The workers’ compensation system is complicated, and although most claims go relatively smoothly, some valid claims get denied, for any number of reasons. Here are 6 explanations of why your workers’ compensation claim was denied:
1 – You Were Injured, But Not at Work
To be eligible for workers’ compensation benefits, a worker must have been injured while in the course and scope of their employment. Under workers’ compensation law, benefits are available to a worker who is hurt on the job, and no proof of fault needs to be made for benefits to be paid. All that needs to be established is that the injury occurred on the job and is connected somehow with the work the employee performed. But if the injury occurred while you were at lunch or running a personal errand, you most likely will not be eligible for workers’ compensation benefits. However, if you were on a work assignment outside the workplace, you could have a valid claim.
2 – You are an Independent Contractor Instead of an Employee
While employers are required to provide workers’ compensation benefits to employees, no such requirement exists for independent contractors. Generally, an employer-employee relationship exists if a worker performs services that can be legally controlled by an employer, such as what will be done and how it will be done, even if the worker is given freedom of action. An individual is an independent contractor if the person paying him has the right to control or direct the result of the work, but not how the work will be done. So if you are an independent contractor, you most likely aren’t covered by workers’ compensation law and entitled to benefits.
3 – You Didn’t File Your Claim in a Timely Manner
Under workers’ compensation law, an injured worker is required to file, in writing, a First Report of Injury within a specified time limit – as soon as possible and usually no later than 30 days after the incident, and failure to do so has different penalties, according to state law. The deadline for filing a workers’ compensation claim can vary from 30 days up to several years, again depending upon state law, and the time limit typically begins on the date of the accident and can be extended to accommodate payment of medical bills or lost wage benefits.
4 – You Weren’t Treated By a WC-Approved Medical Provider
According to workers’ compensation law, you don’t get to choose who provides treatment for your work-related injury – your employer and the insurance company do. You will receive a list of approved doctors that you can seek treatment from, and as long as you visit one of them, workers’ compensation will pay for your medical treatment. Unfortunately, many of these doctors devote their entire practices to performing Independent Medical Examinations for workers’ compensation carriers, and they often downplay your injuries, resulting in decreased benefits for you. If you did not receive any medical treatment for your injury and consequently have no medical records to document your claim, it will most likely be denied because you have no proof.
5 – There Were No Witnesses to Your Injury
Because fraudulent workers’ compensation claims have become relatively common, employers and insurers are usually somewhat wary about a workers’ compensation claim involving an injury that no one witnessed, which is a great disadvantage to those who work alone. If you were injured at work but no one witnessed it, there is nothing you can do about that, but you should immediately report the injury to your co-workers and supervisor, and make sure your paperwork accurately reflects how the accident occurred.
6 – You Didn’t Have a Workers’ Compensation Attorney
While you’re not required to retain an attorney to file a workers’ compensation claim, having one will dramatically increase the chances that your claim will be successful. An experienced workers’ compensation lawyer will guide you through the process, help you fill out the required paperwork, and recommend the documents that you will need to prove your claim.
Even if your claim has been denied, it’s not too late to contact a workers’ compensation attorney begin the workers’ compensation appeals process. For expert legal advice in workers’ compensation matters, contact DDB Law online or call 888-648-5999 to schedule your free initial consultation today.
You’ve just been injured in a car accident, and the insurance company has made an offer to settle your claim. You are tempted to do just that, but you’re wondering if the amount they’re offering is really going to be enough to pay all your accident-related bills. You’re thinking about hiring an accident attorney, but you don’t know if you really need one.
Here are 5 reasons why hiring an attorney to represent you in a personal injury claim could be exactly the right move to make:
1 – You Won’t Save Any Money if You Don’t (But it Could Cost You)
Most personal injury lawyers work on a contingency fee basis, meaning that they won’t take a fee until your case settles. This type of arrangement allows injured people to obtain legal representation without having to pay an upfront retainer. Personal injury lawyers also typically offer free initial consultations, and advance funds for medical experts and the costs of litigation since most injured clients can’t afford to pay for things like obtaining a report from a medical expert, but without such a document they could have a hard time obtaining a fair settlement. But before you hire anyone, be sure you understand their fee structure.
2 – An Attorney Will Deal With Insurance Companies So You Don’t Have To
Once you hire an accident attorney to handle your claim, he will communicate with insurance companies on your behalf. This will not only reduce your anxiety and stress, but will also allow you to get all the information you will need to build your case, such as:
- Whether liability for the accident has been determined.
- The liability limits of the at-fault party’s insurance coverage.
- Specifics about your own insurance, including whether you have medical payments and uninsured/underinsured motorist coverage.
Non-lawyers usually don’t know how to obtain this type of information, but accident attorneys work with insurance companies every day.
3 – Lawyers are Skilled Negotiators
Insurance adjusters routinely offer unrepresented claimants low settlement offers in exchange for a full release early in the claims process, knowing that that they may accept a nominal amount because of financial pressures. An attorney can protect you from this vulnerability, and will likely be able to negotiate a much better award for you once the full extent of your injuries is known. An experienced injury attorney has much more negotiating power than a claimant does, simply because the attorney has the power to file a lawsuit in court, requiring the adverse insurance carrier to spend time and money defending it. If an insurance company doesn’t treat you fairly or refuses investigate your claim, an attorney can also initiate a bad faith claim, something an unrepresented client rarely does.
4 – You Don’t Know the Law As Well As You Think You Do
We’ve all watched our share of legal dramas on television, but there are many rules, regulations, and processes involved in accident cases. Unless you’ve been to law school, learning all of this would be very time consuming for you, but if you don’t take the time to learn the rules, you run the risk of doing major damage to your case.
So if you decide to represent yourself, be prepared for a lot of work. It takes attorneys three years to get through law school, plus all the knowledge they gain on the job. Do you really think you can understand the concept of personal injury law more quickly than that, if at all?
5 – Without a Lawyer, You’re Playing the Insurance Company’s Game
If your accident was minor and you didn’t sustain any injuries, you may not need a lawyer, but if you were injured and still decide not to retain an attorney, you’re doing exactly what the insurance company wants you to do – allowing them to pay you far less than your claim is actually worth. An experienced personal injury attorney will review your claim, understand what it’s worth, and make sure the insurance company treats you fairly.
If you were injured in an accident due to another person’s negligence, contact DDB Law online or call 888-648-5999 to schedule your free initial consultation today.
Attorneys for a 42-year-old Connecticut man recently made the case for legal representation in a workers’ compensation matter when they obtained a $105,000 settlement for the food delivery employee, after an initial demand of $177,500 and a settlement offer of $95,000 from the insurance company.
Workers’ compensation was established to protect both the employer and the employee and to eliminate the need for litigation, but injured employees need to understand that a workers’ compensation attorney will not only protect their legal rights, but could also help them recover a more substantial settlement than what might be determined by the workers’ compensation system alone.
A worker who was injured on the job will typically file a workers’ compensation case without legal representation, particularly if their injuries are minor and temporary in nature, although there are times when it might be in the employee’s best interests to seek legal representation. But before they do so, it is important to understand the costs involved when retaining a workers’ compensation attorney.
Legal Fees in Workers’ Compensation Cases
When an injured worker hires an attorney to represent him in his workers’ compensation case, the lawyer will usually take the case on a contingency basis, meaning that the worker won’t be required to pay anything out of pocket at the onset of the case. Instead, the attorney will receive a percentage of the settlement, the amount depending upon state laws and the complexity of the case.
By eliminating the need to pay a large upfront retainer, such contingency fee arrangements allow all injured workers, including those with limited financial resources, to obtain legal representation. Contingency fee arrangements also provide an incentive for workers’ compensation attorneys to pursue maximum benefits for their clients. Generally, a workers’ compensation case that settles prior to an administrative hearing will require a lower percentage fee than one that requires a hearing or a trial in circuit court.
Workers’ Compensation Regulated by the States
State laws regulate the fees attorneys may charge in workers’ compensation cases, and these regulations vary from state to state. States often cap the amount an attorney can charge and also require that fees be approved by the workers compensation judge or appeals board before the attorney is paid. These laws vary substantially:
- A California workers’ compensation judge is free to approve a fee of between nine and 15 percent, depending on the complexity of the case.
- Florida workers’ compensation attorney fees are set at 20 percent of the first $5,000 of workers’ compensation benefits, 15 percent for the next $5,000, and five to 10 percent of the remainder, depending upon the time the attorney spent on the case.
- In Texas, an attorney is paid by the employer’s workers’ compensation insurance carrier, the percentage is are determined according to the attorney’s time and expenses and must be approved by the Division of Workers’ Compensation. Once the attorney’s fees are approved, the insurance carrier is ordered to deduct the fee amount from the injured worker’s benefits, up to 25 percent of the recovery amount.
Many states prohibit attorneys from charging fees for obtaining routine benefits for their clients, such as compensation for undisputed medical bills and lost wages, but may allow attorneys to petition the judge to order the employer or insurer to pay additional fees in certain circumstances, such as when benefits have been unnecessarily delayed or denied after they have been awarded. Percentage caps do not usually apply to these sanctions or penalties because they aren’t considered part of the injured worker’s compensation award.
Other Out-of-Pocket Costs
In addition to attorney fees, injured workers may be required to pay other out-of-pocket costs for:
- Court filing fees
- Copies of medical records and billings
- Fees for independent medical examinations
- Deposition costs
- Attorney travel expenses
- Postage and copying fees
These costs are typically not covered by the standard contingency fee agreement, and most law firms will cover these expenses as they arise, but the client will need to reimburse the firm for these costs if they are granted an award.
If you were injured on the job and have questions about retaining an attorney to represent you in a workers’ compensation claim, or need more details about the costs involved, contact DDB Law or call 888-648-5999 to schedule your free initial consultation today.