Do I Need an Attorney to Process my Workers’ Compensation Claim?

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Depending on your scenario, you may need a legal advocate to represent you in a workers’ compensation claim. Some injury claims are relatively straightforward and can be settled without legal counsel. Others, however, are more complex, involve vast sums of money, and warrant hiring an attorney who will work to secure the compensation to which you are entitled.

Circumstances that Could Warrant Hiring a Workers’ Compensation Lawyer

In addition to the complexity and scope of a workers’ comp claim, how your employer or insurer handles your case can help determine if it is in your best interests to seek representation from an attorney.

Signs you could benefit from having a workers’ compensation attorney include the following:

Your Claim Is Denied

The most blatant sign you likely need a workers’ comp attorney is if the workers’ comp insurer denies your claim you know is legitimate. Anytime there is contention or disagreement on a benefits decision, legal guidance can be helpful to convince the insurer your claim is valid and supported by evidence.

The Settlement Offer Is Insufficient

Sometimes workers’ comp insurance companies offer settlements that do not cover all of an employee’s lost wages and medical costs. Many workers’ comp cases are for a permanent disability based on a rating specified by your initial examining doctor. This rating is crucial because it will determine how much compensation and medical benefits you will receive.

If the insurer disagrees with this rating, they can require you to undergo an independent medical exam by another doctor they choose. There is a reasonable chance this doctor will assign you a lower rating than you were given in your initial examination. This is when an attorney can step in and work to convince the court your injury deserved a higher rating.

The Insurer Claims Your Injury Was Not Work-Related

If you had a preexisting condition related to a new injury, or the employer/insurer denied your injury was work-related, it may be in your best interest to have an attorney. They can present evidence supporting your claim that your initial condition worsened directly due to an injury you sustained on the job. For example, you may have already had lower back pain that was exacerbated by an accident that occurred under the scope of employment.

Denials can also occur when a person is injured by long-term exposure to chemicals or repetitive motions. Sometimes, these injuries are harder to prove because they were not caused by one specific, identifiable incident.

Your Claim Requests High Compensation for Severe or Catastrophic Injuries

Insurance companies sometimes contest exceedingly expensive claims, such as those involving a permanent disability, to avoid paying large sums of money. This can also happen when a doctor recommends extensive long-term treatment—the insurer may assert you do not need it and be hesitant to cover it. 

Examples of severe and catastrophic injuries that might require comprehensive, long-term treatments include spinal cord injuries leading to paralysis and traumatic brain injuries. In addition, any health complications that require multiple surgeries or long periods of hospitalization or rehabilitation can lead to complicated and expensive claims that an attorney may best handle.

You Encounter Employer Retaliation

Your employer is barred from retaliating against you for applying for workers’ compensation benefits per S.C. Code § 41-1-80. For example, they may reduce your hours, pressure you to return to work before you are medically ready, or fire you for no discernible reason. In these cases, you may need an attorney to inform them that it can warrant legal action.

You Have a Third-Party Claim

If a party other than your employer contributed to your injury, you could seek compensation from them in a lawsuit. For example, if you were on-the-clock and were injured in a car accident caused by another driver, you could pursue them or their auto insurance company for damages.

You Have a Workers’ Compensation Hearing

If the insurer will not agree to a settlement or makes a minimal offer, you may need an attorney’s assistance to substantiate your claim in an evidentiary hearing. This situation is best handled by an attorney who understands workers’ comp laws and your rights as an injured worker.

Any Occasion You Need to Negotiate with the Insurance Company

If the insurer refuses to pay your claim or offer the total amount you are entitled to, you should seek the help of a lawyer who understands how to negotiate with insurers and navigate the workers’ comp system. They can work to ensure you receive fair treatment and that you know precisely how much compensation you should pursue in your claim.

Discuss Your Claim with a Workers’ Compensation Attorney Today

If you have suffered an injury on-the-job and have questions about workers’ compensation, please contact Schiller & Hamilton for a free consultation. We can evaluate your claim, determine your best course of action, and help you decide if you need an attorney to handle your case and work to secure compensation for your losses.

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