Workers compensation is an insurance program that works well in certain cases where the worker is only moderately injured and has a good prognosis of returning to work in the near future. Some workers may need to transfer positions when the company is agreeable, but returning to gainful employment is typically a primary goal for both the company and the injured worker.
The system is designed to help the worker receive medical attention as soon as possible while protecting the employer from an expensive personal injury lawsuit for long-term general damages. This is the trade-off in the system when it is used properly.
However, employers are still often hesitant to place a worker on workers compensation because it impacts their continuing policy premium rate in many instances, Instead, they will either attempt to pay the worker outside of the system or put them on a different “light duty” position.
Alternately, some employers actually terminate the employee immediately when they can prove use of alcohol or drugs while on the job. When any of these types of situations arise, it is vital to retain an experienced workers compensation lawyer because the employer’s decisions are not necessarily acceptable and can require doctor approval or other medical evaluation.
Here are some questions that many potential claimants ask legal counselors when seeking representation.
Is there a retainer fee?
A workers comp attorney will typically take cases by a contingency fee arrangement based on the total amount of compensation they can obtain from the employer. This fee percentage is generally covered by state law, but additional expenses can be collected for costs generated in the process of building the case. A workers comp lawyer should state the percentage up front in the first free consultation when there is no initial retainer fee.
Does it matter if the injury was my fault?
There is no direct yes or no answer to this question, as certain case facts in certain states can justify a claim denial. Drug use is a typical reason for a denial. However, the system is designed as a “no fault” system for the most part that makes it very difficult for an employer to accuse the employee of injuring themselves, and especially intentionally. However, intentional self-injury does occur, and this can be used as a defense when it can be proven in some cases.
What benefits are available?
The insurance company providing employer coverage will determine what benefits they will pay, but the typical coverage is for medical treatment bills and lost wage recovery when the employee is unable to work in any capacity. Some employers will sometimes assign employees alternate job responsibilities, but this is relatively rare unless the situation allows it.
Injured workers must be unable to work for seven consecutive days, and lost wage recovery is retroactive to the date of the injury occurrence. Employees are not taxed for their insurance payments, but they are paid at a reduced rate of pay in most situations to offset the amount. The income is not considered “earned” income.
Can I file a personal injury lawsuit?
This is the most important question that most injured workers have when discussing the case with a workers comp lawyer. Lawsuits are usually not available when the employer has not contested the case and placed the injured worker on standard workers comp.
However, negligence can still be a factor if employers are breaking OSHA rules and regulations or forcing workers to work in illegal or unsafe conditions. This can apply in both contracted and implied non-contracted employment arrangements, including both collective bargaining agreements and individual contracts. The primary issue will be long-term general damage claims for ongoing life problems which are not included in standard workers comp claims.
Ultimately, most cases will not include a personal injury suit, but can still include a bad faith tactic lawsuit against an insurance company as a punitive financial recovery option. The success rate for these claims depends on the material case factors regarding employer or provider behavior both before and after the claim is filed.
What if the injury is debilitating?
This is also another serious situation where legal counsel could well be necessary. Disability benefits could be available in some situations from the employing company, but usually Social Security benefits could be an additional benefit to any workers comp insurance claim.
Injured workers who are permanently injured can be eligible for disability benefits through the Social Security Administration after six months of being unable to work. This time period is often covered by a short-term disability insurance program as well, both of which can require legal representation for full benefit payment. This is especially true for SSA disability insurance claims, as short-term disability is carried by the employer when it applies.
Do I really need a lawyer?
Absolutely, unless the case is simple. There are some workers comp cases that are relatively simple and uncontested. But, anytime there is serious long-term injury or there could be a potential legal action, even if it is with the state workers comp board, legal representation will be a real advantage and true necessity in some cases.
This especially applies when there could a general damages liability case for long-term impact resulting from the injury. Insurance companies know they have the upper hand when a claimant has no legal counsel, and they can be ruthless when denying claims even when they have already begun paying benefits.
There are multiple reasons an insurance provider can use to deny a claim even during the process of regular payments, and it always takes aggressive legal representation to keep them honest.
Always remember that is usually costs nothing to speak with a workers comp attorney because most legal professionals who are dedicated to workers comp financial recovery practice exclusively in the legal field. The right attorney will be focused on recovering as much general damage awards as possible, and will conduct the due diligence investigation into material case facts that will lay out total benefit or damage award potential.
And, the first meeting is usually a free consultation.