If you’re an employee who has suffered a work-related injury or illness, you may be entitled to workers’ compensation benefits. Unfortunately, employers or their insurance companies routinely deny workers’ comp claims, even when they’re legitimate—which leaves injured employees to face a complex system of appeals. At that point, many applicants simply give up, while others try their best to navigate the system on their own.Related Products

The claims adjusters and attorneys working for the insurance company are not looking out for you, and they won’t hesitate to reject your bona fide claim for dubious reasons. Fortunately, there are several things a workers’ comp attorney can do to tilt the scales in your favor.

Hiring a dedicated workers’ compensation attorney will give you a much better chance of obtaining the benefits you deserve. An attorney will communicate with the workers’ comp insurer on your behalf, gather medical evidence that supports your claim, try to negotiate a good settlement, and represent you at your workers’ comp hearing.

The claims adjusters and attorneys working for the insurance company are not looking out for you, and they won’t hesitate to reject your bona fide claim for dubious reasons. Fortunately, there are several things a workers’ comp attorney can do to tilt the scales in your favor.

Develop Medical, Vocational, and Other Evidence

Insufficient medical evidence is probably the most common reason workers’ comp claims are denied. Even if your claim is approved, you’re more likely to receive all of the medical treatment you need—and all of the other benefits you deserve—if you have strong medical evidence that supports your case. An attorney can help develop the medical evidence by:

  • gathering medical records
  • arranging or recommending treatment with certain physicians
  • obtaining medical opinions from your treating physicians and through an independent medical examination
  • representing you when you’ve been requested to appear and answer questions at a deposition, and
  • conducting depositions of medical experts.

There are several other types of evidence that could bolster your case, including:

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

An experienced workers’ comp attorney will understand, based on the strengths and weaknesses of your case, what evidence is needed to maximize the chances of a good outcome.

Negotiate Settlement Agreements

When it’s time to negotiate with your employer’s insurance company to reach a settlement, a workers’ comp attorney has the advantage of being able to estimate how much your case is worth—that is, the amount of benefits you should receive, based on a number of factors, including:

  • the extent of your injuries and resulting limitations in what you can do
  • your past medical expenses, as well as the cost of medical treatment you’ll need in the future
  • whether you have lasting impairments and, if so, the extent of your permanent disability
  • whether your employer owes you for past temporary disability (wage loss) benefits and penalties for late payments, and
  • your previous wages.

Lawyers understand the negotiating tricks and tactics used by insurance companies, from low-ball offers to bogus “final offers” that really aren’t. With few exceptions, workers’ comp attorneys are more likely to engage in productive negotiations with insurers than applicants acting alone.

Your attorney can also ensure that your settlement agreement is properly written to avoid negative consequences down the road. For instance, if you’re receiving or applying for Social Security disability benefits, an improperly designed settlement agreement could cost you hundreds of dollars every month in benefits due to the workers’ compensation offset. An attorney can also help you come up with a reasonable estimate of your future medical expenses, so that the settlement agreement can take that into account.

While it’s true that workers’ comp judges must approve settlements, it wouldn’t be wise to rely on the judge to protect your interests adequately. In settlement negotiations, a lawyer is essential.

Represent You at Your Workers’ Comp Hearing or Trial

If you’re unable to reach a settlement, your case proceeds to an administrative hearing or trial before a workers’ comp judge. During the “discovery” (or investigation) process, your attorney may take depositions of witnesses, request your medical records, perform legal research, write your “pleadings” (petitions, motions, and responses to the insurance company), and make sure that everything is submitted on time. At the hearing, your lawyer will present a “theory of the case” (why you should get benefits) to the judge, make opening and closing arguments, examine witnesses, and raise objections when the insurance company does something improper.

If you’re not satisfied by the result of your hearing, your attorney can help you appeal the decision.

Advise You on Third-Party Claims and Other Potential Benefits

In addition to a workers’ comp claim, you might have a personal injury claim against a third party (someone other than your employer) whose negligence caused or contributed to the injury. Drivers and manufacturers of faulty equipment are frequent targets of third-party suits. A personal injury claim might be more valuable than a workers’ comp claim, because damages can include pain and suffering and loss of potential earnings. (Read more about when you can sue outside of workers’ comp.)

A lawyer can also advise you about your potential eligibility for other benefits, including vocational rehabilitation assistance, wage reimbursement, long-term disability insurance benefitsstate short-term disability, and Social Security disability.

Workers’ Comp Attorneys’ Fees

Most workers’ comp attorneys work under a contingency fee arrangement, meaning they charge no money up front and only get paid if you win your case. Many states strictly limit the amount workers’ comp lawyers can charge, with fees often capped at 10 to 20 percent of your benefits. In addition, attorneys’ fees might need to be approved by the workers’ comp judge or appeals board. (Read more about how much workers’ comp attorneys charge.)

When to Contact a Workers’ Comp Attorney

If your workers’ compensation claim is simple, straightforward, and low value, you might be able to get away with representing yourself. But there are a number of situations in which hiring a lawyer is critical, including if:

  • you don’t have much medical evidence to support your claim
  • your claim is high value or you’ve suffered serious, long-term injuries
  • your employer disputes your claim
  • you’re unsure whether to accept a settlement, or
  • your claim has been denied and you need to appeal.

If any of the above apply to you, dcontact an experienced workers’ comp lawyer right away.