Applications & Appeals: Workers' Compensation Attorneys
Insurance companies and employers will frequently try to deny and minimize the benefits paid out to employees who were injured on the job. They will often claim that workers’ injuries developed outside the realm of employment or that their injuries are less serious than they claim they are. To ensure that you are treated fairly in this situation and are offered the benefits you deserve, it is important to obtain legal counsel.
The process of recovering workers’ compensation benefits can be simplified with the help of an attorney. If you or a loved one has been hurt on the job, please fill out a free case evaluation form to learn more about how our workers’ compensation lawyers may be able to help you.
Hiring the Right Workers’ Compensation Attorney
At Morgan & Morgan, we take pride in protecting our clients’ rights to obtain full compensation after an on-the-job accident. Our workers’ compensation attorneys are not intimidated by the cost-cutting tactics used by employers and insurance providers, and have years of experience recovering benefits for injured workers through both workers’ compensation and third-party claims.
Despite changes in workers’ compensation laws in 1990, 1994, and 2003 that resulted in radical reductions in the amount and duration of workers’ compensation benefits available to injured workers, the attorneys at Morgan & Morgan are dedicated to helping injured employees receive full benefits for their injuries.
Filing a Workers’ Compensation Claim
Most workers are covered by workers’ compensation. With only a few exceptions, it is mandatory for employers with four or more employees to provide workers’ compensation insurance for their employees. Employers in the construction field with at least one employee must carry workers’ compensation.
The majority of inadvertent injuries, diseases, illnesses, accidents, and deaths occurring at the workplace are covered by workers’ compensation laws. Further, because workers’ compensation is a no-fault system, workers are not required to prove fault for their injuries to recover benefits.
In many states, a worker must report their workplace injury to their employer within 30 days of the incident. After an employee’s initial injury report, they will have two years to file a workers’ compensation claim. The injured worker should provide specific details when first reporting the accident, such as names of witnesses, as well as location, cause, and time of day of the accident and injury. Next, they should seek an immediate medical evaluation to determine the extent of their injury by an approved, “authorized” medical provider of their employer’s choosing. Injured workers seeking a second medical professional’s opinion may switch doctors only one time.
Workers’ Comp “Independent” Medical Examination
A treating doctor’s testimony on the severity of a claimant’s injuries will greatly influence the amount of benefits awarded. To receive workers’ compensation, injured workers must submit to an independent medical examination or insurance medical exam (IME). An IME, in theory, clarifies the worker’s medical condition and determines if the injury was caused by work-related activity. While the IME is meant to provide an accurate diagnosis and recommend appropriate treatment, insurance companies often use it as a tool to limit payouts and liability. Assigned doctors can work in tandem with insurance companies to protect the financial interests of both parties, sometimes by denying the existence of an injury or wrongfully clearing an employee to return to work. To ensure that you are receiving the right prognosis, it is important to have an experienced attorney help you through the process.
Workers’ Compensation Appeals
An injured worker’s claim for benefits may be denied if the insurance company:
- Denies that an injury occurred on the job
- Accuses the employee of fraud or misrepresentation of an injury
- Blames a worker’s injury on a preexisting condition
Injured employees have the right to contest the denial of workers’ compensation benefits. Upon receiving notice of a denied claim, injured workers can file a petition with the Division of Administrative Hearings (DOAH). The DOAH will then assign the case to a judge who will schedule a hearing within 40 days.
At the hearing, the worker can present evidence showing why they are entitled to benefits. This evidence often includes the details of the workplace accident—where, when, and how an accident happened— and a detailed account of the employee’s subsequent medical treatment. An attorney may utilize medical records to clarify the extent of their client’s injuries to the judge, as well as a physician’s opinion on the employee’s ability to work and how the claimant’s work injury was directly related to his or her job. In some instances, medical experts may be called upon to attest to an employee’s ability to return to work and perform their job responsibilities going forward.
The hearing conversely serves as an opportunity for insurance companies and employers to rebut evidence and attempt to prove a worker is not entitled to benefits. After all evidence is presented and testimony is heard, a judge will typically make a decision within 30 days.
Alternative solutions may be available through mediation to settle workers’ compensation disputes. A mediator may be allowed to assist in obtaining a more creative and mutually acceptable resolution involving modified job assignments or monetary arrangements. It is advisable for an injured worker to retain an attorney even when negotiating an alternative solution, as insurance companies generally will have legal representation present at a meditation hearing.
Theme Park Workers’ Compensation
Workers’ compensation benefits may be available to many types of workers, including those employed by theme parks. While there have been many reports of theme park employees becoming severely injured, even killed on the job, workers’ compensation claims may not be a priority for large corporations. In some instances, risk-management and safety education programs in place by amusement park management benefit customers more than employees facing less-than-ideal working environments. Many amusement parks, despite citations from the Federal Occupation Safety and Health Administration (OSHA), may fail to upgrade safety conditions for their workers, resulting in potentially catastrophic job injuries.
Workplace Accidents: Cases Our Attorneys Handle
Our attorneys handle on-the-job injury claims involving, but not limited to, the following:
- Muscular injuries, broken bones, torn ligaments, torn rotator cuffs, and herniated disks from lifting, pushing, or other actions
- Sickness from exposure to toxins, including occupational diseases like mesothelioma or Black Lung
- Head injuries like concussions or traumatic brain injuries (TBIs) from falling objects or falls
- Tendonitis or other repetitive motion injuries
- Construction accidents
- Hearing loss or damage
- Cold and heat stress or burn injuries from accidents like electrocution
- Assorted injuries to the back, spinal cord, shoulder, eyes, knees, neck, hip, respiratory organs, ankles, wrists, feet and hands
These injuries may be the result of unavoidable accidents, dangerous working environments, inadequate training, or faulty machinery. Under workers’ compensation, however, employees are not required to prove the reason that their injury occurred, as workers’ compensation is a no-fault system that compensates injured workers without regard to negligence or fault.
Workers’ Compensation FAQs
What is a work-related injury?
Any injury sustained by an employee performing duties related to his or her job is considered work-related. These can include a sudden accident or repetitive motion trauma. For instance, a typist developing carpal tunnel syndrome, or any other illness stemming from the nature of an individual’s work.
Does my injury qualify me for workers’ comp?
Workers’ compensation is available to employees who suffered traumatic physical injuries, repeated trauma injuries, mental injuries and occupational diseases.
How much time do I have to report my injury and file a claim?
An injury should be reported to an employer within 30 days. An injured worker then has a two-year window to file a workers’ compensation claim.
What benefits am I entitled to?
An employer’s healthcare provider is required to pay for necessary medical treatments, testing, rehabilitation, and prescription drugs associated with a work injury. Death benefits, payment for missed work time, and compensation for permanent disability may also be available.
Are my wages covered?
An individual receiving workers’ compensation is entitled to two-thirds of their gross wages from time lost.
When can I expect to be paid?
A worker’s first check is typically received within 21 days of reporting their injury to an employer.
Can my employer fire me?
It is against the law for an individual to be fired for filing a worker’s compensation claim.
Can I sue my employer?
Workers’ compensation is an exclusive remedy, meaning an employee cannot bring an injury claim against his or her employer. An employee can, however, file a lawsuit against a third party believed to have contributed to an accident and injury.
What if I caused my own injury?
Workers’ compensation is payable regardless of fault or cause of injury under the statues of several states. The exception to this rule is if an employee’s injury was caused by any form of intoxication on the job or with willful intent to harm oneself.
What should I do if my employer won’t report my injury?
Claimants have the right to report their injuries directly to their employer’s insurance company.
If your workers’ compensation benefits claim has been denied or you are receiving inadequate benefits, please fill out our free, no-obligation case review form to learn more about how we may be able to help. Our lawyers may also be able to assist in third party claims against entities other than your employer.