Top 12 Ways A Workers' Compensation Lawyer Helps [2022]

1. Overturning A Denied Claim

Workers' Compensation Lawyer

When a claim is denied it means that the insurance company intends to pay you no benefits whatsoever. If you have received a denial either verbally or in writing, the top way a lawyer helps is by fighting to get your case admitted/accepted. When a claim is denied there is a court process to appeal the decision by your employer. A workers' comp. lawyer knows the rules and can request a priority trial to present your case to a judge to request that a denial be overturned. Once turned into an accepted claim, the lawyer can fight for the benefits under workers' compensation law.

Claim denials happen for many different reasons

1. A lack of substantial medical evidence;
2. A lack of factual evidence; and/or
3. The claim was filed following termination or layoff (post-termination claim)

2. Turning a Delayed Claim Into an Accepted One

Injuries occur. As an injured employee, you have the right to file a workers' compensation claim. At the same time, your employer has the right to investigate during the first 90-days. This is known as the "delay period." During this period of time, the injured employee has the right to medical treatment provided by the employer up to $10,000.00. However, if you are missing work, then the adjuster still doesn't have to pay wage replacement (temporary disability benefit) to cover your lost wages.

Expedited Hearing During the Delay Period

A workers' compensation attorney can request an expedited hearing to get you treatment during this period. This will help to establish the medical evidence needed to substantiate the nature of your injuries at work.

If you are being sent to Concentra or another clinic, you may want to request a Qualified Medical Evaluation to help obtain the evidence you need. A lawyer knows the process and how to accomplish goals early on that will help the claim in the long-term.

3. Doctor Selection Within the Medical Provider Network (MPN)

Your employer has a right to control the injured employee's medical treatment using several different instruments provided by law. One of these is the Medical Provider Network, which sets up a small number of physicians and facilities where the employee is required to treat within.

Your employer controls the first doctor you see

The employer also controls your medical treatment during the first 30 days of the claim. The doctor has tons of control over how your injuries are documented and treated. You won't be very happy once you see the clinic. You may want to find a different doctor, especially for serious injuries where a specialist or multiple specialties are necessary.

A lawyer knows how to demand the medical provider list and enforce the demand with a judge. They also have the acumen and experience to help select a primary treating physician. Medical treatment is often slow under workers' comp and a lawyer can help move things along when the adjuster isn't responsive to your needs.

4. Helping Obtain Secondary Treating Physicians

Did you know that if your work-related injury requires more than once specialty that the insurance company must authorize a secondary treating physician? If you have a complex injury situation involving multiple body systems, then you need to see more than one specialist. Experienced lawyers know how to identify this needs and put things in motion to get you reasonable and necessary treatment.

Here are a few examples of multiple specialties:

1. Injured worker is hit in the head from above by a falling object injuring their neck and sustaining a traumatic brain injury. This worker needs to be examined by a orthopedist for their neck and a neurologist for the concussion.
2. Employee falls from an elevated platform breaking their leg and causing internal injuries. The employee needs an orthopedist and internal medicine.
3. Employee has the need for only one specialist at first, but over time develops the need to see a second type of specialist. This happens often when internal damage is done with medications or where additional issues are discovered during the claims process.

5. Denied Medical Treatment on Accepted Claim

Oftentimes, medical treatment is denied by the insurance company despite being recommended by an MPN doctor! At first glance this seems ridiculous. If the company doctor requests medication, physical therapy, or diagnostic testing, it should be provided. But the law allows the insurance company to deny these prescriptions using Utilization Review (UR).

A workers' compensation lawyer can identify the basis of the UR denial and work to resolve it. A professional also knows the time frames and can hold the adjuster accountable for a late denial or a failure to address important facts known to the carrier in the UR denial. The appeals process, known as Independent Medical Review, is also a process an attorney can help you navigate when necessary.

6. Negotiate a Better Settlement for Your Case

Lawyers know how to work the legal process to obtain more benefits. The appeals process costs the employer and their carrier money. By having an attorney fighting for your benefits you open up the possibility of a better negotiating position. Not only can you achieve more in the process, you will probably leave the process looking better financially.

There are two ways to settle a workers' compensation claim in California. By Compromise & Release or Stipulation and Award. A lawyer knows which one is best for your situation and works hard to maximize the value of a settlement for you. Learn about the different ways California workers' compensation claims are settled.

7. Hiring a Workers' Compensation Lawyer is Affordable

Another top way a lawyer helps with a workers' compensation claim is not charging the injured worker anything up front. A contingency fee allows you to hire a lawyer with nothing out of pocket. And since you only pay a max attorney fee of 15% in California, and only if you win, it's quite affordable. So while your employer pays their attorney by the hour, you pay nothing at all unless you get a settlement.

8. Cross Examination of the Qualified Medical Evaluator

Unlike in civil litigation (personal injury), you cannot hire any medical expert you want to present to the judge. There are only a few ways to get medical reports into evidence in workers' compensation. This restricts what reports you can present to the judge. The medical report that is likely to control your case will be from your Qualified Medical Evaluation.

But what happens if you disagree with your Qualified Medical Evaluation? A lawyer can identify whether or not there is a basis to object. Then the lawyer can follow through by scheduling an interview with the doctor to ask questions. The QME doctor might change their mind upon questioning. It happens a lot.

9. Getting Outstanding Medical Bills Paid

Employer's must pay for up to $10,000.00 of medical treatment until the claim is denied. Emergency room and hospitalization can turn into an unpaid bill when the employer doesn't do the right thing. If this is the case, you might have a large outstanding bill looming. But no adjuster in sight to pay for it. In this case, a lawyer can file for a conference to see a judge about payment of outstanding medical bills that are going to hit your credit if left unpaid.

10. Helping the Injured Worker Understand Their Case

Part of the highest dozen situations where A Workers' Compensation Lawyer Helps is understanding the situation. Having a lawyer gives you the knowledge that they have accumulated on other cases. A work injury lawyer helps you understand your injury claim in context. They also give you advice and guidance on what to expect. This helps you make better decisions that will benefit your life.

11. Identify Other Legal Violations That May Exist

Sometimes employees are mistreated just for getting injured. Being injured on the job can turn your life upside down, particularly when your workers comp. benefits are denied or your adjuster is playing games or stalling, while you can't return to work due to your serious injuries. Unfortunately, if you are granted workers' compensation, you may not be entitled to compensation for damages such as pain and suffering, or mental distress.

When your employee starts mistreating you. Then several laws might step in to protect you. These include Labor Code section 132(a), the Americans with Disabilities Act (ADA) and the Fair Employment Housing Act (FEHA). A job accident lawyer can help identify discrimination and refer you to the right attorney to pursue additional legal violations by the employer.

12. Fight to Maximize All the Benefits

There are many benefits under workers' compensation. A lawyer knows them all and when they apply to the facts of your specific case. This helps you collect more. Here are just a few:

1. Medical attention to cure or relieve the industrially caused condition;
2. Money to replace paychecks while in recovery unable to perform job;
3. The right to select second opinion doctors if in the event of disagreement with the primary physician;
4. At the end of the claim, most should be awarded at least some money regardless of how small the injury may have been (excluding cuts, bruises and other first aid, minor injuries);
5. At the end of the case, there should also be an outline of medical benefits the insurance company must provide into the future.
6. Mileage reimbursement to and from doctor appointments.
7. Job retraining.

Why Workers Compensation Lawyer Help For Work Accident Injury Victims.

When you are injured at work, you are entitled to workers' compensation benefits despite fault. An injury that leads to a period of debilitation whether permanent or just short-lived is a severe concern that has substantial effects on an individual's way of life, capability to work, physical convenience and financial resources. After reading about Top 12 Ways A Workers' Compensation Lawyer Helps [2022] you probably have a good idea about whether or not you should call a workers' comp. lawyer for help. Remember that this article is general information only and not legal advice. Only decide to hire a lawyer or not once you have consulted with one.

Workers Compensation Insurance Explained

Workers' compensation is a no-fault insurance coverage program, meaning injured workers and families will not have the ability to sue their company for neglect. A seasoned workers' compensation attorney will work with your company and their insurance to supply you with your workers' compensation benefits you deserve. Sometimes, an employer may not want to provide you with the compensation you need for your injuries. There are many methods that an insurance provider may try to avoid paying the full amount to cover your losses or perhaps avoid paying you benefits at all. As an outcome, companies can not attempt to put blame on employees for a job related accident as a way to attempt to deny or limit the payment of injury, illness benefits.

Injured at Work or on the Job

Being injured on the job can turn your life upside down, particularly when your workers comp. benefits are denied or your adjuster is playing games or stalling, while you can't return to work due to your serious injuries. Unfortunately, if you are granted workers' compensation, you may not be entitled to compensation for damages such as pain and suffering, or mental distress.

If you have suffered injury or illness in the work environment, you likely have many concerns not just about your physical ability to recover, however about how you will financially support yourself and your household till you can work again. If you suffered a work-related injury, you might be entitled to workers' compensation benefits to spend for these expenditures and others. The workers' compensation system was developed making sure workers are safeguarded financially in the case of an on the job injury. If you have suffered an injury on a job accident and are unsure of your rights, Contact our law offices today. An experienced and powerful Workers' Compensation Attorney is here to assist you through the injury claim process. No matter how big or small the case may be.

Workers Compensation Lawyer

When Should I seek Attorney Representation

If you are not getting any one of these benefits, or are worried that they will be denied, hiring a lawyer who knows California workers compensation law may not be a bad idea. In addition to aiding in the fight for the above-listed benefits, a good attorney should also be able to do the following if applicable to the case:

1. Penalize the insurance company if the appropriate benefits and/or compensation is not provided;
2. Counsel the client on the best course of action, whether that be advising on how to maintain a good relationship with the employer throughout the claims process or advising on what doctors have a better bedside manner or are more generous with providing treatment.
3. Identify other possible claims the client may have against the company and refer to the appropriate attorney in that specialty; and
4. Act as a barrier between the applicant and the adjuster so that you do not have to deal with the adjuster anymore.

What To Look For In a California Workers Compensation Law Attorney

The difference between a good California workers compensation lawyer and a poor one mostly depends on the attorney’s caseload (how many cases they are handling at one time) and their ability to apply the law to an individual's circumstances over the life of the claim. Many lawyers out there that advertise for California workers compensation law business look very professional and seem legitimate, but in reality are either overloaded with cases to make the maximum amount of money possible, or lack the knowledge and ability to appropriately handle your case.

Workers' Compensation Claims Attorney

When you hire these types of attorneys, you do not usually meet an actual lawyer from their office for several months into the case. If you do not at least speak with a lawyer during the initial consultation, stay far far away from that law office.

At Napolin Accident Injury Lawyer, all cases are overseen by Mr. Napolin. He never charges for consultations, and he is only paid if he settles or wins the legal case. He has successfully helped thousands of injured workers navigate the complex California workers compensation law. He also looks forward to learning about your unique situation and developing a plan to get you the justice and benefits that you deserve.