Workers’ Compensation Lawyer: When Do I Need One? Sep 2024

How Does a Workers' Compensation Lawyer Fit Into the Workers’ Comp System?

The workers’ compensation process is a highly regulated insurance system. Employers in 49 states must pay the cost of a workers’ comp policy. In exchange, they become immune from negligence lawsuits from injured employees. Although Texas employers are not required to buy a policy, it still offers legal immunity to those who do.

When a worker suffers an on-the-job injury or occupational illness, the workers’ comp insurer must provide benefits to them. The amount paid by workers’ comp varies by state.

However, all insurers must pay for medical care and partial wage replacement. The main differences among the states involve who can treat the workers and how much they receive in replacement wages.

Some cases involve permanent disability or even death. Workers and their families receive long-term benefits in these cases. Ultimately, the insurer may choose to enter into a lump sum workers’ comp settlement rather than continue paying weekly benefits.

In many situations, this system works as intended. The injury or illness clearly arose from the worker’s job duties, and the insurer agrees to pay the benefits they want. However, the insurer can also deny claims by disputing the worker’s injuries or the treatment they require.

A workers’ comp lawyer has experience dealing with insurers and the regulators who oversee them. When claims or benefits hit a snag, hiring a workers’ compensation lawyer can protect you against insurance companies.

Issues Handled by a Workers’ Compensation Attorney

You will likely have many of the following questions early in the claim process:

• Is my injury eligible for workers’ comp benefits?

• How do I file a claim?

• What benefits will I receive?

• How long do I have to file?

• What is the process if the insurer denies the claim?

One of the easiest ways to get answers is by scheduling a free consultation. Importantly, attorney-client confidentiality applies to this meeting. You should ask any and all questions you may have, such as how much a workers’ comp lawyer charges, and speak freely about your injuries and how they occurred so the lawyer can provide the most accurate legal advice possible

Some issues that may require legal assistance include the following:

Claim Denial

Workers’ compensation is a no-fault system. Insurers must pay claims for all work-related injuries and illnesses whether the employer was negligent or not. However, insurers can still deny claims for many reasons, including that:

• You were not injured

• The injury was not work-related

• The treatment is not reasonable and necessary for your work injury

• You filed a claim for a pre-existing condition

For example, an employer might deny that the chemicals you used at your job, like Roundup pesticide, caused your cancer. As a result, the insurer could refuse to pay a settlement to cover your cancer treatments.

Additionally, insurers can deny claims for specific exclusions provided by the state. For example, many states do not require insurers to pay for injuries resulting from the following:

• The worker’s intoxication

• Horseplay

• Recreational activities, even if they happened during company events

Insurers must give reasons for claim denials. If you receive a denial, a workplace compensation lawyer can review the letter from the insurer and help you develop a strategy for responding to it with medical records and legal arguments.

Claim Settlement Offer

Workers’ comp settlements often occur when you have a permanent partial or total disability. A permanent partial disability will not heal, but it leaves you able to obtain gainful employment. For example, losing a finger in a workplace accident is a permanent partial disability.

A permanent total disability deprives the worker of all ability to earn a living. Brain damage, spinal cord injuries and terminal illnesses can qualify as total permanent disabilities, depending on the circumstances.

In both these cases, you become entitled to long-term disability benefits. Instead of mailing a weekly check, the insurer may make a lump sum settlement offer. Understanding when a workers' comp settlement offer might occur is crucial in deciding whether to accept or negotiate, which is where a workers' compensation lawyer can assist.

Independent Medical Examination

Sometimes, workers’ comp insurers want to verify that you and your doctor have given the full picture of your injuries. In these situations, most states allow insurers to seek an independent medical examination (IME). The IME doctor works for the insurer, not the worker. They provide a report to the insurer to verify or dispute the worker’s injuries.

IME doctors face serious ethical dilemmas since they potentially act against the patient’s interests. The reports these doctors produce become the basis of claim denials and terminations. A workers' compensation insurance lawyer can provide legal assistance and even hire a medical expert to dispute the IME report.

Third-Party Disputes

Some, but not all, workers’ comp attorneys also handle personal injury claims. Although your employer is immune from worker lawsuits for workplace injuries, other parties are not.

For example, suppose that you suffered an injury because an electrical generator malfunctioned and set the job site on fire. In such a case, you may have a claim against the product’s manufacturer.

Talk to your workers’ comp law firm about your claims against third parties. If the firm cannot represent you, the lawyers may refer you to a personal injury lawyer who can handle your third-party claims.

Contact ConsumerShield for a Referral to a Workers’ Comp Attorney

ConsumerShield helps people understand their legal rights and reach a lawyer who can help them. Rather than searching for a “workers' compensation lawyer near me,” contact ConsumerShield for a free case evaluation and a referral to a lawyer to represent you.