Workers’ compensation is a type of insurance policy that most private employers must obtain on behalf of their employees. In the event of an employee’s workplace injury or illness, the employer’s workers’ compensation policy will provide coverage of medical treatment and wage loss regardless of who was at fault. Additional benefits are available to compensate the family for a worker’s death. Show
While there are clear laws and policies regarding providing workers’ compensation benefits, issues often arise during the claims process that an experienced workers’ compensation attorney can help with. Here is a look at some of the services workers’ compensation attorneys provide to their clients. Gathering Medical Evidence to Prove the ClaimEach year in the U.S., private employers pay around $100.2 billion in workers’ compensation insurance. Like most types of insurance claims, the employer and the insurer both look to reduce payouts by investigating claims and determining:
A workers' compensation attorney helps their client gather substantial evidence for the insurer to accurately assess the injury and costs of treating it. The Types of Injuries and Illnesses Covered by Workers’ CompWorkers’ compensation benefits are available to provide wage replacement and treatment for the following types of injuries and illnesses:
The types of documentation that can help prove your claim include witness testimony from a coworker who saw the accident occur, the physician’s notes on what they learned about the injury through examination, copies of diagnostic or laboratory testing, and other information about the worker’s treatment or prognosis. Independent Medical ExaminationsAlthough many states—including Minnesota and Wisconsin—allow the injured worker to choose their treating physician, the employer’s workers’ compensation insurer often requests an independent medical evaluation (IME). The American Medical Association explains that an IME is a medical exam provided by a physician of the insurer’s choosing to provide examinations. An independent medical examiner has only a limited relationship with the worker to evaluate their injuries and the documentation provided by the worker’s treating physician. Appealing the Insurer’s Denial of the ClaimAll state workers’ compensation programs provide a process the injured worker can use to appeal the insurance company’s decision about their claim. For example, in Minnesota, injured workers who had their claims denied can file an employee claim petition form if they have never received any benefits. To appeal the loss of benefits, the employee should have their attorney call to talk to the insurer about the reason for the denial. The state also provides mediation services for injured workers, employers, and workers’ comp insurers to resolve the matter. Reasons Workers’ Comp Denies ClaimsInsurers deny workers’ compensation claims because:
Negotiating a Settlement for the WorkerMany people experience issues receiving benefits from their employer’s insurance provider after an injury. Others experience an initial approval of their claim and begin to see payments, only to have those payments stop for some reason. An experienced workers’ compensation attorney is trained in evaluating claims disputes and understands workers’ compensation laws that allow them to advocate for their clients. Often, when there are disputes involving the provision of workers’ compensation benefits, those disputes can be resolved through a negotiated settlement, in which the attorney for the claimant works with the employer’s insurance provider to come up with a solution that all parties can agree to. The benefits received through a negotiated settlement are determined based on:
Employer RetaliationMany states have workers’ compensation laws that prohibit an employer from retaliating against the employee over filing a claim. Unfortunately, employer retaliation for workers’ comp claims is not an uncommon problem. Some actions that an employer could take to retaliate against a worker for filing a claim include:
Employers generally will not tell you when they retaliate against you for filing a claim. Often, workers find themselves written up for disciplinary issues after filing a claim when they were never the focus of corrective actions at work before the injury. If you feel that your employer retaliated against you because you filed a workers' compensation claim, discuss the matter with your workers' compensation attorney as soon as possible. Fighting for Your Right to Continue Receiving the Treatment You NeedThe insurance provider and your employer each have commonsense reasons for wanting an injured worker to recover and return to work as soon as possible. Unfortunately, these needs don’t always align with the time it takes for the worker to recover. If your physician or an independent medical examiner determined that you can return to work and you disagree, your workers' compensation attorney can help you consider your options for continuing treatment and develop a strategy for proving the need for continued treatment. Reopening a Workers’ Compensation ClaimSometimes, when an employee experiences a workplace injury, they are provided with medical coverage and temporary disability payments until they are well enough to return to work. However, weeks or months later, the injury flares up again, and they are required to miss even more work because of it. Most states allow workers to reopen their claim at any time within several years after an injury to obtain additional coverage of treatments and wage loss. An attorney can provide:
Determining if You Have a Valid Third Party Personal Injury ClaimA personal injury claim generally compensates individuals for injuries they receive outside of work, such as injuries from a car accident or a slip and fall accident they experienced while shopping for personal goods at the grocery store. However, one of the main purposes for creating workers’ compensation insurance policies was to compensate for injuries experienced in the workplace without the need for the employee to file a lawsuit against a negligent employer or coworker. The personal injury claims process is only available to those injured in accidents at the workplace if the accident occurred as a result of negligence by a third party (not your employer or coworker). Examples of the workplace accidents that can result in a third-party personal injury claim include:
Individuals who are permitted to file a personal injury claim for a workplace accident have a wider range of expenses and impacts they can seek compensation for, including the psychological impacts of the injury, such as pain and suffering or loss of the enjoyment of life. However, they often have to wait longer for their compensation than a workers' comp claimant would. Many workers' compensation attorneys also provide assistance and services for clients seeking compensation through the personal injury claims process. Other civil claims can arise from a work-related injury, including the ability in some states to file a legal claim against an employer for failing to provide a workers' compensation policy for their employees, employers who retaliate against employees for filing claims, and workers' compensation insurance providers who fail to respond to the claim promptly. Workers’ Comp Benefits Are Too Important to Pursue AloneRussell Nicolet, Workers' Compensation LawyerObtaining wage replacement and medical coverage after an accident isn't always easy for injured workers, who often find themselves overwhelmed by medical jargon, insurance requirements, and insurance requests by the insurer. A workers' compensation attorney is an experienced advocate who understands the process, the parts of the process that often lead to disputes or delayed payments, and the actions you can take to resolve these disputes. If a workplace accident injured you, Contact an experienced workers' compensation attorney help you fight for your rights. |