When to Hire a Workers' Comp Attorney

Hiring a lawyer can greatly improve your chances of winning your workers' comp claim. Unless your claim is very low value or straightforward, hiring a workers' comp attorney usually makes sense.

If you have suffered an injury at work, you might be eligible for benefits through your state's workers' compensation system, commonly known as "workers' comp." You must notify your employer about your injury, and then file a claim with a state agency or your employer's insurance provider. You might be wondering whether you need to hire a workers' comp attorney to help with your claim. This depends on the particular issues presented by your claim. The more complex or difficult your case, the more help a lawyer can offer you.

When You Might Not Need a Workers' Comp Lawyer

A lawyer is not necessary for every workers' comp claim. If every item on this list applies to you and your claim, you might not need an attorney:

  • You have no pre-existing condition that affects the injured area, such as a knee injury that occurred before you hurt the same knee on the job;
  • Your injury was minor and did not require medical attention beyond first aid;
  • Your employer acknowledges that your injury was work-related; and
  • The injury did not cause you to miss work for longer than a day or two.

A workers' comp claim that meets this description is not likely to run into complications, although something unexpected could always happen.

When You Should Hire a Workers' Comp Lawyer

A workers' comp lawyer can help you understand the claims process and your rights. They can be particularly helpful when your employer or their insurer is resisting your claim. The following are some of the circumstances where a workers' comp lawyer can help.

Your Workers' Comp Claim is Denied

It is not at all uncommon for insurers to deny valid workers' comp claims. Advocacy by an attorney might result in the insurer reversing their decision and approving benefits.

It might be necessary to present your case at a hearing before an administrative law judge or other officials. A workers' comp attorney with experience arguing cases could greatly improve your chances of success. Judges often send disputed claims to mediation, where an attorney can advocate for your interests with the mediator.

Your Employers Denies that Your Injury Was Work-Related

Workers' comp benefits are only available for injuries suffered on the job that are related to the injured person's work responsibilities. A delivery driver who suffers injuries in a car accident while making deliveries would probably qualify for worker's comp benefits. A construction worker who is injured while "horsing around" on their lunch break, however, might not be eligible.

Employers fund workers' comp systems in most states through payroll taxes. The more successful claims an employer's workers make, the more that employer will have to pay into the system. This leads some employers to dispute that an injury was work-related, even if it was. A workers' comp attorney can help you present evidence to show that the injury was related to your job.

You Have a Pre-Existing Condition

A pre-existing condition affecting the injured area can make it difficult to prove how much damage was the result of the work-related injury, and how much was already present. This could lead to fewer benefits than you should receive, or denial of benefits altogether.

The Insurance Company Is Disputing Your Permanent Disability Rating

Many workers' comp claims seek permanent disability benefits. Part of this process involves a rating system in which your doctor states the extent of your impairment as a percentage. This could be the percentage of impairment in a particular body part or the entire body.

If the insurer disagrees with your doctor's rating, it can choose its own doctor to conduct another medical examination. This doctor might conclude that your disability rating should be lower, which would result in fewer benefits. A lawyer can argue for the higher rating before a judge.

You Cannot Get Medical Care that You Need

Denial of insurance coverage for necessary medical care is, unfortunately, a regular occurrence in our society. Workers' comp insurance is no different. An attorney can advocate for the insurer to approve coverage for the care you need.

Your Settlement Is Not Enough to Cover Your Medical Bills

If you have a settlement offer from your employer, but you do not think it will be enough to pay for your medical care, a workers' comp attorney can get your employer back to the negotiating table or take your case before a judge.

Your Employer Retaliated Against You

Workers' comp laws prohibit employers from retaliating against employees for filing claims. Your employer cannot fire or demote you, cut your pay or hours, or take any other adverse action against you for taking any action allowed under the law.

You Cannot Return to Work at All Because of Your Injury

If your injury is so bad that it prevents you from returning to your previous job, or returning to any job at all, your workers' comp case is likely to be complicated. You will need to claim permanent partial or permanent total disability, and you can almost certainly expect resistance from your employer or the insurer.

You Intend to Apply for Social Security Disability or Medicaid Benefits

Receiving workers' comp benefits will affect your eligibility for Social Security disability benefits and Medicaid. It is possible, however, to structure a workers' comp settlement in a way that minimizes its impact on your eligibility for other benefits.

Your Employer or Someone Else Caused Your Injury

Workers' comp systems provide benefits for work-related injuries regardless of fault, usually in place of filing a lawsuit. If a third party was responsible for your injury, however, you might be able to file suit against them. You might also be able to sue your employer if they intentionally injured you. A lawyer with knowledge of your state's workers' comp laws can help you understand your rights.

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