One of the most common questions we get is one you’ve probably been wondering yourself:
Do I have a solid case?
Basically, is pursuing a workers compensation case worth your time and energy? Is your case likely to succeed, either through a settlement or winning in court? Or are you better off biting the bullet and paying your medical bills yourself?
These are tough questions because every injury and every case is unique. Even if you feel like your situation is hopeless and that no one has your back, the right attorney can often provide clarity for the murkiest of cases.
Right now you’re probably feeling frustrated and angry with your employer, their insurance company, and the whole workers comp system that’s designed to protect you, but seems to be leaving you behind.
Before you weigh your options and decide whether or not to pursue your workers compensation claim, let’s examine some crucial information about the whole process that might make your decision a little easier.
Ready? Let’s get to work.
Maybe you didn’t get a reason. Maybe you got a bad reason or an unbelievable reason. But if you’re here, one thing’s for sure—your claim was denied.
One of the biggest reasons most workers comp claims are denied is that they weren’t filed or reported on time.
Workers compensation claims must be reported ASAP, usually within a few days of the injury. Your employer is also responsible for telling the appropriate insurance provider just as fast.
The other common reason for denied claims is simply that your employer is disputing the claim. They may dispute that the accident ever happened at all, that your accident isn’t work related, or that your accident was work-related but your symptoms aren’t related to the accident.
In that case, you’ll need to prove your claim is legitimate. You can do so by gathering witness testimonials and doctor statements.
Unfortunately, employers and insurance companies often look for any reason at all to deny workers comp claims. A denied claim means reducing expenses, and companies are sometimes concerned more with their bottom line than employee well-being.
Next up, let’s take a look at what rights you have as an employee under workers comp laws.
Workers compensation laws vary from state to state, but most afford the same basic rights to all employees.
State Employee Rights: An Example
Here, we’ll use Utah as an example—your state’s exact laws may vary, but should afford similar fundamental benefits.
Anyone in the direct service of an employer, whether working illegally or legally, is considered an employee. That means minors and aliens are also protected by Utah’s workers compensation laws.
Independent contractors, on the other hand, are a little bit different. Independent contractors and their employees/subcontractors are not eligible for workers compensation claims against the business for whom they’re working for—and indeed some businesses mislead employees into working as ‘independent contractors’ to avoid workers comp claims.
However, if these independent contractors become statutory employees—meaning the employer retains the right to supervise and control the contractor’s work—then the contractor may receive the same benefits as a traditional employee.
In some cases, you may even be eligible for workers compensation benefits if you were injured working outside of your home state, but this depends on factors such as reciprocal workers comp agreements between states, time spent out of state, and how soon your injury occurred after beginning work outside the state.
Injuries Typically Covered By Workers Comp Insurance
Accidental employee injuries (not self-inflicted) that occur during the normal course of employment are covered under your state’s workers comp laws.
Covered diseases and illnesses are any that arise during your employment and are directly caused or made worse by your employment.
Here’s the most important piece of the puzzle. Whether your injury or illness happened at work forms the foundation of your workers compensation claim. Every day, people are shocked to find out that—according to their employer—their injury doesn’t count as ‘work-related.’
But how can that be? Let’s take a look at some common situations that happen at work, and how they could affect your workers comp case.
Were you hurt because you broke one of your company’s safety rules? Surprisingly, your claim still likely holds water.
In some cases, breaking company rules (even criminally) doesn’t automatically disqualify you from workers comp benefits. That holds doubly true if the behavior that led to your injury—such as roughhousing near heavy equipment or falling asleep on a tall shelf—was known by your employer, and they still allowed it.
While there are some exceptions (such as self-inflicted injuries), generally misconduct doesn’t prevent you from receiving workers comp.
Illnesses and Diseases
Most diseases and illnesses caused by work are difficult to prove. The exception are environmental diseases, such as asbestosis and black lung triggered by exposure to asbestos and coal dust, respectively.
These environmental diseases have a clear causal agent, and can directly be linked to your workplace.
Loss of Hearing
While it’s commonly accepted by factory and construction workers that some hearing loss is inevitable, that doesn’t mean you have to deal with it on your own.
These types of injuries are clearly work-related, and should be covered by workers comp insurance.
Another assumption many people make is that aggravating a pre-existing condition at work doesn’t allow you to file a workers comp claim.
That’s not true! If you injure your knee and start a new job after it heals, but slip on a patch of ice at work and re-injure your knee, you should still be eligible for workers comp.
If you’ve been traumatized by an event that happened at work—such as a co-worker suicide or severe injury—medical expenses related to your trauma should be covered by workers compensation.
Stress and depression caused by your work environment are also eligible, but these can be tricky to prove. That’s where having an experienced lawyer can come in handy.
Injuries sustained on your commute to and from your normal worksite are usually not covered by workers comp.
However, any injuries you receive traveling for business—such as driving a company vehicle to another job site, or traveling to meet with clients—should be covered.
Lunch breaks are a little tricky. If you’re hurt on your lunch break, you’re usually not eligible for benefits. There are a few exceptions:
Your lawyer can help you navigate the ins and outs of lunch break injuries, and help you figure out if you’re entitled to payments.
Say you twist your ankle at a company softball game, or slip in a puddle of soda at your company Christmas party.
Picnics, parties, you name it—injuries sustained at company functions are usually covered by workers comp.
Work-Related Injury or Not?
Many times we see cases with blurred lines between work-related and not. Proving your injury is work-related is critically important to building a case, which is where experienced attorneys can pay dividends.
In many cases, the letter you receive describing why your claim was denied also includes information on how to appeal the denial. Read this letter very carefully, and write down any appeal deadlines.
First of all, get in touch with your employer or its insurance company to discuss the denial. Sometimes claim denials boil down to incorrect paperwork or clerical errors, and can easily be straightened out. If your employer still refuses to approve your claim, it might be time for an appeal.
In this case, it’s better to speak with an attorney. The appeals process can be time-consuming and difficult without professional legal council. Oftentimes, simply hiring an attorney is enough to convince the insurance company to settle out of court without a lengthy legal battle.
And speak with a lawyer sooner rather than later. Appeal deadlines, like your initial claim deadlines, are very strict. Act fast before you lose your right to appeal.
If you choose to hire a lawyer, you should also meet with the attorney before filing the appeal. Workers comp claim appeals are complicated—if you make a mistake early on, you may lose out on the compensation you deserve.
In fact, one of the biggest reasons honest people lose out on their benefits is because they didn’t hire a professional workers compensation attorney.
Can You Represent Your Own Case?
We never push people to seek professional help if they don’t need it. Let’s go over a few scenarios where you can feel comfortable representing your own case, and a few situations where professional legal help can make all the difference.
When You Can Comfortably Represent Yourself
Most people who go down the path of self-representation do so for a handful of reasons, which have to do with their injury’s severity and how much their employer decides to cooperate.
If your accident meets all of the following criteria—all of them, not one or two—you can feel safe moving forward without a lawyer:
I say it’s important to hit all of these criteria, and I mean all of them. I’ve seen so many heartbreaking cases of workers choosing self-representation when they don’t have an airtight case, and the results are usually not good.
Failing to meet just one of these criteria means your employer’s insurance company can and will find a loophole that lets them off the hook. That means you’re stuck high and dry footing those medical bills, which isn’t pretty—or fair.
But let’s say you don’t have a cut-and-dry injury, and self-representation isn’t an option. When should you seek professional help?
When to Hire a Professional Legal Team
As soon as your case gets too complicated, lawyers become necessary. Consider the following scenarios:
1. Your employer flat-out denies your workers comp claim, OR your benefits are delayed/never show up.
This might surprise you, but insurance companies regularly deny real, honest-to-goodness workers comp claims every day. And why do they do that?
Because they know the game, and they realize many of these denied workers just won’t appeal the claim—they’ll accept the denial and pay for healthcare out of pocket, wanting to avoid the hassle.
And you know what? They’re right. A majority of people who are denied just give up. However, a workers comp lawyer has no up-front cost, but a huge upside once those well-deserved benefits start rolling in.
2. You’re facing retaliation from your employer for filing a claim.
Ridiculous when you think about it, but it happens—demotions, reduced pay, cut hours, shaming, harassment, bullying, and in extreme cases even termination can be direct consequences of filing a workers comp claim.
If you’re facing unfair treatment from your boss because of your injury, you need a workers comp lawyer ASAP.
3. You’re getting Social Security disability benefits.
Poorly structured workers compensation claims could cause a huge portion of your benefits to be leeched away by Social Security. The best lawyers know exactly how to minimize or totally offset this deduction.
4. Your initial settlement offer only covers part of your medical expenses.
Although a workers comp settlement is overseen by a judge, most judges will sign off on any settlement that isn’t criminally unfair to you—meaning you’re probably leaving a lot of money on the table.
Great workers comp attorneys know exactly how much money you need to cover all of your expenses, not just some of them.
5. Your injuries leave you unable to return to your previous job, or any other job.
People who suffered permanent (total or partial) disability due to a work-related injury could be entitled to weekly or lump sum payments to cover lost wages.
As you can imagine, these payments are extremely costly to insurance companies, so they’ll fight you to the bitter end in order to not pay them. If you’ve become disabled, hiring an experienced lawyer is vital to ensure you’re being paid every penny of what you’re owed.
The Professional Difference
Workers compensation attorneys are trained to precisely identify the “worth” of your case, determining how much money you’re entitled to and formulating a plan to get that money.
They’ll also work closely with you to ensure you get the right medical evidence to support your case, rather than relying on the opinions of an initial medical evaluation on the insurance company’s behalf.
Plus, you have to understand that the workers comp system no longer acts as a safety net for injured workers. It’s tilted to the benefit of employers and insurance companies, who maintain vast networks of high-paid lawyers for the express purpose of denying your claim.
Ultimately, whether you choose to self-represent or hire a legal expert is up to you. However, if your case involves any sort of complexity, I urge you to seek professional assistance.
Finding a workers comp lawyer isn’t actually that hard, but taking the first step can be confusing. Let’s take a look at the calling cards of a bright, dedicated attorney, and how you can land the best lawyer for YOUR workers comp case.
Look for Recommendations, Reviews, and Testimonials
With many lawyers relying on word of mouth to get referrals, the best place to start your search is with family, friends, or colleagues.
Attorneys who handle cases will have no shortage of happy clients. Another great place to look is at state or local legal aid offices and bar associations.
Referrals are much more likely to produce skilled workers comp attorneys than simply calling the first name that pops up in the phone book.
Research Attorneys Online
Online sites allow users to review everything from ice cream shops to travel agents—and that means lawyers, too. Sites like Avvo have extensive lawyers directories nationwide, spanning all practice areas. Using these sites is a nice way to collect extra information to supplement personal referrals.
Of course, don’t overlook your prospective attorney’s website. A professional-looking site with well-written, knowledgeable content is a sure sign that the law firm is committed to educating and reaching out to potential clients online.
On their site, look for answers to the most common workers comp questions, testimonials from past clients, and detailed information about the lawyer’s experience with workers comp cases.
Websites don’t tell the whole story, but a solid site more often than not means the firm in question is a reputable choice.
Go with Your Gut Instinct During the Consultation
The most important step in this process is the consultation. Even great websites and shining reviews can be useless if the lawyer just doesn’t feel right after meeting face-to-face.
Choosing a workers comp attorney should be treated as a job interview. During the consultation, your lawyer will ask you many questions to get a firm grasp of your case—but you must also ask the lawyer dozens of questions! Here are just a few to find out whether they’re a good choice to represent your case:
These are just a handful of questions, but should be enough to get you started. The key here is feeling totally comfortable. Great lawyers should be able to answer all of your questions honestly, without any slippery sales talk.
Decision Time: Can the Attorney Get the Job Done?
Walking away from the consultation, do you feel confident? Assured that the lawyer in question can get the job done? Meet with several lawyers to avoid making a snap decision.
Patience, authority, friendliness, responsiveness—these are a few of the qualities you should look for in a lawyer (and the rest of their office staff).
The workers comp process can take a while. It’s crucial to find a partner who can get you to the finish line. Find a team that treats you with respect, and that gives your case the best chance at success.
As you can see, figuring out if you have a case or not—and whether that case is strong or not—is a tough process. You might even have people actively working against you to make you feel isolated and weak, and that your case has no hope in court.
That’s the story of countless hurt workers all across the United States, but many of these stories have a happy ending.
If you believe your injury is work-related, if you’ve been ignored and denied by the insurance company, and if being denied those benefits is interfering with your ability to live a full life and get back to work, you may very well have a workers comp case.
The only way to remove all doubt is to speak with an experienced workers compensation specialist who knows all the ins and outs of the system, someone willing to fight on your behalf to get the compensation you deserve.
And even if you think your case is hopeless, don’t give up just yet. You deserve a second opinion.
*The information provided on this website does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available on this site are for general informational purposes only.
Davis & Sanchez