What To Expect In A Workers’ Compensation Claim

In 2020, American employers reported almost three million nonfatal workplace injuries. Most of these injuries caused the victims to miss a substantial amount of work. Additionally, the average injury-related hospital bill is over $55,000. This one-two financial punch is more than many families can endure, especially since most people live from paycheck to paycheck.

These families badly need workers’ compensation benefits, like medical bill payment and lost wage replacement. However, these families lack the means to hire a lawyer to represent their interests. A Tampa workers’ compensation lawyer works on a contingent fee basis. So, these victims pay nothing upfront for quality legal representation. That’s a very good thing, because the workers’ compensation system is very complex, and insurance companies fight job injury claims tooth and nail.

Covered Injuries

Usually, workers’ compensation covers both trauma injuries, like falls, and occupational diseases, like hearing loss.

This no-fault insurance applies if the injury was work-related. Florida law defines this phrase in broad, victim-friendly terms. For example, if Lisa hurts her knee during a company softball game, she’s probably eligible for workers’ compensation benefits. More than likely, playing shortstop isn’t in Lisa’s job description. However, the employer benefited from the game, largely because of the free advertising it generated. Therefore, her injury is compensable.

This no-fault insurance also applies if the victim had a pre-existing condition. If Lisa had a bad knee due to a prior sports injury, workers’ compensation still applies, if the job injury aggravated her pre-existing condition, as opposed to the other way around. If necessary, a Tampa workers’ compensation lawyer can work with an independent doctor and obtain the evidence necessary on this point.

Claims Examination

Initially, a Claims Examiner evaluates the case, largely based on the medical records. Lawyers can help victims present their cases. But they cannot advocate for them. As a result, the Claims Examiner usually denies the workers’ compensation claim, at least in part.

Don’t get discouraged. This denial doesn’t mean your claim is weak or meritless. This denial is just your ticket to the next level, where there’s a much better chance of obtaining maximum compensation for your serious injury.

Administrative Law Judge Appeal

This next step is an appeal before an administrative law judge. These hearings are a lot like civil trials. However, there’s no jury and usually no court reporter.

The burden of proof is rather low in these claims. Victims must only prove that the injury was work-related and their medical expenses were objectively reasonable.

ALJ hearings are much more wide open than preliminary claims examinations. Attorneys can introduce additional evidence, challenge existing evidence, and make legal arguments. As a result, workers’ compensation claims often settle on victim-friendly terms prior to the ALJ hearing. Insurance company lawyers know their cases cannot withstand that level of scrutiny.

Count on a Thorough Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We do not charge upfront legal fees in these cases.

Source:

bls.gov/news.release/pdf/osh.pdf