What To Expect In A Workers’ Compensation Claim
A hundred years ago, due to the Grand Bargain between workers and management, job injury victims quickly got the benefits they needed to return to work as soon as possible. Furthermore, back then, Claims Examiners had a holistic, victim-friendly view of things like lost wage replacement and medical bill payment. Today, a Claims Examiner’s interpretation is most likely much narrower and whatever an insurance company adjuster says it should be.
The demise of the Grand Bargain has been especially bad in Florida. Until recently, it was basically illegal for injured workers to partner with attorneys. Therefore, these victims were at the mercy of insurance company adjusters. These individuals only care about the company’s bottom line. Now, it’s much easier to partner with a Tampa workers’ compensation attorney. A lawyer fights insurance company lawyers and helps ensure that victims get the benefits they need and deserve.
Laying the Foundation
Workers’ compensation is no-fault insurance that replaces lost wages and pays medical bills. So, victims don’t need to prove negligence or fault. However, they do need evidence to support their claims.
Victims must prove the injury was work-related. In trauma injury claims, like falls, this element is often straightforward. Emergency medical personnel usually respond to the scene and they carefully document the time and place. If EMS doesn’t respond, the victim’s own statement is usually sufficient, since the burden of proof is so low.
Additionally, victims must prove the amount of lost wages and medical bills. This burden includes prior damages as well as future damages. Medical bills and pay stubs usually establish prior damages. The AWW (average weekly wage) is sometimes tricky. Prior lost wages include both cash and non-cash compensation, like per diem allowances.
Future damages are more problematic. Frequently, a Tampa workers’ compensation attorney must partner with another doctor to determine any future medical expenses. If the settlement doesn’t cover these costs, the victim is normally financially responsible for them. Additionally, future lost wages include irregular compensation, like lost future overtime opportunities.
Initial Examinations
As mentioned, back in the day, initial workers’ compensation reviews were fair and evenhanded. Today, insurance company interests dominate these first reviews.
As a result, most Claims Examiners deny most claims, at least in part. Generally, the insurance company hopes that victims will lose heart and either abandon their claim or settle them for pennies on the dollar. Until the recent legal changes, this strategy often worked. Now, a Tampa workers’ compensation attorney helps victims hang in there and get the compensation they need and deserve.
Usually, these awards are retroactive to the filing date. In other words, the longer the insurance company drags the matter out, the more back pay the victim receives. Additionally, only a lawyer can connect victims with top-notch doctors who charge no money upfront.
ALJ Appeals
The Administrative Law Judge appeal is usually the final step in a workers’ compensation claim. At first, victory seems unlikely in these forums. Frequently, the ALJ is a paid insurance company employee or contractor. Furthermore, an administrative hearing is not a trial. It’s not public and there’s never a jury.
However, attorneys have free reign to introduce evidence, challenge evidence, and make legal arguments.
The forum gives victims a distinct advantage. Insurance company lawyers know this, which is why they’re usually willing to settle these claims on victim-friendly terms, especially as the hearing date gets closer. In fact, almost all workers’ compensation claims settle out of court.
Reach Out to a Diligent 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. Virtual, home, and hospital visits are available.
