If you’ve suffered an injury on the job that’s left you unable to work, you may need to contact a workers’ compensation attorney right away. Luckily, our team at The Fakhouri Firm Accident and Injury Lawyers is here to help.
Between us, we have years of experience fighting cases just like this, and we’ll help guide you through this case all the way from claim to comp.
We can help you maximize the benefits you are able to recover after your injury, and we can also explore your options for a separate third-party claim against any negligent, non-employer parties.
To schedule a free initial consultation to discuss your case and the types of benefits or damages you may have been entitled to, simply call 312-999-9990 or contact us online today.
How Having a Workers’ Compensation Attorney Helps
If you’ve been injured on the job, you may be entitled to worker’s compensation benefits.
Workers’ compensation lawyers represent employees who have suffered work-related injuries, illnesses, or disabilities. Their goal is to help clients obtain medical care, reimbursement of lost wages, and compensation for any permanent disabilities.
They know the ins and outs of workers comp law and will fight insurance companies on your behalf.
Most work-related injuries and illnesses are covered under workers comp, including injuries from slips and falls, repetitive stress injuries, respiratory diseases, and stress claims. The key is that the injury or illness must arise out of (and occur within) the course of employment.
If your employer claims your injury isn’t work-related — or is trying to deny your benefits — that’s when it’s time to call a worker’s compensation lawyer.
When To Call a Workers’ Compensation Lawyer
The workers’ compensation process can be complicated. A qualified personal injury lawyer knows how to gather medical evidence to support your claim, challenge unfair denials, and negotiate the maximum settlement in the shortest time.
They can also take your case to court if needed.
While every situation is different, here are a few signs it may be time to hire a workers compensation attorney:
- Your employer denies your claim or cuts off benefits
- Your doctor says you have a permanent disability, but your employer or their appointed examiner disagrees
- You’re unable to return to work after 12 weeks of benefits
- Your employer retaliates against you for filing a claim
- You receive a low settlement offer that won’t cover your needs
What Is Workers’ Compensation?
Workers’ compensation provides wage replacement and medical benefits to employees injured in the course of their work duties. It’s a form of insurance paid for by employers to protect both parties.
As an employee, you don’t have to prove negligence to qualify for benefits. You only need to show your injury occurred during the course of your normal work responsibilities.
Some of the injuries and illnesses that may entitle you to workers comp include:
- Traumatic injuries like broken bones, burns, head injuries
- Repetitive stress injuries such as carpal tunnel syndrome
- Occupational diseases from long-term exposure to hazards
The claims process begins when you report your injury to your employer and then see an authorized physician. Your employer’s insurance carrier will review your claim and may dispute it or reduce your benefits. This is where an attorney comes in.
A workers’ compensation lawyer advocates on your behalf to maximize the chances that you receive fair benefits. They can help prove your claim is legitimate, ensure proper medical treatment, and fight denials or reductions.
While the system can be navigated without an attorney’s help, insurance companies will have the upper hand. A lawyer levels the playing field and maximizes your benefits.
Denied Claims and Appeals: When to Get Legal Help
If your workers’ compensation claim has been denied, it may be time to consult with an attorney. Legal counsel can help you determine if you have grounds for an appeal and guide you through the appeals process.
Appealing a denied claim typically involves presenting new evidence to support your case or arguing that the insurance company did not evaluate your claim properly. An attorney who specializes in workers’ compensation law will know what constitutes valid new evidence and the proper procedures for submitting an appeal.
They can review your claim details, medical records, and the insurance company’s reason for denial to build a strong appeal on your behalf.
Some common reasons for appealing a denied workers comp claim include:
- The insurance company disputed the cause of your injury or illness. Your attorney can obtain statements from doctors and witnesses to prove your condition is work-related.
- The insurance company claimed your injury did not require medical treatment or time off work. Your attorney can provide medical records and statements showing how your injury impacted your ability to work.
- Lack of communication or misunderstanding. Sometimes, claims are denied due to missing information or confusion. Your attorney can ensure all the necessary details and documentation are included in your appeal to clarify the situation.
- Unreasonable denial. If it is clear your claim should have been approved based on the details, your attorney can argue the insurance company’s denial was unjustified. They can put pressure on the company to reverse their decision.
While the appeals process can be complicated, an experienced workers’ compensation attorney has the knowledge and resources to give your claim the best chance at approval. If your claim has been denied, don’t delay — consult with a lawyer regarding your legal options as soon as possible.
The sooner you start the appeals process, the better.
Loss of Wages and Permanent Disability Benefits
Permanent disability benefits provide compensation for long-term loss of ability to earn wages. The amount of benefits will depend on the severity of your disability and occupation.
If your employer denies your claim for these benefits or does not agree with the disability rating, a workers comp lawyer can help negotiate a fair settlement and take the claim to trial if needed.
In some cases, workers comp claims become complex. For example, if there are multiple employers or if the injury aggravates a prior condition.
Legal counsel can help navigate complicated claims, review medical records, and determine who is liable.
While one of the main reasons to hire a workers comp attorney is if your employer denies or undervalues your claim for workers’ compensation benefits, you should also consider legal counsel if your employer terminates or demotes you after filing a workers comp claim.
Retaliating against an employee for filing a claim is illegal. An attorney can take actions like filing a wrongful termination lawsuit to protect your rights.
Medical Expenses Covered by Workers’ Compensation
If you have suffered an injury or illness due to your job, workers’ compensation should cover all reasonable and necessary medical treatment related to your claim. This includes hospital stays, surgery, physical therapy, medications, travel costs to receive treatment, and other medical care recommended by your doctor.
The insurance company is obligated to pay for medical care that is deemed medically necessary to treat your work-related condition.
However, the insurance company can deny specific treatments or tests if they believe they are excessive or unrelated to your work injury. In these cases, you have the right to appeal the decision.
In addition to medical treatment, workers’ compensation may provide benefits for temporary or permanent disability if your injury prevents you from working. Disability benefits are calculated based on your average weekly wage and the severity of your disability.
When Your Employer Disputes Your Claim
Disputes typically arise when an employer believes an injury is not work-related or that you are not entitled to the benefits you are claiming.
To dispute a claim, your employer must provide clear and convincing evidence that contradicts your account of events or your physician’s diagnosis and recommendations. As your legal counsel, an attorney can obtain all medical records and opinions supporting your claim to seek to build a strong case.
If a dispute cannot be resolved through initial petitions, the claim may proceed to mediation, arbitration, or, in exceptional circumstances, trial. An attorney can negotiate a fair settlement with your employer to avoid time-consuming (and costly) legal proceedings.
They will advise you on any settlement offers and ensure you receive appropriate compensation for your injury and losses.
Deadlines and Statutes of Limitations for Filing Claims
Each state has statutes of limitations that determine how long you have to file a claim to receive benefits and coverage of medical bills. Missing these deadlines could result in the denial of your claim.
In most states, you have a limited amount of time from the date of your injury to report it to your employer and file the appropriate claim forms. This is typically between 30 to 90 days.
Your employer is then required to report the injury to their workers’ compensation insurer within a certain number of days as well. Failure to promptly report the injury and file a claim could jeopardize your ability to receive benefits.
If your claim is denied by the insurance company, you have the right to appeal. However, there are also strict deadlines for filing an appeal, which are usually a few weeks from the date of the denial notice.
Workers’ Compensation Law on a National Level
Workers’ compensation law aims to provide wage replacement and medical benefits to employees who are injured or become ill on the job. Each state has its own workers’ compensation program, but there are some overarching principles that apply nationwide.
The Federal Employees’ Compensation Act (FECA) covers federal government employees and provides wage loss compensation, medical care, vocational rehabilitation, and survivor benefits for work-related injuries or illnesses.
FECA also sets some standards and limits on compensation that most state workers’ compensation programs have adopted.
Common Features of Workers Compensation Plans
Most workers’ compensation programs, whether state or federal, share several key characteristics:
- They’re no-fault, meaning benefits are provided regardless of who was at fault for the injury or illness.
- They are the exclusive remedy for workplace injuries, so employees cannot sue their employers for damages except under extreme circumstances like intentional assault.
- They provide wage replacement, medical care, and rehabilitation for employees. The level and duration of benefits can vary significantly between states.
- They require employers to carry workers’ compensation insurance to fund the program. Some employers can self-insure.
- They cover both temporary injuries as well as permanent disabilities. Severe permanent disabilities may qualify for lifetime wage replacement.
Does My Employer Pay For My Workers’ Compensation Benefits Out of Pocket?
The short answer is no: employers are generally required by law to carry workers’ compensation insurance to cover work-related injuries.
Workers’ compensation insurance provides wage replacement and medical benefits to employees who suffer job-related injuries, illnesses, or diseases. Employers pay premiums to an insurance company, which then pays the benefits.
The premiums are based on the employer’s industry and claim history.
Some key points to note:
- Employers must pay for workers’ compensation insurance in most states. It is illegal for employers not to carry coverage.
- Some states allow an employer to be exempt if they have no employees or if they are able to demonstrate adequate proof of financial responsibility. These requirements are strict, and any deviations can open an employer up to liability for failing to provide the needed worker coverage.
- Benefits are paid by the insurance company, in most cases, not the employer directly. The employer only pays the insurance premiums.
- Premiums vary but typically range from 1% to over 10% of an employer’s total payroll costs, depending on the industry and claim history. Higher-risk jobs usually mean higher premiums.
- The insurance company, not the employer, determines claim eligibility and benefit amounts based on state laws. Employers have no direct control over claim approvals or denials, although they can affect the facts officially stated on the claim, such as whether the employee was technically working.
- Employers cannot be sued by employees for work-related injuries in exchange for the benefits provided by the insurance under most circumstances. This is known as the “exclusive remedy” provision.
What If My Employer Never Secured Workers’ Compensation Insurance?
If your employer fails to secure workers’ compensation insurance, you may still be entitled to benefits. While workers’ compensation laws require most employers to carry insurance, some companies are non-compliant and operate without proper coverage.
If your employer is found to be uninsured, they can face significant consequences such as fines, criminal charges, and lawsuits. However, this process can take time.
An attorney can help ensure your rights are protected so you receive wage replacement, medical care coverage, and other benefits in a timely manner.
Work With an Experienced Workers’ Compensation Law Firm
Whether you’re filing an appeal or your very first claim, it’s always going to be in your best interest to secure the help of a qualified workers’ compensation attorney.
At The Fakhouri Firm Accident and Injury Lawyers, we’re here to help. To schedule a free initial consultation to discuss your case and the types of damages you may have been entitled to, simply call 312-999-9990 or contact us online today.