You could be working in a factory, at a desk in an office, or out in the field. You could be a driver, laborer, or an office clerk. Regardless, you could get hurt on the job. In many cases, this means you’d need to file a workers’ compensation claim.
Workers’ compensation coverage is supposed to do the following: You get hurt on the job and can’t work, so you file a claim for benefits, and you get some level of compensation.
In exchange, your employer and coworkers are off-the-hook for liability for your on-the-job injury — you can’t sue them, in most cases, but you’re still getting something out of it. This is generally how workers’ compensation is supposed to function.
However, it doesn’t always work like that. Insurance companies or employers sometimes try to deny and/or minimize the benefits paid out to employees injured on the job. They might allege that workers’ injuries developed while they weren’t on the job or that workers’ injuries aren’t as serious as the worker says.
The process of recovering workers’ compensation benefits can be time-consuming and frustrating, but an experienced workers’ compensation attorney could make it easier for you. If you or a loved one has been hurt on the job and your claim is denied, please fill out a free case evaluation form to learn more about how our workers’ compensation lawyers may be able to help you.
What Does a Workers' Compensation Attorney Do?
As a workers’ compensation attorny, I help workers who were injured on the job and were denied their workers comp claims. Using our experience advocating for workers, we help them navigate the process of trying to recover the money they might rightfully be owed.
Our attorneys handle on-the-job injury claims involving, but not limited to, the following:
Muscular injuries, broken bones, torn ligaments, torn rotator cuffs, and herniated disks from lifting, pushing, or other actions;
Sickness from exposure to toxins, including occupational diseases like mesothelioma or Black Lung;
Head injuries like concussions or traumatic brain injuries (TBIs) from falling objects or falls;
Tendonitis or other repetitive motion injuries;
Hearing loss or damage;
Cold and heat stress or burn injuries from accidents like electrocution; and
Assorted injuries to the back, spinal cord, shoulder, eyes, knees, neck, hip, respiratory organs, ankles, wrists, feet, and hands.
Third-party claims: Although workers’ compensation is typically no-fault, employees injured on-the-job by products or machinery could sue the manufacturer of those items to obtain compensation in court (in addition to their filing a standard workers’ compensation claim).
These injuries may be the result of unavoidable accidents, dangerous working environments, inadequate training, or faulty machinery. Under workers’ compensation, however, employees are not required to prove the reason that their injury occurred, as workers’ compensation is a no-fault system that compensates injured workers without regard to negligence or fault.
Who is Eligible for Filing a Workers' Compensation Claim?
Workers’ compensation eligibility depends on several factors, including what state the employee’s job is in, if the employee works for the federal government, and even the industry (for example, the railroad industry has its own system spelled out by a special federal law). All in all, most employees are covered by a workers’ compensation plan of some sort.
For example, with some exceptions, in Florida employers who have four or more employees, and construction companies with even just one employee, must provide coverage; and in Georgia businesses with three or more employees must provide insurance, with some liable for subcontractors’ employees. In a state like New York, essentially every employer must offer insurance. In Massachusetts, the requirements are similar, although there are more exceptions than in New York.
The majority of unintentional injuries, diseases, illnesses, accidents, and deaths occurring in the workplace are covered by workers’ compensation laws. Importantly, because workers’ compensation is a no-fault system, workers are not required to prove fault for their injuries to recover benefits.
In many states, a worker must report a workplace injury to his or her employer within 30 days of the accident. The employee has a certain amount of time after the initial injury report to file a workers’ compensation claim — in some states that’s two years.
When first reporting the accident, the injured worker should provide specific details, such as:
Names of witnesses;
Location of accident;
Cause of accident; and
Time and date of the accident and injury.
What Is a Workers’ Comp ‘Independent’ Medical Examination?
Next, the injured worker will seek an immediate medical evaluation to determine the extent of their injury by an approved, “authorized” medical provider of their employer’s choosing — the specifics of this may be different depending on the state. If an injured worker seeks a second medical professional’s opinion, depending on their state there could be certain restrictions on this. For example, in Florida workers can only switch doctors once.
To receive workers’ compensation, injured workers must submit to an independent medical examination or insurance medical exam. An IME, in theory, clarifies the worker’s medical condition and determines if the injury was caused by work-related activity. While the IME is meant to provide an accurate diagnosis and recommend appropriate treatment, insurance companies often use this as a tool to limit payouts and liability.
Assigned doctors can work in tandem with insurance companies to protect the financial interests of both parties, sometimes by denying the existence of an injury or wrongfully clearing an employee to return to work. To ensure that you are receiving the right prognosis, it is important to have an experienced attorney help you through the process.
Appealing a Workers’ Comp Denial
An injured employee’s claim for benefits may be denied if the insurance company:
Denies that an injury occurred on the job;
Accuses the employee of fraud or misrepresentation of an injury; and/or
Blames a worker’s injury on a preexisting condition.
If a worker’s claim is denied, they have a right to appeal the denial of benefits. Once an employee receives the denial, they can file a petition with a workers’ compensation appeals board in their state.
The process varies by state. In Florida, for example, injured workers filed with the Division of Administrative Hearings, which assigns the case to a judge who will schedule a hearing within 40 days.
The Hearing: Advocating for Workers’ Rights
Although an injured worker isn’t required to have an attorney at the hearing, it is often advisable. An experienced workers’ compensation attorney will know what to expect and how to better address situations that may arise during proceedings.
At the hearing, an injured employee or their attorney can present evidence showing why they are entitled to benefits. This evidence often includes the details of the workplace accident—where, when, and how an accident happened— and a detailed account of the employee’s subsequent medical treatment.
An attorney may utilize medical records to clarify the extent of their client’s injuries to the judge, as well as a physician’s opinion on the employee’s ability to work and how the claimant’s work injury was directly related to his or her job. In some instances, medical experts may be called upon to attest to an employee’s ability to return to work and perform their job responsibilities going forward.
The hearing also serves as an opportunity for insurance companies and employers to rebut evidence and attempt to prove a worker is not entitled to benefits.
How long a workers’ compensation appeal takes depends on several factors. Generally, though, after evidence is presented and testimony is heard, a judge will typically make a decision within 30 days.
Alternative solutions may be available through mediation to settle workers’ compensation disputes. A mediator may be allowed to assist in obtaining a more creative and mutually acceptable resolution involving modified job assignments or monetary arrangements.