First of all, let me just say, not everyone needs a lawyer. In many cases, you don’t necessarily need the involvement of workers’ compensation lawyer to obtain your benefits after a work injury. If your claim is accepted and medical care is being approved and (when applicable) lost wage benefits are being paid properly, you may not need a lawyer. However, when in doubt, you should always consult a lawyer just to be sure. A good workers’ compensation lawyer will have no problem telling you that you don’t need to pay for representation if you don’t truly need it.
I’ve listed some of the most common reasons you may need to hire a lawyer to assist with your workers’ compensation claim.
The Insurance Company Denies Your Claim
Sadly, workers’ comp insurance companies do routinely deny legitimate workers’ comp claims because they know workers’ often take their denial at face value, not knowing that they can appeal the insurance companies denial by filing a Claim Form through the Virginia Workers’ Compensation Commission. The good news: filing this Claim Form through the Commission does not cost you anything if you file it on your own! However, if the claim is still being denied by the insurance company once it is filed at the Commission, you will likely be going to a hearing and you most certainly want an experienced lawyer on your side when you go before the Commission!
Claims can be denied by an insurance company for a variety of different reasons and often times the insurance company is not very forthcoming in explaining to you the basis for their denial. Getting a workers’ compensation lawyer may be necessary to find out why the claim has been denied and if this denial is legitimate or if it can be overturned at a hearing.
You Are Offered A Settlement
In some situations there may come a point when the insurance company might contact you and ask if you are interested in a settlement. Sometimes the adjuster will call you and ask what you would be willing to settle for (hoping you won’t know what your claim is worth) or other times the adjuster may even present you with a dollar amount (which, more often than not, is not fair value for the claim). Do you know how a workers’ compensation claim is evaluated for a settlement amount? In many cases, you will find that it is best to have a lawyer to valuate your case and negotiate on your behalf to ensure that you get a fair settlement.
This is most especially important for those of you dealing with extremely complex situations surrounding your settlement.
For example –
- any injury that ends or permanently alters your career
- any injury leaving you with a permanent loss of use of a body part
- any situation where you are also dealing with Social Security benefits (there is particular settlement language that needs to be used in your settlement agreement) –OR- any situation where Medicare may be involved (you may need a Medicare Set Aside fund or MSA).
You will absolutely want to talk to a workers’ comp lawyer before entertaining a settlement if any of these apply to your situation.
Your Injuries Prevent You From Returning To Your Job
If your workplace injury leaves you permanently unable to return to your job or your chosen field because your doctor has given you permanent work restrictions, the insurance company may ask you to participate in what is called “Vocational Rehabilitation”. Vocational Rehabilitation is a program by which the insurance company will pair you with a Vocational Counselor, whose job is to help you re-enter the workforce. This process can be tricky so you’ll want a lawyer overseeing this and working to make sure you’re benefits are protected during this process and insuring that your Vocational Counselor is not over asserting the influence.
Your Injuries Prevent You From Doing Any Work At All
If your injuries have impaired you to the point that your doctor says that you are rendered permanently unable to work, the Virginia Workers’ Compensation system does have what is call “Permanent Total Disability Benefits” or (PTD benefits). PTD benefits are lifetime weekly payments that can be paid by the workers’ compensation insurance company for your loss of income. I must warn you, these benefits are extremely difficult to obtain as Virginia has a very high standard in order to qualify for these. You will absolutely need an experienced lawyer to ensure that the medical documentation you have is sufficient to qualify for these benefits and that you are applying for these benefits within the proper time-period.
You Have A Third-Party Claim
When your work injury involves a third party (someone outside of your employer), there sometimes can be a separate claim for a third party personal injury claim.
For example: If you a working as a delivery driver for ABC Company and are hit by another driver, you would likely have a worker’s compensation claim with ABC Company, but you may also have cause to bring a civil claim against the driver who hit you (the third party).
These situations can be complex as you are often times still dealing with the workers’ compensation insurance company, for things like lost wages and payment for medical care, but you may be dealing with a separate insurance company for other things, like negligence or pain and suffering, which are benefits that the workers’ compensation system does not address.
Every situation is different so if you are unclear about anything or need some guidance, call my office. It will cost you nothing to get some guidance and, as I said, a good workers’ compensation lawyer will have no problem telling you that you don’t need to pay for representation if you don’t truly need it!