LAWYER FOR WORKERS’ COMPENSATION: When Do You Need One

lawyer for workers compensation
cropped view of worker with broken arm signing form for compensation claim opposite to businessman in blue jacket in office, compensation concept
Table of Contents Hide
  1. What Makes You Eligible for Workers’ Compensation?
  2. What you should be aware of about Workers’ Compensation:
  3. Why Should You Seek The Advice of a Workers’ Compensation Lawyer?
    1. #1. You have an Underlying Condition
    2. #2. Your Employer Denies that you Incurred the Injury on the Job
    3. #3. Your Benefits are Rejected or Postponed.
    4. #4. Your Benefits do not cover all your losses and Injury
    5. #5. You have been seriously Injured and cannot work for a Long Time
    6. #6. You might be able to make a Claim against a Third Party.
    7. #7. You may experience Workplace Retaliation because you have been Injured
    8. #8. You and your Employer do not Agree on your Ability to Work
    9. #9. Your Employer Tells you that you are not on Workers’ Compensation
    10. #10. Your Employer has failed to Provide Workers’ Compensation Insurance
    11. #11. You do not Understand the Process of Workers’ Compensation
    12. #12. You’ve been Charged with Fraud
    13. #13. Your Employer Dissentions or Disputes a Decision made by the State Workers’ Compensation Division
    14. #14. Your Employer or its Insurance Company Requests an IMEor other Evaluation after Recieving Benefits for Sometime
    15. #15. You don’t know what could Impact your Claim
    16. #16. You are or will be eliible for Medicare within the Next 30 Months
    17. #17. You may Require Medical Treatment Long after Your Injury
    18. #18. Medically, your Injury is Difficult to Quantify
  4. When a Workers’ Compensation Lawyer Isn’t Required
  5. How a Good Workers’ Compensation Lawyer Can Help Your Case
    1. #1. Create Medical, Vocational, and Other Proof
    2. #2. Negotiate Settlement Agreements
    3. #3. Represent You at a Workers’ Compensation Hearing or Trial
    4. #3. Provide you with information about third-party claims and other potential benefits.
  6. Is it Worthwhile to Hire a Workers’ Compensation Lawyer?
  7. When Should You Consult a Workers’ Compensation Lawyer?
  8. Lawyer Workers Compensation FAQ’s
  9. Is it worth getting a workers comp attorney?
  10. How much does it cost to hire a workers compensation lawyer?
  11. What disqualifies you from workers comp?
    1. Related Articles

Following a workplace injury, you may be asking how to file a workers’ compensation claim. How do workers’ compensation lawsuits work? A skilled workers’ compensation lawyer can assist sufferers of workplace injuries or illnesses in obtaining the benefits they are entitled to. 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 before a workers’ compensation hearing.

What Makes You Eligible for Workers’ Compensation?

Workers’ compensation insurance is provided by employers and pays for medical expenses incurred as a result of workplace injuries or illnesses. According to the Insurance Information Institute (III), you may be eligible for workers’ compensation if you were injured while doing your job duties in the “course and scope.”

If you work at a home improvement store and injure your back while lifting a big load of lumber, you may be eligible for workers’ compensation.

In another case, you work as an administrative assistant and eventually develop carpal tunnel syndrome, a repetitive stress condition common in persons who use a computer all the time. Workers’ compensation may cover both sudden and gradual injuries if you are an employee and are injured on the job.

What you should be aware of about Workers’ Compensation:

Each state has varying requirements for employers to carry workers’ compensation, and one state does not require it at all.

Workers’ compensation may be available to full-time, part-time, and seasonal employees.

Although certain employers may have a probationary period, you are normally insured from the minute you start working for them. Regardless of who is at fault for your injury or illness, you are entitled to workers’ compensation.

Why Should You Seek The Advice of a Workers’ Compensation Lawyer?

In an ideal workers’ compensation case, your damage is small, and there is no doubt that you will receive benefits. However, not every workplace accident occurs under optimal conditions. Depending on your situation, you may require the assistance of an advocate to ensure that you obtain the compensation you deserve. If any of the following apply to you, you might consider engaging a worker’s compensation attorney:

#1. You have an Underlying Condition

If you have a serious underlying health issue, it could be used to deny your compensation claims. Insurance companies and employers may claim that your current ailment is the result of a pre-existing condition and that your injury is unrelated to a working accident. However, having a pre-existing ailment does not exclude you from receiving benefits.

#2. Your Employer Denies that you Incurred the Injury on the Job

Problems may emerge if your employer refuses to admit that your injury occurred at work or was caused by your job activities. A worker’s compensation attorney can clearly prove the connection between your injury and your job. You may be denied benefits that are legally yours if you do not have this link.

#3. Your Benefits are Rejected or Postponed.

Eighty percent of those who have had their workers’ compensation benefits denied do not pursue them. Even if you have been refused or your payments have been delayed, you can file an appeal. A workers’ compensation attorney may walk you through the procedure and obtain any medical records required to prove your claims.

#4. Your Benefits do not cover all your losses and Injury

You may be concerned about how your pay loss benefits are calculated in some circumstances. Incorrect calculations may result in you receiving fewer wage loss benefits than you should. This may be a concern if all of your medical expenditures are not covered, you must pay a deductible, or you must pay a portion of your costs. A workers’ compensation attorney can help you acquire the benefits you need to pay for high-quality medical care.

#5. You have been seriously Injured and cannot work for a Long Time

If your damage is persistent or long-term, your medical bills and treatment requirements may be substantial. In these circumstances, your employer or its insurance provider is more likely to attempt to lower your benefits so that they do not have to pay exorbitant fees. When you are unable to work due to a permanent or major injury, you should not have to worry about finances. A workers’ compensation attorney can help you get the long-term benefits you deserve.

#6. You might be able to make a Claim against a Third Party.

Employers are protected from legal claims as part of the workers’ compensation program. However, in other situations, legal claims may still be warranted. If your injuries were caused by a defective piece of machinery, you may be able to file a claim against the maker of that machinery. Because civil actions can seek both economic and non-economic damages, they may result in greater settlements. In certain circumstances, an expert workers’ compensation attorney can advise you on the best course of action.

#7. You may experience Workplace Retaliation because you have been Injured

If you submit a workers’ compensation claim and your employer appears to be retaliating against you, you should consult with a workers’ compensation attorney as soon as possible. This retaliation could take a variety of forms, such as lowering your hours, demoting you, harassing you, terminating your employment, or engaging in other retaliatory behavior.

When an employer retaliates against a worker for exercising their rights and filing a workers’ compensation claim, the company is breaking the law. Hiring a workers’ compensation lawyer can assist you in righting the wrongs caused by company retribution following a workplace injury.

#8. You and your Employer do not Agree on your Ability to Work

Your employer or their insurance carrier may claim that you are able to return to work with restricted work obligations in order to minimize, reduce, or suspend your benefits. If you disagree or believe you may be unable to return to work due to the severity of your injury, a workers’ compensation attorney can analyze your case and submit evidence of your critical medical condition. When you choose skilled attorneys, you can rest assured that you will not be without a job or benefits.

#9. Your Employer Tells you that you are not on Workers’ Compensation

A limited minority of workers are not eligible for workers’ compensation. Contact an attorney if your employer claims you work as an independent contractor and hence do not qualify for workers’ compensation, despite the fact that you execute the job obligations of a full-time employee. An attorney can examine your employment contract and field of work to see whether you are eligible for benefits.

#10. Your Employer has failed to Provide Workers’ Compensation Insurance

Employers in Pennsylvania are required by law to provide workers’ compensation coverage to all qualified workers. Even in tiny and non-profit organizations, this is true. Employers can meet this insurance requirement by self-insuring or by working with an insurance carrier.

If your company has let your insurance lapse or has never obtained insurance for you as required by law, you may still be eligible for benefits from the Uninsured Employer Guaranty Fund. Consult with an attorney to learn about your alternatives.

#11. You do not Understand the Process of Workers’ Compensation

If you are new to the process of workers’ compensation, it can be scary. You may have concerns about how to complete our documents, your rights, what you can and cannot say about your settlement, and other issues. Even in the best-case scenario, a knowledgeable attorney can assist you with all of these worries.

#12. You’ve been Charged with Fraud

Workers’ compensation fraud occurs when an employee obtains pay while also obtaining entire or partial disability benefits that exceed the maximum allowable for their situation. While workers’ compensation fraud is a serious threat, you should not be denied benefits if you have been injured on the job. If your employer or their insurance company claims you aren’t truly injured or are attempting to scam the system, you should contact a workers’ compensation lawyer.

#13. Your Employer Dissentions or Disputes a Decision made by the State Workers’ Compensation Division

You may not obtain your due benefits if your employer and insurer try to avoid honoring a decision made by the workers’ compensation division or a judge. Consider hiring a workers’ compensation attorney to defend you as you traverse the legal steps required to get your workers’ compensation.

#14. Your Employer or its Insurance Company Requests an IMEor other Evaluation after Recieving Benefits for Sometime

Even if you have been authorized for benefits, your employer or its insurance company may want to have you reevaluated to see if your injury has improved. An independent medical examination (IME) may be performed by a business doctor to demonstrate that your injury no longer exists or is less serious.

An IME is frequently used as a prelude to terminating, decreasing, or eliminating your benefits. If you are asked to submit to additional tests or a labor market study, get legal counsel to guarantee that your benefits are not lowered or terminated unfairly.

#15. You don’t know what could Impact your Claim

Many minor details can jeopardize your claim. Innocent pictures you publish on social media can be used against you. If you post a photo of yourself at a particular event on social media, insurance companies may claim you are not as injured as you claimed. A workers’ compensation lawyer can counsel you on seemingly insignificant situations that could jeopardize your claim. They will train you on how to build your claim instead. In many cases, injured workers do not even consider these difficulties.

#16. You are or will be eliible for Medicare within the Next 30 Months

Your settlement may be sent to Medicare if you file a workers’ compensation claim and are Medicare-eligible. You may enter into a Workers’ Compensation Medicare Set-Aside Arrangement in certain circumstances (WCMSA). A WCMSA allocates a portion of a workers’ compensation settlement to fund future medical expenditures related to your job injury. The assigned portion of a WCMSA must be used up before Medicare will pay for your occupational injury treatments.

Unless you proceed with caution, Medicare may deny part of your medical bills. A workers’ compensation lawyer can work with you to ensure that your medical expenses are paid. They will also ensure that any arrangements benefit you as much as possible.

#17. You may Require Medical Treatment Long after Your Injury

Some injuries will necessitate lifelong care. If you were injured at work and required amputation, you may need to change your prosthetic on a regular basis for the remainder of your life. You must verify that your settlement includes these additional fees. An attorney can analyze your case and your injuries to help you determine how much money you will need to cover all of your present and future medical expenses.

#18. Medically, your Injury is Difficult to Quantify

Some injuries are quite obvious. If you have a crushing injury, a serious laceration, or require surgery, it may be simple to demonstrate that you have been severely harmed. Other injuries are more difficult to prove. You may be unable to work if you have undergone serious mental stress as a result of your injury. Medical examinations might make it difficult to quantify the impact of trauma. Soft tissue injuries can also be difficult to prove because they are not always visible on X-rays. A workers’ compensation lawyer can make certain that you are evaluated by certified professionals who can provide compelling medical evidence concerning your injury.

Read Also: Compensation Plan: Best United States Practices (Updated)

When a Workers’ Compensation Lawyer Isn’t Required

If you sustain a small injury at work that cures entirely with treatment, you generally won’t need to contact a lawyer. Insurance companies are unlikely to contest claims that include:

  • Involve plainly work-related injuries
  • Do not necessitate substantial medical treatment
  • It doesn’t necessitate extended amounts of time away from work, and
  • Do not result in permanent injuries

Assume you sprained your ankle after slipping on some water in the break room. Your doctor advised you to apply ice to your ankle, take pain medicines, and rest for a few days. However, because you work at a desk job, you were able to return to work quickly, and your ankle healed in a few weeks. In this situation, your doctor’s visit would be covered. However, because you were only out of work for a few days, you are unlikely to get pay loss compensation in most states.

How a Good Workers’ Compensation Lawyer Can Help Your Case

Hiring a committed workers’ compensation attorney will greatly improve your chances of receiving the benefits you deserve. The lawyer will interact 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.

Fortunately, a workers’ compensation attorney can do a number of things to tip the balances in your favor.

#1. Create Medical, Vocational, and Other Proof

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

  • collecting medical records
  • organizing or advocating therapy with specific doctors
  • seeking medical opinions from your current doctors and conducting an independent medical evaluation
  • representing you at a deposition when you’ve been asked to appear and answer questions, and
  • conducting medical expert depositions

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

  • testimony from a vocational expert regarding the physical requirements of your employment
  • remarks about your daily activities from friends and relatives, or
  • evidence demonstrating your employer’s track record of inadequate workplace safety or a lack of training

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

#2. Negotiate Settlement Agreements

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

  • The nature of your injuries and the resulting limits in your ability to do work
  • your previous medical expenses, as well as the cost of future medical treatment
  • whether you have long-term disabilities and, if so, how severe your permanent disability is
  • whether your company owes you money for prior temporary incapacity (wage loss) benefits and late payment penalties, and
  • your prior earnings

Lawyers are familiar with insurance companies’ negotiation strategies, which range from low-ball proposals to phony “final offers” that aren’t. A workers’ compensation lawyer, with few exceptions, is more likely than applicants working alone to participate in fruitful talks with insurers.

Your attorney can also make certain that your settlement agreement is correctly prepared in order to avoid bad ramifications later on. For example, if you are receiving or filing for Social Security disability payments, a poorly constructed 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 fair estimate of your future medical bills so that the settlement agreement can account for them.

While it is true that workers’ compensation judges must accept settlements, it is not prudent to rely on the judge to fully safeguard your interests. A lawyer is vital in settlement negotiations.

#3. Represent You at a Workers’ Compensation Hearing or Trial

If you are unable to negotiate a settlement, 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). They 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.

#3. Provide you with information about 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 carelessness caused or contributed to the damage. Third-party lawsuits frequently target drivers and manufacturers of defective equipment. A personal injury claim may be more valuable than a workers’ compensation claim since damages might include pain and suffering as well as lost earnings potential.

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

Is it Worthwhile to Hire a Workers’ Compensation Lawyer?

Workers’ compensation attorneys do not bill on an hourly basis. Instead, they charge a contingency fee, which is a portion of whatever workers’ compensation payments you obtain. Furthermore, many states limit contingency fees in workers’ compensation disputes. The proportion varies from state to state, although it is often between 15% and 25%. However, in some states, the cost might be as low as 10% and as high as 33%.
When you hire a workers’ compensation lawyer, you are significantly more likely to receive a substantially greater settlement offer. Lawyers understand the law, how to bargain, and can utilize a variety of techniques to help you establish your case. As a result, even after the workers’ compensation lawyer cost, you will most likely gain greater benefits if you hire a lawyer.

When Should You Consult a Workers’ Compensation Lawyer?

You may be permitted to represent yourself if your workers’ compensation claim is short, clear, and low in value. However, there are a few occasions in which employing a lawyer is essential, such as if:

  • You don’t have a lot of medical data to back up your claim.
  • You have a high-value claim or you have sustained serious, long-term injuries.
  • Your employer contests your claim
  • You’re undecided about accepting a settlement, or
  • Your claim has been refused, and you must file an appeal.

If any of the following apply to you, you should call an expert workers’ compensation lawyer right once.

Lawyer Workers Compensation FAQ’s

Is it worth getting a workers comp attorney?

If your injuries are not clearly work-related, necessitate extensive medical care, necessitate extended time away from work, or result in permanent impairment, you should contact a workers’ compensation lawyer. Not every wounded worker will require the services of an attorney.

How much does it cost to hire a workers compensation lawyer?

The majority of workers’ compensation lawyers are compensated between 10% and 20% of a settlement or award. Workers’ compensation cases are similar to personal injury cases in that most lawyers work on a contingency fee basis. When you are awarded damages or a settlement, your lawyer is paid a predetermined portion of the money you recover.

What disqualifies you from workers comp?

Workers’ compensation claims are frequently denied by insurers if the employee’s explanations regarding how the event occurred are inconsistent. If you tell your boss that the accident happened one way but tell your doctor that it happened another, it will weaken your case.

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