A workers’ compensation attorney handles all aspects of claiming insurance compensation for a work-related injury, illness, or death. An attorney can apply for workers’ compensation insurance benefits, respond to an insurance company or employer inquiries, appeal adverse workers’ comp benefit decisions, and pursue workers’ comp insurance companies and others in court for payment.
If you or someone close to you got hurt or sick in connection with their job, chances are you have the right to receive workers’ compensation medical and financial benefits. Here’s an overview of what a workers’ compensation attorney can do to get you the maximum payments available.
Overview of Workers’ Compensation
Workers’ compensation (or just workers’ comp) is a form of no-fault insurance that employers purchase for their employees to cover the costs of getting hurt or sick on the job. Most employers in the United States are legally obligated to buy workers’ comp coverage. The insurance generally applies to all full and part-time workers, including minors and undocumented individuals.
With limited exceptions, any worker who gets hurt or sick while doing their job, no matter the cause of that harm, can receive workers’ compensation insurance benefits. You can even receive benefits for injuries you sustained in a work-related accident that was your fault.
Workers’ compensation benefits usually include:
- Coverage for all reasonably necessary medical treatment of a work-related injury or illness
- Payment for a portion of the income the worker lost by being temporarily or permanently disabled (unable to work), either partially or totally, due to the injury or illness
- Job retraining and other vocational rehabilitation
- In the event of a work-related death, financial benefits to replace a portion of the deceased worker’s income
Workers’ compensation does not pay for an injured or sick worker’s pain and suffering. But workers can sometimes seek compensation for those non-economic harms by pursuing a personal injury lawsuit for damages (see below).
The workers’ compensation system is highly regulated. State legislatures and agencies set standards for who may issue workers’ compensation insurance, which employers must purchase, and how workers or their families can claim its benefits. State governments also administer the process of resolving disputes that arise when insurance companies deny or limit payments to workers who file claims.
The Role of a Workers’ Compensation Lawyer
Workers’ compensation lawyers fight to ensure that injured and sick workers, and the families of workers who have died from work-related health problems, get the money they deserve from workers’ comp insurance and other available sources. These lawyers have a role to play at every step of seeking workers’ comp benefits and further compensation, from initiating a claim to going to court.
CLAIM PREPARATION
A workers’ compensation attorney can handle any step in claiming benefits for a work-related injury or illness. Those steps vary from state to state, but in many parts of the country (including Nevada), a worker must complete paperwork and meet deadlines for seeking medical care to start a claim. In some states, workers must seek care only from a medical provider approved by the government or their employer. A workers’ compensation attorney can oversee those initial steps to ensure a worker can avoid any costly mistakes.
DEATH BENEFIT CLAIMS
Workers’ compensation lawyers regularly represent the surviving spouses or family members of deceased workers in pursuing death benefits from a workers’ compensation insurance company. No one should have to worry about dealing with an insurance company while grieving the loss of their loved one to a work-related injury or illness. A workers’ compensation lawyer can take care of all the details and make sure the insurer pays death benefits quickly and in full.
CLAIM SUPPORT AND FOLLOW UP
Workers’ compensation insurance companies tend to pay medical benefits claims directly to the medical provider who treats an injured or sick worker. They typically send disability (or wage replacement) benefits to the injured worker or grieving family.
But insurers do not necessarily make those payments automatically after receiving a claim. Often, they’ll ask the injured worker or medical providers for documentation or other evidence to support the claim.
For example, a workers’ compensation insurance company might want to know more about why a doctor recommends a particular treatment, how expensive a treatment might be, whether the worker has pre-existing medical conditions, or which treatments offer the best chance of returning a worker to good health.
A workers’ compensation lawyer can act as a worker’s representative in responding to these requests from an insurance company.
A lawyer can also coordinate the flow of information between medical providers and insurers, ensuring that the insurance company receives as much information as it needs, but only as necessary, to process a claim. And a lawyer can follow up with an insurance company periodically to check on the progress of a claim and be proactive about addressing potential delays or disagreements about the level of benefits due.
These legal services protect a worker’s rights while, in many cases, also streamlining the approval of a claim.
APPEALS OF DENIED CLAIMS
If a workers’ compensation insurance company denies part or all of a claim for benefits, a workers’ compensation attorney can represent the worker in every stage of appealing that decision. Every state with a workers’ compensation system has laws and regulations that give workers the right to appeal adverse claim decisions. Workers can usually request an informal review of the decision by the insurance company, a more formal review by a state workers’ compensation agency, and, if necessary, even further assessment by a state court.
Appealing the denial of a workers’ compensation claim takes legal skill and knowledge. Most injured or ill workers need an experienced workers’ compensation attorney to represent them in appeals. Appealing a denied claim is a technical process in which a single slip-up can doom your chances of reversing the insurance company’s decision.
Contact a workers’ compensation lawyer immediately if you receive notice that an insurance company has partially or totally denied your claim for medical or disability benefits.
You have a limited amount of time to begin the appeal process, and if you miss a deadline or try to move forward without a lawyer, you run a high risk of losing your rights.
THIRD-PARTY LIABILITY LAWSUITS
As discussed, workers’ compensation insurance covers medical care and a portion of a worker’s lost income. Those benefits help, but they do not cover the full amount of a worker’s losses. Workers’ comp may not pay for services the worker needs or certain types of specialty care. It also does not compensate the worker for the non-financial impact of an injury or illness, like pain and suffering or loss of quality of life.
But that doesn’t mean hurt and sick workers have no options for obtaining compensation for those losses. An experienced workers’ compensation lawyer can review their case to determine if they have the right to file a lawsuit for damages against a party at fault for their injury or illness (known as a third-party claim).
For example, a lawyer might determine that the manufacturer of hazardous building materials that caused a worker’s cancer may owe monetary damages. Or the worker may have a claim against a contractor whose employee caused a vehicle accident on a job site.
By pairing workers’ compensation claims with third-party lawsuits, lawyers can frequently secure far more money for their clients than they might receive through a workers’ comp claim alone. Never assume that workers’ comp is the only compensation you can expect to receive for your work-related injury or illness. Instead, talk to a lawyer about whether you have the option to pursue a third-party lawsuit as well.
HOLDING EMPLOYERS AND INSURERS ACCOUNTABLE FOR BAD FAITH
Employers and workers’ compensation insurance companies owe significant legal obligations to injured or sick workers. Failing to meet those obligations subjects employers and insurers to liability for potentially significant monetary damages.
Examples of bad faith can include:
- An employer interfering with a worker’s right to receive workers’ comp benefits, such as by making it difficult to pursue a claim or lying to a workers’ comp insurance company about the employee’s conduct.
- An employer forcing workers to pay for workers’ compensation coverage out of their own pockets.
- An employer taking adverse employment actions (firing, demoting, reassigning) against an employee who files for workers’ comp.
- An insurance company intentionally delaying the processing of a workers’ comp claim.
- An insurance company knowingly relying on invalid or false justifications for denying a claim.
A workers’ compensation attorney can review your situation to determine if an employer or insurance company has acted in bad faith in connection with your claim. If so, you may have the right to pursue additional monetary damages designed to penalize those wrongful actions.
When to Contact a Workers’ Compensation Lawyer
Any worker who suffers an injury or illness related to their job can usually benefit from contacting an experienced workers’ compensation lawyer right away.
It’s an especially good idea to contact a lawyer if:
- You have questions about how to file a claim for benefits.
- You find the process of filing a workers’ comp claim confusing or overwhelming.
- Your employer makes it difficult for you to file a workers’ comp claim.
- Your employer penalizes you for filing a workers’ comp claim by firing, demoting, or reassigning you.
- A workers’ compensation insurance company delays processing your claim, refuses to respond to your inquiries, or makes it difficult for you to provide information to support your claim.
- You receive notice that your claim has been partially or fully denied.
Workers’ compensation lawyers offer a free consultation to anyone with questions about their rights after suffering an injury or illness at work or losing a loved one due to work-related reasons.
Workers’ comp lawyers also typically represent their clients on a contingent fee basis, meaning they do not charge upfront fees or hourly rates. Instead, they only get paid out of the money they recover for their clients—you don’t pay them unless they get you results.
Protect Your Rights
Contacting a skilled workers’ comp lawyer is the most reliable way to protect your rights after getting hurt or sick in connection with your job. In addition to speaking to an attorney, you can protect your rights by following these three tips.
1. REPORT YOUR INJURY OR ILLNESS TO YOUR EMPLOYER RIGHT AWAY
It’s usually crucial to report your injury or illness to your lawyer as soon as possible. In most states, giving prompt notice—immediately or within a few days—to your employer is a condition of receiving workers’ comp benefits. If you fail to report, you might not be able to have your medical expenses covered or receive disability payments.
2. GET MEDICAL CARE
Go to the doctor immediately for treatment of your work-related injury or illness. Do not wait to get care or try to tough it out through an injury. In most states, seeking prompt medical care is also a requirement for workers’ comp benefits. If you don’t get care right away, workers’ comp might not cover it. Also, remember to check with your employer or a workers’ comp lawyer to determine if your state requires you to seek care from an approved medical provider.
3. DON’T AGREE TO A QUICK SETTLEMENT WITHOUT TALKING TO A LAWYER FIRST
A workers’ comp insurance company that owes you compensation for a disability might offer you a lump sum settlement of your claim. Do not accept that settlement without first discussing it with a qualified attorney. In many cases, a skilled workers’ comp lawyer can get you more than the workers’ comp insurer offers. If you take the money without getting legal advice first, you could lose your valuable right to further compensation and leave money on the table.
Contact an Experienced Workers’ Comp Lawyer Today
If you or someone you love sustained injuries or got sick in connection with doing a job, you may have the right to receive significant workers’ compensation benefits and other financial compensation. Contact an experienced personal injury attorney in your area today for a free consultation.