February 11, 2020

When do you need a Work Injury Lawyer?

When do you need a Work Injury Lawyer?

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John Metz, AttorneyNot every injured worker will need to hire workers compensation attorney. After all, the workers’ compensation system is an administrative process, not a lawsuit and there is no jury trial. Simple first-aid claims are relatively easy for workers to navigate. If you have a straightforward claim that is not being disputed by your employer or its insurance company, that does not result in any permanent work restrictions, lost time from work, or need for future medical care, you probably do not need a lawyer. Unfortunately, the process is not always that simple. Many injured workers will need to hire a workers’ compensation lawyer if there is any dispute or complexity to the case.

In some circumstances, an employee who suffers an injury at work can make a claim outside of workers’ compensation. In those cases, a work injury or employment lawyer referral should be made to handle that aspect of the case as that will be litigated in a different court system. For example, if you were injured as a result of a negligent third-party in a traffic collision while working or if you’re the victim of sexual harassment or wrongful termination, you can usually sue your employer or the third party that caused your injury in court for a workplace injury.

When a Work Comp Lawyer Isn’t Necessary

If you suffer a relatively minor injury at work that completely heals with treatment, you probably won’t need to hire a lawyer. Insurance companies are unlikely to dispute claims that:

  • involve injuries that are clearly work-related like first-aid claims
  • don’t require extensive medical treatment
  • don’t involve long periods of time off work, and
  • don’t result in permanent injuries are permanent impairments or work restrictions.

When a Workers Compensation Lawyer Is Typically Necessary

Any time you’re in a dispute with the insurance company, you should consider hiring a lawyer to represent you as Worker’s Compensation rules are complex and arcane. You will need to gather medical evidence in order to challenge the insurance company’s position, which may include taking depositions, requesting a qualified medical evaluation QME, and hiring expert witnesses, all of which require legal knowledge and skill of a local Worker’s Compensation.

Here are some examples of when you’re going to need an experienced local work injury lawyer:

Your claim is denied. Worker’s Compensation Insurance companies deny workers’ compensation claims for a variety of reasons. For example, the work comp insurance company might claim that your injury wasn’t work-related or that you filed your claim too late or there is no substantial medical evidence that you sustained a work injury. You can appeal the denial through the workers’ compensation system. An experienced workers compensation can guide you through this process and come up with a plan for the best outcome based on the circumstances of your work injury case. Your work injury lawyer will file the necessary formal paperwork, use legal tools to gather medical evidence, and present your case at a mandatory settlement conference or other type of hearing at the WCAB, the Worker’s Compensation appeals Board.

Your permanent disability PD rating is disputed. The majority of most workers’ comp settlements and awards are for permanent partial disability benefits based on the impairment your primary treating physician or qualified medical evaluator QME report calculates based on your impairment which translates to your permanent disability rating. If the insurance company doesn’t agree with the rating assigned by your MPN primary treating doctor, it can require you to attend a qualified medical examination (QME). If you pick the wrong QME doctor, will likely result in that physician assigning a much lower disability rating favoring the insurance carrier, which the insurance company will use to justify paying you less in benefits. A workers compensation lawyer can be essential to getting you a fair settlement by providing the necessary input and knowledge into selecting your qualified medical evaluator QME or convincing a judge that you are entitled to benefits and permanent disability PDA.

You have a preexisting condition. If you have a preexisting injury or condition involving the same body part you injured at work, you’ll be facing an uphill battle with the workers compensation insurance company. The insurance company will likely blame your injury on your previous condition rather than your work activities. This is called apportionment. This is especially true if your injury has developed slowly over time, rather than during a single work accident. Remember, your wages paid for your time and effort, not your body parts so if you have wear and tear injuries, remember to mention this to your lawyer about repetitive stress injuries or cumulative trauma claims from continuous work duties that have injured you over time.

You’re having trouble getting the treatment you need. Insurance companies often deny or delay in approving any medical treatments or prescriptions, such as surgery. The workers compensation insurance carrier does not care if you recover from your injuries or not. A work injury lawyer can handle all of your IMR, independent medical review appeals when the insurance company denies your medical treatment requests through utilization review (UR). Picking the right doctor in the medical provider network(MPN) is critical. A local workers compensation attorney should be familiar with all the qualified medical evaluators and primary treating physicians within the medical provider networks in your geographic area

Your ability to work has been affected. If you can never work again, you’ll need to maximize your workers’ comp benefits and structure them in a way to last well into the future. If you need to change careers, you’ll need to secure job training in a new line of work often called vocational rehabilitation. A work injury lawyer can help you do both.

You’re receiving other government benefits. If you’re receiving Social Security Disability Insurance (SSDI) benefits, these benefits may be reduced if you receive workers’ compensation benefits. A lawyer can help you minimize how much your SSDI benefits will be reduced or offset by way of a Hartman formula.. If you are eligible for Medicare, you may also need to set aside a portion of your workers’ comp benefits to pay for future medical treatment. A workers compensation attorney can help you do this in the most beneficial way as an experienced local work injury lawyer will know how to structure your settlement that is most advantageous to you.

You are having a workers’ comp hearing. If the insurance company refuses to settle—or only makes lowball settlement offers—you’ll need to go prove your case at a hearing. Because this is like a mini-trial, you will almost certainly need a lawyer to represent you. If you have a WCAB court date pending, I recommend you contact the work injury attorney immediately.

Is a Work Injury Lawyer Worth the Cost?

Workers’ compensation lawyers don’t charge in the typical hourly fashion. Instead, work injury attorneys charge a contingency fee: a percentage of any workers’ comp benefits they help you recover. In California, the fees are regulated and have to be approved by the Worker’s Compensation judge in your case, fees are generally capped at 15% and have been that way since about 1992.

You’re likely to get a much higher settlement offer when a work injury lawyer is involved. Work injury lawyers understand the law, know how to negotiate, and can use various tools to build up your case. An experienced lawyer will likely know the work comp adjusters, the defense attorneys, the judges and you will benefit by this experience. Because of this, you will probably receive more in benefits if you hire a local work injury lawyer, even after the lawyer takes his or her fee.

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