Not every injured worker will get to hire an attorney. After all, the workers’ compensation system is an administrative process designed to be relatively easy for workers to navigate. If you've got an easy claim that's not being disputed by your employer or its insurance firm, you'll probably handle your own claim. Unfortunately, the process is not always that simple. Many workers will need to—or can benefit greatly from—hiring a workers’ compensation lawyer.
In only a few cases, an employee who suffers an injury at work can make a claim without of workers' compensation audit, and a private injury lawyer would be appropriate. For example, if you were injured as a result of your employer's intentional act, or if you are a crew member on a vessel or an interstate railroad worker, you can usually sue your employer in court for a workplace injury.
When a Lawyer Isn’t Necessary
If you suffer a comparatively minor injury at work that completely heals with treatment, you almost certainly won’t get to hire a lawyer. Insurance companies are unlikely to dispute claims that:
- involve injuries that are clearly work-related
- don’t require extensive medical treatment
- don’t involve long periods of time off work, and
- don’t result in permanent injuries.
For example, suppose you sprained your ankle after you slipped on some water within the break room. Your doctor ordered you to ice your ankle, take pain relievers, and stay bed rest for a couple of days. However, because you're employed a desk job, you were ready to return to figure fairly quickly and your ankle healed within a couple of weeks. In this case, your trip to the doctor would be covered. However, you almost certainly wouldn’t even receive wage loss benefits in most states because you were only out of labor for a couple of days.
When a Lawyer Is Typically Necessary
Any time you’re during a dispute with the insurance firm, you ought to consider hiring a lawyer to represent you. You will need to gather evidence in order to challenge the insurance company’s position, which may include taking depositions, requesting an independent medical examination, and hiring expert witnesses—all of which require legal knowledge and skill.
The following are some examples of when you’re best served by hiring a lawyer:
Your claim is denied. Insurance companies deny workers’ compensation claims for a spread of reasons. For example, the insurance firm might claim that you simply r injury wasn’t work-related or that you filed your claim too late. (To learn more, see our article on common reasons workers’ comp claims are denied.) you'll appeal the denial through the workers’ compensation system. While the appeals process varies from state to state, it generally requires you to file formal paperwork, use legal tools to collect evidence, and present your case at a hearing.
Your permanent disability rating is disputed. The bulk of most workers’ comp settlements and awards are for permanent disability benefits. These benefits are calculated supported your permanent disability rating. If the insurance company doesn’t agree with the rating assigned by your treating doctor, it can require you to attend an independent medical examination (IME) with a doctor of its choosing. The IME doctor will likely assign a way lower disability rating, which the insurance firm will use to justify paying you less in benefits. A lawyer is often essential to getting you a good settlement or convincing a judge that you simply are entitled to a better rating. (To learn more, see our article on how permanent disability ratings work .)
You have a preexisting condition. If you've got a preexisting injury or condition involving an equivalent part you injured at work, you’ll be facing an uphill battle with the insurance firm. The insurance firm will likely blame your injury on your previous condition instead of your work activities. This is very true if your injury has developed slowly over time, instead of during one work accident. (To learn more, see our article on repetitive stress injuries.)
You’re having trouble getting the treatment you need. Insurance companies often deny—or delay in approving—expensive medical treatments, such as surgery. A lawyer can put pressure on the insurance company to approve the necessary medical treatments in a timely manner.
Your ability to work has been affected. If you'll never work again, you’ll get to maximize your workers’ comp benefits and structure them during thanks to last well into the longer term. If you need to change careers, you’ll need to secure training in a new line of work. A lawyer can help you do both.
You’re receiving other government benefits. If you’re receiving Social Security social insurance (SSDI) benefits, these benefits could also be reduced if you receive workers’ compensation benefits. A lawyer can assist you to minimize what proportion your SSDI benefits are going to be reduced. If you're eligible for Medicare, you'll also get to put aside some of your workers’ comp benefits to buy future medical treatment. A lawyer can assist you to do that within the most advantageous way.
You are having a workers’ comp hearing. If the insurance firm refuses to settle—or only makes lowball settlement offers—you’ll get to go prove your case at a hearing. Because this is often sort of a mini-trial, you'll almost certainly need a lawyer to represent you.
Is a Lawyer Worth the Cost?
Workers’ compensation lawyers don’t charge within the typical hourly fashion. Instead, they charge a contingency fee: a percentage of any workers’ comp benefits they assist you to recover. Additionally, many nations place caps on contingency fees in workers’ comp cases. The percentage varies from state to state but is usually between 15% and 25%. However, the fee can be as low as 10% and as high as 33% in some states. (For more information about fees, see our article on what proportion it costs to rent a workers’ comp lawyer .)
You’re likely to urge a way higher settlement offer when a lawyer is involved. Lawyers understand the law, skills to barter, and may use various tools to create up your case. Because of this, you will probably receive more benefits if you hire a lawyer, even after the lawyer takes his or her fee.
