’ Compensation

Workers’ compensation is an insurance program that most employers are required by law to provide for their employees to cover work-related injuries and illnesses, and provide wage-replacement benefits, medical care, and compensation for any injuries that result in disability.

While this may sound simple enough, there are many nuances and state-specific procedures involved that can make things tricky for those inexperienced in the legal process.

Each state has different laws, and there are strict deadlines for reporting your injury and filing a claim with your state agency or HR department.

Once you’ve made a claim, your employer’s insurance company will need to investigate your injury and determine whether your claim is valid. While the system is designed to ensure injured workers are compensated without having to file a lawsuit, the process often doesn’t go as smoothly as it should.

A valid workers’ compensation claim typically hinges on a few key factors. For your claim to be accepted, you must meet some specific criteria, to ensure that you qualify for benefits.

These usually required that:

• Your Injury Must Be Work-Related: Your injury or illness must have happened while you were performing job duties or acting within the scope of your employment. This can include injuries that occur at your place of work, a related job site, or while you’re engaged in a work-related task somewhere other than your normal work environment (traveling for business, for example).
• The Employer Must Have Workers’ Compensation Insurance Coverage: Most employers are required by law to carry workers’ compensation insurance. If your employer doesn’t have coverage when they should, you may still be able to file a claim through a state-run fund or file a lawsuit against your employer.
• You Must Be Officially Classified as an Employee: Workers’ compensation benefits are only available for employees. If you’re an independent contractor, volunteer, or freelance worker, you’re not generally covered unless specific provisions apply under your state’s laws or you have a pre-existing contractual agreement for benefits from your employer.
• You Must Give Your Employer Proper Notice: You must report any injury to your employer as soon as possible, typically no more than a few days to weeks after the incident. (Immediate reporting is best). Failing to provide a notice of injury in a timely manner, can result in your claim being denied,
• You Must Seek Licensed Medical Treatment: Receiving medical care for your injury and having dated documentation about the extent of your injury from a healthcare provider is essential to your claim. You must also follow any prescribed treatments and submit copies of any medical reports as part of the claim.
• Your Injury or Illness Must Cause Losses: For your worker’s compensation claim to be valid, your injury or illness should have resulted in economic and non-economic losses like medical expenses, lost wages, or a reduction in the employee’s ability to work. Otherwise, there’s nothing to compensate you for. The seriousness and estimated length of your disability status (temporary or permanent) will often play a key role in how much compensation you’re owed.

This is where having a workers’ compensation lawyer in your corner, to ensure that all of these requirements (and any others) are met, can be invaluable.

When You Need a Workers’ Compensation Lawyer

These are just some of the situations where hiring a workers’ compensation lawyer is not just advisable but vital.

Here are more common scenarios where hiring a legal professional can be beneficial:

Your Claim is Denied

If your claim worker’s compensation claim is denied, you still have some options.

You can appeal the board’s decision through your workers’ compensation system. However, the appeal process can be even more complex than the initial claim, and you’ll likely be up against a team of experienced insurance adjusters and lawyers.

Having an attorney on your side will increase your chances of a successful appeal, as they’ll gather the necessary evidence, present your case, and represent your interests in hearings or negotiations.

You Have a Pre-Existing Condition

Pre-existing conditions can be a major complication to a workers’ compensation claim and are a frequent reason for denial. An insurance company will likely argue that your current injury isn’t work-related but caused by your pre-existing condition. This is a common tactic used to avoid paying out claims, especially with injuries involving the back, neck, or joints.

If you do have a pre-existing condition, you’ll need hard evidence to prove that your current work-related injury either made your condition worse or that it’s entirely separate from it. An experienced workers’ compensation lawyer can help gather proper medical records and expert testimony, and then present that evidence to prove that your work caused or worsened your injury.

Your Injury Prevents You from Working

If your injury is so debilitating that it keeps you from returning to your previous job, or any job, you may be entitled to long-term or permanent disability benefits (your doctor will assign you an impairment rating, typically expressed as a percentage, which represents the extent of the permanent disability.)

These can provide you and your family with ongoing wage replacement if you can’t work.  Most employers are also required to make reasonable accommodations for injured employees under workers’ compensation laws or the Americans with Disabilities Act (ADA), as well.

Insurance companies often contest permanent disability cases out of hand due to the significant financial burden can represent.

Having a lawyer in these cases is especially crucial. Your worker’s compensation attorney will fight to secure the maximum benefits in a lump-sum settlement or structured payments, depending on your personal situation and needs.

Also, if you qualify for Social Security Disability benefits, your attorney can help coordinate those with your workers’ compensation payments to ensure that you’re getting the maximum benefits that you’re entitled to.

Your Employer Retaliates Against You

Unfortunately, some employers may react negatively when you attempt to file a workers’ compensation claim. Employees have faced retaliatory actions like being demoted, having hours reduced, or even being fired.

Retaliation is illegal, but proving it can be difficult without experienced legal help. If you feel that your employer has retaliated against you for filing a worker’s compensation claim, an attorney can help protect your rights by filing a complaint on your behalf and pursuing additional compensation for your employers’ illegal actions, and ensuring that you’re not subjected to additional mistreatment.

Hiring a workers’ compensation lawyer provides numerous benefits beyond just navigating paperwork and deadlines. Here are the three major ways that an attorney can help you:

• Case Evaluation: Your attorney will evaluate your case, explain your legal options, and help you understand the benefits you’re legally entitled to.
• Negotiating with Insurance Companies: Workers’ compensation attorneys are experienced in negotiating with insurance companies to secure the maximum fair compensation that you need and deserve.
• Representation in Hearings or Trials: If your case goes to a hearing or trial, your lawyer will represent you before a judge and present compelling arguments on your behalf.

At Belsky & Horowitz, LLC, we understand that workers’ compensation claims can be stressful and confusing, especially when there are disputes over issues like the severity of your injury, your benefits, or whether your injury was work-related.

In these situations, our workers’ compensation lawyers can make a significant difference. One of our experienced attorneys will help you navigate the claims process, protect your rights, and ensure you receive the benefits you’re entitled to.

While not every claim requires legal representation, it’s important to recognize when a lawyer is necessary. If your claim is denied, your benefits are insufficient, or your injury is severe, having a lawyer on your side can give you the best chance of a favorable outcome.