What Does a Workers Compensation Lawyer Do?
Compensation attorneys assist workers injured on the job to receive full and fair treatment, this often means dealing with insurance companies and understanding complex laws which change often.
Workplace injuries often manifest themselves gradually over time, making it harder to establish that an incident was directly attributable to workplace conditions. A workers’ compensation attorney can assist you in securing medical evaluations that provide evidence when negotiating settlement offers.
Notification of an Injury
As soon as a workers’ comp case starts, the first step should be notifying both your employer and insurer of an injury that occurred. This is usually accomplished via filling out a First Report of Injury (C-3) form that can be found online for each state workers’ comp website. You must include information such as date, time and place in this notification letter, as well as record any witnesses.
Forms can be submitted verbally or in writing and signed by those affected. Some states mandate filing initial reports within 10 days after an accident occurs and failure to do so can incur penalties against the injured worker.
Employees should feel free to directly reach out for help from a workers’ compensation specialist for guidance. These specialists understand the program, can offer invaluable guidance, and assist with filing the appropriate paperwork for a claim.
Employers and insurers typically maintain a list of preferred doctors that employees can visit to receive medical care, which helps keep costs to a minimum for all involved parties. It’s essential that employees use only certified occupational medical providers who specialize in treating workplace injuries and illnesses.
An injured worker should always be upfront with their doctor regarding what happened in order to avoid any misunderstandings. Focusing solely on their injury rather than any preexisting conditions that might contribute to its cause can also help avoid unnecessary questions from doctors; their inquiries should focus on accidents rather than investigating personal medical histories or opinions regarding what caused their condition.
Case-Specific Benefits
Lawyers can assist in securing case-specific benefits, such as reimbursement for education or training to learn a new job, as well as pressure insurance companies to authorize expensive surgical procedures. Many people struggle to pay their bills, leaving an injury as one more financial strain – an attorney can help maximize workers’ compensation benefits so that they will last into the future, and facilitate requests for reevaluation to determine whether your condition has improved or no longer is related to work-related trauma.
Reopening a Claim
Reopening your workers’ compensation claim is an important tool if you have suffered additional damages since initially closing it. A policyholder might discover that their injuries have long-term ramifications which should have been included in their initial settlement, such as diminished quality of life, permanent impairment and future medical costs. Filing for reopening is possible provided it hasn’t been too long since closing; your lawyer can help determine whether this right exists and help devise the most efficient strategy to proceed with this reopening request.
If you wish to request a reopening, new evidence must be presented that clearly establishes:
(1) Since closing a claim, your condition has significantly worsened.
(2) Your condition has changed due to an injury sustained on the job.
(3) Your condition changes have a direct bearing on your ability to earn wages or receive treatment.
(4) New evidence supports a reconsideration.
Insurance companies will carefully consider any new evidence submitted to them and, if they believe it suffices to reopen your claim, will notify you accordingly.
An experienced attorney knows exactly how to present strong arguments in favor of reopening your case, such as getting an affidavit from your physician that supports changes to your health condition and their link.
If the Branch Chief believes that evidence presented is insufficiently convincing or that delegated reopening authority has been delegated by the Director, then they will refer the request back for review by them. This applies especially when dealing with unique, complex or sensitive requests for reopening.
Determining Eligibility
Though your injury or illness occurred at work, workers’ compensation laws can be complex and difficult to navigate. A lawyer can help determine whether you meet all legal criteria to receive benefits; Florida law stipulates that victims who sustain injuries which exacerbate preexisting medical conditions must receive additional payments; they can also help decide which types of benefits (medical and disability benefits) you should pursue.
Your eligibility for workers’ compensation depends on various factors, including your base-year wages and credit weeks, quarterly wages and total base-year earnings. In addition, there may be special rules applicable to some groups of employees such as domestic workers or temp agency workers who need special protection. A lawyer can ensure your claim meets all necessary criteria while also offering advice if it is denied.
If you suspect your employer’s insurance company of discriminating against members of a protected class, legal assistance can help with both investigation and filing a formal complaint. An investigator should evaluate if the challenged compensation policy or practice is job related and consistent with business necessity; and assess if there are alternative practices which fulfill similar business purposes without negatively affecting members of this protected group. The investigator should use statistical methods discussed earlier in this Manual Section to analyze eligibility standards at stake.
Requesting a Hearing
Hearings allow you to speak directly to an administrative law judge. You can do this either face-to-face, via videoconferencing online, or over the phone. At a hearing, the judge will consider all evidence and arguments presented during your request, before making their determination and writing up their order accordingly.
If the initial response from a department to your request was unacceptable, you may have the option of asking for a reconsideration hearing or appealing the decision. Either way, it is imperative that an appeal hearing request be filed within 60 days.
Once your request is received, an acknowledgment notice will confirm its receipt as well as assign you a number and tell you whether aid-to-continue (ATC) payments continue while waiting for a fair hearing hearing date and location are scheduled. Within two weeks or less you will also receive a fair hearing scheduling notice with details on when, where and when evidence packet copies can be requested from HRA for use during your hearing date/time/location/days etc.
Make sure that your fair hearing request includes information on all the issues you wish to bring up at the hearing, since an administrative law judge can only discuss what has been specifically mentioned in your request.
Your hearing can include the introduction of sworn affidavits; testimony; witnesses and any additional evidence such as photographs, receipts or documents. As with court proceedings, evidence must be proven by “preponderance of evidence”. For assistance preparing for your hearing you can always reach out to a compensation lawyer.