What to Expect in a Workers’ Compensation Case
Most claimants can expect long waits. From start to finish, the workers’ compensation process usually takes at least a year. Most cases require less time, because as the Administrative Law Judge appeal date looms closer, most cases settle out of court. However, a case shouldn’t settle too quickly. If it does, the settlement might not account for all future medical costs, which means the victim is financially responsible for them. So, a long and frustrating delay is almost inevitable,
Job injury victims should also expect some things from a Tampa workers’ compensation lawyer. Successful settlements are built on hard work, just like students who do well on homework assignments typically do well on tests. Victims should also expect no-holds-barred advocacy. A good lawyer isn’t satisfied with anything less than the best possible results under the circumstances. Finally, job injury victims should expect open, two-way communication at all times.
Initial Claims Examiner Review
A workers’ compensation claims examiner is basically a semi-independent claims adjuster. Like a claims adjuster, a Claims Examiner briefly reviews the facts of the case. Then, if at all possible, the Claims Examiner denies the claim, at least in part.
A Claims Examiner investigation is usually limited to the medical bills. Very few Examiners consider the circumstances of the accident, the victim’s employability and other non-medical disability matters, or a victim’s unique medical circumstances.
So, these examinations are incomplete, at best. In fact, there’s no guarantee the Claims Examiner will review all medical bills. Many examiners cherry-pick the bills or other documents that support their findings and largely ignore all other documents.
If a Claims Examiner offers a partial payment, many job injury victims accept that offer, just to “get it over with.”
Claims Examiner Re-Review
In most jurisdictions, if the victim appeals the initial decision, a senior Claims Examiner reviews the file. Unless the first review included an egregious error, like looking at the wrong person’s file, the senior Claims Examiner almost always upholds the initial decision.
Many victims also lose heart at this stage. They believe that if two people denied their claim, the claim must be meritless. But initial denials aren’t commentaries on the quality of a claim. They’re just part of the process.
Settlement Negotiations
A Tampa workers’ compensation lawyer typically gets involved after the claims examiner review stage. A good lawyer always tries to resolve disputes the easy way first. In this context, the “easy way” is a settlement.
To determine a claim’s settlement value, or asking price, an attorney not only looks at medical records. An attorney also looks at employment and educational records. Some injuries are disabling to some people but not others. The partial loss of function in a hand usually ends a dentist’s career, but it barely affects other workers.
Furthermore, as mentioned, attorneys consider how a work-related injury affects a certain victim. Some victims can recover faster than others.
Administrative Law Judge Hearing
If the case doesn’t settle, the matter usually proceeds to an ALJ review. An ALJ is much like a regular trial judge, but an ALJ doesn’t have quite as much power. Furthermore, an ALJ hearing is much like a trial, except no court reporter is present and no jury makes a decision.
Attorneys have full rein to make legal arguments, introduce evidence, and challenge evidence at Florida ALJ hearings.
The process usually ends here, although in some cases, a victim might appeal the ALJ’s decision to a federal judge.
Work With a Compassionate Hillsborough County Lawyer
Injury victims are entitled to important financial benefits. For a confidential consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. Virtual, home, and hospital visits are available.
Source:
ssa.gov/policy/docs/ssb/v65n4/v65n4p7.html
