Don't Rely on an insurance company or employer to protect your rights.
Worker's Compensation is that area of the law which provides medical and disability benefits to injured workers. It differs from personal injury claims in that it is governed by a series of statutes, rather than common law. Because the rights and obligations of interested parties (the worker, employer and insurance company) are more or less clearly defined in the statutes, many if not most worker's compensation claims do not necessarily require an attorney. However, disputes do often arise, and it often behooves a client to seek legal counsel. Attorneys, including this office, often offer to represent a client on a contingency basis, which is limited in most cases to a 20% fee against the value of permanent disability benefits ultimately ordered. The attorney's fee agreement should clearly define the basis of any fee.
Following is a simplified description of the law:
A person is entitled to benefits if they are injured in the course and scope of employment. The claimant need not show the employer or anyone else (including the claimant) was at fault for the injury. Upon being injured, a claimant is entitled to:
Reasonable and necessary medical treatment;
Temporary Disability Benefits, either total or partial ("TPD" or "TTD"), if the claimant is missing work, equal to 2/3 the claimant's average weekly wage;
Permanent Impairment Benefits, often called Permanent Partial Disability ("PPD"), if there is a permanent impairment resulting from the injury; before such a rating is given, the claimant must be at "maximum medical improvement" ("MMI"), which is a determination that medical treatment will not improve the patient's condition, even though it might be required to maintain the claimant's condition; and
in relatively rare cases, Permanent Total Disability benefits, if a person can no longer be employed in any capacity.
While the above may seem relatively straightforward, needless to say disputes can arise in any number of areas, such as, was the claim denied unfairly, is the claimant getting appropriate medical treatment, what is the actual average weekly wage, and/or is the claimant at maximum medical improvement, or is more medical care required.
Another complication can arise if you are injured by a third party. For example, if you are driving for work and your car is struck by a negligent driver, you have a right to worker's compensation benefits and damages for bodily injury caused by the negligent driver. In such situations a claimant would be well-served consulting an attorney.
Disputes are resolved by an administrative law judge, through a separate court-like system set up to resolve worker's compensation claims as well as other administrative claims.
If you have questions as to whether you are being treated fairly on your worker's compensation claim, I urge you to contact this office for a free consultation.