Things Your Workers Comp Lawyer Won’t Tell You, But We Will
Knowledge Can Help You Maximize Your Financial Recovery After an Occupational Injury
There are some things that other workers comp lawyers may need to share with you about your occupational injury or illness case, but they don’t.
Our style is different.
If you spend some time on this website, you will see that transparency and delivering information about workers compensation laws so you can make informed choices about your case are important to us.
From determining eligibility for workers comp to dealing with the insurance adjuster to winning at trial and negotiating a top-dollar workers compensation settlement, our law firm guides you at every step.
Now keep reading as we uncover what other workers comp attorneys may not tell you, but you need to know to put more money in your pocket.
18 Things Workers Comp Lawyers Won’t Tell You
#1: You May Have a Personal Injury Lawsuit
Although workers compensation is the sole remedy for most on-the-job injuries, some industrial accidents provide other causes of action under tort law.
These civil actions are called third-party lawsuits. And they can provide additional income if they survive a defendant’s plea in bar.
For example, you may file a lawsuit against another driver for negligence if that person causes your work-related motor vehicle crash.
Or you may seek damages from a product manufacturer if their defective machinery causes a head injury, amputation, or other injury in a construction site accident.
Or you may file a civil action against a student or parent for assault and battery if you are a teacher who is the victim of workplace violence.
You can pursue these third-party lawsuits despite filing a workers comp claim or receiving benefits. And doing so is often a good idea, as personal injury lawsuits allow you to recover money for physical pain and suffering.
#2 You May Qualify for Social Security Disability Insurance (SSDI) Benefits
Catastrophic work injuries often serve as the basis for applying for Social Security disability and qualifying for these benefits. For example, you may get approved for Social Security disability (SSDI or SSI) if your back injury requiring spinal fusion surgery or torn rotator cuff cause permanent impairment or nerve damage – especially if you are 50 years old (or older).
Indeed, you can receive SSDI and weekly workers comp payments simultaneously.
However, your workers comp lawyer may not tell you to seek Social Security disability benefits because they don’t know enough about the program or want to avoid potential Medicare involvement in settling your case.
If the Social Security Administration awards disability insurance benefits, you will become Medicare-eligible. And Medicare’s approval is needed to settle your case if the amount of the compromise and release exceeds certain thresholds.
#3 You May Have Employment Law Claims Arising from How the Employer Treated You After the Work Injury
Although workers comp programs exist to protect injured workers while limiting the liability exposure for employers, some employers take work accidents personally and retaliate against the hurt employee.
If your employer fails to treat you properly after an occupational injury, you may have a legal under one or more labor and employment laws.
For example, the employer’s actions may violate the Family and Medical Leave Act (FMLA), the Age Discrimination in Employment Act (ADEA), the Americans with Disabilities Act (ADA), or other employment laws enacted by your state.
Make sure you look into these potential claims before resigning your job as part of your workers comp settlement.
#4 The Insurer May Not Negotiate a Settlement Until You Reach Maximum Medical Improvement (MMI)
I have yet to meet an injured employee who wants their workers comp claim to go on forever.
Although the lifetime medical award is good, it’s not the goal.
Instead, healing and receiving a reasonable amount for wage loss and permanent partial disability while cashing out the lifetime medical award is preferred. This route gives you more control over your life and healthcare.
Unfortunately, you may have to wait to settle your claim for a lump sum.
Some insurers and third-party administrators (firms like Sedgwick CMS, Gallagher Basset, ESIS, etc.) may only negotiate a settlement once you reach maximum medical improvement (MMI) for the work injury. Depending on the extent of your injuries, this could take months or even years. And there is nothing that you or your lawyer can do about it.
Regardless of this possibility, your attorney should evaluate your claim for settlement purposes when they have enough information to make educated recommendations.
#5 Vocational Rehabilitation Can Hurt More Than It Helps
You may want to return to work as soon as you can after getting hurt. Even if it’s a light-duty position, employment can improve your mental health and motivate you while going through grueling physical recovery.
So, in theory, vocational rehabilitation is a good thing. Its dual purposes – returning the injured worker to gainful employment and relieving the defendant’s burden to pay future wage loss benefits – have something for everyone.
But unfortunately, vocational rehabilitation may harm your claim, even costing you the benefits a Workers Compensation Award Letter provides.
In my experience, there is a higher likelihood that the vocational rehabilitation counselor finds some reason to allege you have failed to cooperate fully than the counselor finds a job within your medical work restrictions.
And if the Commission agrees with the vocational counselor hired by the employer and insurer, your workers comp benefits will stop.
#6 You Should Represent Yourself if You Had a Minor Injury
You have the right to represent yourself in workers compensation proceedings.
And you probably should handle the claim by yourself if it meets most of the following criteria:
- You did not miss time from work
- The employer accepted your claim
- Your medical bills are less than $1,000
- You healed entirely, with no residual problems with your arms, legs, hands, or feet.
#7 It Doesn’t Matter How Negligent or Intentional Your Employer Is
Few things are as frustrating as suffering an injury due to an unsafe work condition you warned your employer about for months before the accident.
However, this type of behavior by the employer does not increase the value of your workers comp case.
Unlike civil actions, statutory law dictates what benefits you can receive for a workplace injury. And an employer’s negligent acts are not a factor in increasing the money you recover.
#8 You Have the Right to Ask Another Attorney for a Second Opinion
The Rules of Professional Conduct prevent an attorney from communicating with a person represented by counsel.
But there is an exception.
If you seek a second opinion or replacement legal counsel, the lawyer you have contacted for a second opinion may communicate with you even if you have representation already.
So if you have concerns about how your lawyer handles your claim and are unhappy with the answers to your questions, get a second opinion.
#9 They Are Not a Workers Comp Specialist
Some personal injury lawyers and civil litigators accept representation in workers comp cases because they know the medicine central to these claims.
But workers comp has different procedural rules, claim elements, timelines, and available damages than civil actions. And if an attorney doesn’t handle many occupational injury claims, they may be disadvantaged.
#10 You Do Not Have to Settle Your Claim
Bad workers comp lawyers pressure their clients to settle their claims too early before knowing the extent of the injury and disability.
Sometimes they do this because they fear going to court or want a quick payday.
Although an early settlement makes sense if there is a significant risk you will lose on compensability and you have private health insurance coverage, you should take your time to evaluate your options.
Having an experienced work injury attorney with the patience to know when to strike will scare the insurance adjuster and help you get everything you deserve.
#11 You Can Add Body Parts and Medical Conditions to Your Award
Some symptoms take days or weeks to develop after a work incident.
And some medical conditions take years to arise after a workplace accident.
For example, an otherwise healthy knee may deteriorate from overuse because you limp after suffering a torn meniscus.
Or you may become depressed due to chronic pain from a herniated disc.
In these situations, you can add the gradually developing injuries and medical impairments as compensable consequences under the Award Order.
If you succeed, the insurer must pay wage loss benefits and medical expenses related to these consequences.
#12 The Insurer Can Deny Treatment Even if You Have a Lifetime Medical Award
The term “lifetime medical award” is misleading.
Instead of guaranteeing the insurer must pay for treatment for your injury, a lifetime medical award gives you the right to seek authorization and payment of recommended care.
If the insurer refuses to pay for an appointment or surgery, you must prove that the medical treatment is reasonable, necessary, and related to the workplace accident.
For example, the insurer may accept that you suffered a muscle injury, strain, or sprain.
But if you need surgery, it will argue that the initial injury healed, and your ongoing disability and care are related to preexisting conditions such as degenerative disc disease.
#13 The Insurer Can Get Away with Bad Behavior
Insurers sometimes ignore the rules and send income replacement checks late because they can – to an extent.
For example, in Virginia, the Workers’ Compensation Commission will only consider penalizing the insurer for sending checks late if the payment is more than two weeks late. And even then, the penalty is limited to adding 20% to the unpaid amount.
In addition, winning a bad faith claim due to the workers comp insurer’s acts is unlikely because it is third-party insurance, not first-party insurance.
#14 The Insurer Can Appeal if it Loses
Litigation is often time-consuming.
The appellate rules are one reason for the delays.
If you win at trial, the insurer may appeal the decision to the Full Commission.
And if it loses before the Full Commission, it can file an appeal with the Court of Appeals.
These extra appeals levels add months (if not years) to the timeline to resolve your case.
#15 Your Wage Loss Benefits Will Stop Even if You Have Permanent Restrictions
Many states have caps on the number of weeks of wage loss payments you can receive.
For example, in Virginia, you cannot receive more than 500 weeks of wage loss benefits (including temporary total, temporary partial, and permanent partial disability) unless you have a significant loss of use of two or more body parts.
Therefore, you may need income after a specific period but have limitations making it difficult to do so.
#16 The Insurer Can Terminate Your Benefits Without Giving You Due Process
Unfortunately, your employer or the insurance company may suddenly terminate your benefits.
And the burden of proof to suspend payments is low.
Although you can (and should) fight the suspension, you may go months without income while litigating the claim.
#17 Pretrial Discovery is Intrusive
You and the insurer can engage in pretrial discovery when there is a dispute about your entitlement to benefits.
This means you may have to answer questions about your health, work history, and criminal history in writing (interrogatories) and orally (at a deposition). In addition, you may have to produce financial records such as tax returns from the past few years.
#18 You Can Fire Your Workers’ Comp Attorney
You can end your relationship with the law firm if you need to receive better legal representation from your attorney.
Some main reasons to fire your lawyer include the following:
- Lacks communication
- Lacks experience handling workers compensation claims
- Conflict of interest and personality clash
- Costly fees
Depending on where you are in the litigation, firing your attorney is a drastic step.
We recommend trying to reconcile. But if the relationship is beyond repair and you do not trust your attorney, consider finding a new one.
We Give You the Information Other Workers Comp Attorneys Won’t
Hiring a workers comp lawyer to prosecute your claim and safeguard your interests is often your best decision.
But make sure you use their knowledge as a valuable resource and ask them about the items discussed in this article so you have the information needed to get all the money and medical care you can.
If you have questions about the process, call me at (804) 251-1620 or (757) 810-5614. Our law firm helps injured workers in Virginia and Maryland win their claims.
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