Imagine you’re at work and need to move a stack of boxes. Suddenly, pain starts screaming through your shoulder and neck and you can’t even touch, let alone lift, another box.
Whether it turns out to be a pulled muscle or a slipped disc, you’re going to need medical help. That means you’re about to enter the workers compensation maze.
The question is: Who you gonna call?
The first call some people make is to a workers comp lawyer. That’s a great idea, except when it’s not.
Allow us to explain the difference and help you decide when to lawyer up.
The first word of advice belongs to New York City based attorney Barry Janay.
“When I started my practice in 2003, our slogan was, “not all lawyers are created equal,” said Janay, whose broad-based practice includes employment law. “Someone who isn’t experienced in a certain area could end up doing more harm than good.
“Experience obviously matters. If you’re injured on the job, find a local lawyer and talk to him or her about what you can expect to happen in filing your claim. If you’re seriously injured this could be the biggest deal of your life. Workers comp is a high volume business. Find someone who doesn’t treat you like a number.”
Signs You Should Hire a Lawyer for a Work Injury
How your company – or more importantly its insurance carrier – handles your case will determine whether it’s in your best interest to get a lawyer.
Here are 10 signs you need a workers comp attorney on your case.
- Your employer or insurance carrier denies it happened at work. This is often the case when a slight injury happens at work and goes unreported. That injury is aggravated further at work, suddenly becomes serious and the employer/carrier says the original injury didn’t occur at work. This also happens when the long-term effects of exposure to something at work result in a disease.
- Your company drags its feet with your claim. If you’re injured on the job, you should immediately notify your employer and start the reporting process. The company must provide you with the proper paperwork, report your case to the state workers comp board and file a claim with its insurance carrier. Reporting regulations and deadlines vary from state to state, but it should take no longer than 30 days to complete this process.
- If you suffer permanent disability, either partial or total, that will prevent you from ever fully returning to work. Insurance companies are more likely to contest such claims because they are the most expensive.
- Your doctor recommends treatment and the insurance company won’t pay for it. This too is a common practice when an injured worker’s recovery means rehabilitation visits that an insurance company doesn’t think are necessary.
- If the insurance company denies your claim. If you appeal that decision – and you should if you feel your claim is legitimate – this is where things can get complicated and expert advice is needed. “If it gets contentious, if there’s a disagreement, then it’s time to get a lawyer,” said Jeff Branham, a workers compensation lawyer in Florida.
- If the settlement offer doesn’t cover all lost wages and medical bills. Most worker comp settlements are for permanent disability benefits, which are based on a rating system determined by examining doctors. If the insurance company doesn’t agree with the rating, it can require you to get an independent medical exam (IME) by a doctor of its choosing. Chances are that doctor will give you a lower rating than what you (and your sore neck) feel you deserve. A lawyer can help convince a judge you are entitled to a higher rating.
- You have a preexisting condition. If you already had neck problems before lifting that heavy box, the insurance company likely will blame your new pain on that. You’ll need evidence to prove otherwise.
- You plan to file for Social Security disability benefits. Those benefits, known as SSDI, may be reduced by workers comp benefits. A lawyer can structure your settlement to minimize or eliminate the offset.
- Your employer retaliates against you. If you are fired, demoted, have your hours cut or are pressured to return to work too soon, a lawyer can argue the penalties are unwarranted.
- If you have a third-party claim. You can go outside the workers comp system and file a workers comp lawsuit if someone other than your employer contributed to your injury. For instance, if a negligent driver hits you while you are driving for work, you can sue that person for damages.
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Signs You Should Not Hire a Lawyer for a Work Injury
- Your injury is minor and doesn’t require much medical treatment. The workers comp system is specifically designed to handle these types of cases.
- You have a preexisting condition that was aggravated by the accident. Preexisting conditions can complicate your claim, like a neck injury from a car wreck that is inflamed by a fall at work.
- You miss little or no work. This type of claim should be straightforward.
Pros and Cons of Hiring a Workers Comp Attorney
If your work injury is serious and things get contentious between you and your employer or the insurance carrier handling the case, there is no question that it’s in your best interests to at least talk to a workers comp lawyer.
Conversely, if you’re worried about rocking the boat at work or the expense of hiring a lawyer, not calling one could end up costing you a lot more.
Pros of Hiring a Workers Comp Attorney
- Experienced help with navigating workers comp paperwork can prevent errors that might otherwise invalidate your claim.
- You don’t have to deal with insurance companies or issues that might arise with your employer in a contested claim.
- Meeting workers comp deadlines can be challenging depending on your home state.
- Typically, injured workers who hire experienced workers comp attorneys receive more money from their claim.
- If your claim is denied, workers comp attorneys are best suited to handle the appeal.
- Your workers comp attorney has your best interest in mind. Your employer may not.
- Your employer has access to legal support with workers comp claims. Hiring an experienced workers comp attorney levels the playing field for you.
Cons of Hiring a Workers Comp Attorney
“Too many claimants get a lawyer the day after the accident,” said Branham.
There are reasons to be judicious in making the decision to hire a workers comp lawyer.
- If injuries are minor, no workdays are lost and your company is cooperating, you might well handle the claim on your own and avoid the cost of hiring a workers comp attorney.
- If the injury is minor and you don’t project it will cause long-term issues, hiring an attorney could drag out the process.
- Some employers might see a litigious employee as overly aggressive or hold you in a negative light.
- If money is an issue for you – especially if your injury involves lost wages – you might want to avoid the cost. Just know that most workers comp lawyers get paid on a contingency basis, meaning they get paid if they win the case and you get paid. But still, a percentage of your claim will go to paying your workers comp attorney.
- If lost wages are recovered, some workers comp attorneys may get as much as 10% of that award.
The flip side is that an experienced workers comp attorney might well get you a better settlement than you could hope to get on your own.
“The perception of the public is that I can’t afford a lawyer, or it’s going to cause unnecessary delays or the lawyer is going to take too much of my award,” said Judge Neal Pitts, a Judge of Compensation Claims in Florida. “If the case settles for $100,000 with a lawyer or $10,000 without, that’s a no-brainer. And that happens.”
When You Should Get a Lawyer for Workers Compensation
Notifying your employer of a job-related injury is clearly your first best step.
Let’s face it. An employer being informed that you’ve hired an attorney, either before you’ve even reported the injury or at the same time you report the injury, is probably going to scratch you off the company Christmas card list.
After reporting the injury – depending on the seriousness of the accident – it’s typically in your best interest to consult with a workers comp attorney for information and insight into what can be a complicated process.
“Talk to an attorney who can help you navigate the rules of workers comp,” said Janay. “First of all, some people don’t even know that workers comp insurance exists. There are so many things about the laws and how they work that people simply don’t understand.”
As for hiring a workers comp attorney to manage your claim, it’s imperative to do so as soon as you decide to contest the settlement decision (presumably for legitimate documented reasons) if not before.
At that point, workers compensation can quickly turn into a legal jungle of paperwork, deadlines, depositions and evidence gathering. It’s easy to get lost if you don’t know what you’re doing. (And that pain you felt in your shoulders and neck will travel throughout your body.)
“You don’t have to hire an attorney every time you have a claim,” said Tom Holder, a prominent workers comp lawyer in Atlanta, “but you should at least call one and let them explain how the process works and what benefits you are entitled to receive.”
Why You Need a Workers Comp Lawyer
An early consultation with a workers comp attorney can provide helpful information – what size award might your case bring for example – and also give the consulting lawyer a sense of how complicated your particular claim might be.
“Ninety-nine percent of the workers comp cases that come through my door I’ll probably have seen before,” said Janay. “If it’s a particularly complex case, I’m going to partner with someone who only does workers comp law.”
There will be court proceedings before your case is heard by a workers comp judge. A lawyer will file the paperwork on time, build your case, negotiate with the insurance company and draft a settlement, if an agreement is reached.
If it’s not, you’re headed for a hearing. It’s High Noon, and everything will depend on how effective your side makes its case.
An attorney not only will prepare your argument, he or she will prepare you to say the right things in testimony. They’re able to direct you to workers comp doctors. They also will cross-examine the insurance company’s witnesses. That job should not be left up to amateurs.
Unlike civil cases, workers compensation law has a safety net of sort. When an employee represents himself or herself, the settlement is not final until the judge approves it.
They can reject the settlement if they feel it’s not reasonable and the employee is getting a raw deal. But the settlement usually has to be grossly unfair for a judge to reject it.
Workers who hire an attorney typically receive more compensation than those who file a claim without legal representation.
So get a lawyer at the first sign of trouble. You’ve already been injured on the job. You don’t need what follows to turn into a bigger pain in the neck.
Handling a Case on Your Own
We’ve mentioned SSDI and IME, but do terms like AOE/CEO, cumulative trauma, DEU, IIPP, PDRS and WCAB mean anything to you?
Unless you’re an attorney or enjoy reading workers compensation manuals in your spare time (if so, there’s a reason why you’re not getting invited to those cocktail parties and golf outings), probably not.
Handling a case on your own is usually a bad idea, especially since the insurance company will be represented by someone who’s probably handled hundreds of cases.
Even when employees win their appeals, most would have done better with a lawyer arguing their case.
“Way more than half, way more,” Judge Pitts said. “Probably closer to 80%. It’s rare that you get a situation where the employee likes the insurance rep and the insurance rep likes the employee and things work out.”
About The Author
Tom Jackson won dozens of national awards as a columnist for newspapers in Washington, D.C., Sacramento and Tampa. His writing has spread from business to politics to sports with an emphasis on community issues. Tom splits his time between Tampa and Cashiers, N.C. with his wife of 40 years, a college-age son and a yappy Shetland sheepdog named Spencer. Tom can be reached at firstname.lastname@example.org.