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State workers’ compensation programs provide financial benefits to employees injured in work-related accidents. While injured or sick workers may apply for these benefits without first speaking with a workers’ comp attorney, dealing with the claims process can be a frustrating experience. The deadlines for submitting claims paperwork are generally enforced strictly, and even minor errors, omissions or oversights could lead to applications being delayed or denied.
It is not unheard of for workers’ compensation coverage to reject claims made by injured or sick workers. Only about 20 percent of denied workers’ compensation claims are appealed. Attorneys have an ethical duty to advocate vigorously on behalf of their clients, and filing appeals paperwork in a timely manner is an important part of meeting this duty.
Attorneys Can Ensure That Workers’ Compensation Claims Are Filed on Time
State laws require injured workers to notify their employers about work-related injuries or illnesses and submit workers’ compensation claims paperwork within strictly enforced time limits. The amount of time workers are given varies from state to state, but they usually have between 30 and 90 days to make the necessary notifications and submit the relevant documents. Workers’ compensation attorneys ensure that applications are completed properly and submitted on time, and they may also help clients to gather other documents needed to support their claims such as doctors' reports and medical bills.
Attorneys Can Advocate For a Fair Settlement
Workers’ compensation settlements do not go into effect until they have been reviewed and approved by a judge, but judicial objections are rarely raised unless settlements are grossly unfair. This provides employers and their insurance providers with plenty of opportunity to offer injured or sick workers less than they are really entitled to. They may think twice about taking this approach when an attorney is involved. Attorneys familiar with workers’ compensation laws know the various benefits available and what their clients may be entitled to, and they could negotiate tenaciously to reach settlements that are equitable and fair.
Serious Injury and Permanent Disability Cases Are Complex
The workers’ compensation claims of employees who have suffered catastrophic injuries can be extremely expensive for employers and insurance companies, and this may be especially true when workers have been left permanently disabled. This type of claim is generally scrutinized carefully, and it is not uncommon for employers to allege that the injuries suffered were not work-related or accuse their injured workers of drinking or using drugs. Experienced attorneys may anticipate these tactics. They could also proactively gather the evidence needed to refute such allegations.
Attorneys Understand Why Workers' Compensation Claims Are Denied
Workers' compensation claims can be denied for several reasons, but this does not mean that affected employees will be denied the benefits they need to make ends meet until they are able to return to work. Attorneys may file appeals when claims have been denied unfairly for several reasons, such as:
Deadline issues: Attorneys may submit proof that procedural steps were followed when claims have been denied because deadlines were allegedly missed or notifications not made in a timely manner.
Employer disputes the facts: When employers claim that accidents were not work-related, attorneys could base their appeals on accident reports, OSHA or police investigations and the statements made by injured workers, their supervisors, paramedics and hospital staff. Doctors could provide details about the nature of injuries or illnesses, and work schedules or time sheets may be used to establish that injured workers were hurt while on the job.
Non-covered injuries: Attorneys may demand compelling supporting evidence when employers claim that injuries are not covered under workers' compensation laws because they were self-inflicted or suffered while workers were violating company policies or breaking state or federal laws.
Workers' Compensation Appeals Can Be Daunting
Going through a workers’ compensation hearing can be an intimidating experience for injured or sick workers even when the law is on their side. These are adversarial proceedings and can last from a few hours to several days, and judges may show little patience for employees who seem unprepared or lack the evidence needed to back up their claims. Attorneys familiar with these hearings may help their clients to prepare for the questioning they will face and seek to keep matters moving by presenting their cases supported by appropriate documentation such as:
Injured Workers Sometimes Face Other Legal Issues
Filing a workers' compensation claim may not be the last contact an injured worker has with the legal system. Workers injured in accidents caused by subcontractors or other non-employer third parties may seek compensation by filing civil lawsuits, and they could also sue their employers when their injuries were caused by recklessness so severe that it amounted to a willful intent on the part of the employer to cause harm. Injured workers who pursue their claims in court may be entitled to recover compensation for pain and suffering as well as punitive damages which are generally not available under state workers' compensation programs.
It is not uncommon for an employer to try to dissuade an employee from filing a claim for benefits or to terminate or otherwise retaliate against one who does. Most states have laws prohibiting this type of action by an employer, and a workers' comp attorney can be of much assistance.
This article is intended to be helpful and informative. But even common legal matters can become complex and stressful. A qualified workers' compensation lawyer can address your particular legal needs, explain the law, and represent you in court. Take the first step now and contact a local workers' compensation attorney to discuss your specific legal situation.