What To Expect In A Workers’ Compensation Claim
Florida and most other states enacted workers’ compensation laws around 1910, when management and labor struck the Grand Bargain. Management provided no-fault insurance that covered economic losses, and workers gave up their right to sue in court. Back in the day, workers only needed to file paperwork to obtain these benefits. Now, the system is much more complicated and frustrating, as outlined below.
In this new system, a Tampa workers’ compensation lawyer is basically no longer a luxury option. Almost anyone can fill out paperwork. But almost no one, other than an attorney, can stand up for your legal and financial rights throughout the process. Insurance company lawyers do whatever it takes to reduce or deny worker benefits. An attorney does whatever it takes to maximize these benefits.
This stage was once the only stage in most workers’ compensation claims. Now, it’s just the beginning. It’s usually a very frustrating beginning for victims, mostly because the claims denial rate is so high.
Many Claims Examiners use procedural matters as an excuse to deny claims without addressing their merits. Common examples include filing a claim a few hours too late, not having the proper medical bill documentation, and showing up late to the claims examiner review.
Substantive denials often involve the aforementioned medical bills, as well as a failure to prove the injury was work-related. A medical bill, by itself, may not be reimbursable. Most Claims Examiners want proof that the procedure was reasonably necessary. Additionally, if the victim had an occupational disease, like hearing loss, many Claims Examiners automatically declare the injury wasn’t work-related.
These denials are frustrating to say the least. Injured workers need financial benefits, like medical bill payment and lost wage replacement. They need them now, not tomorrow.
As the claim moves forward, a Tampa workers’ compensation attorney addresses these deficiencies, so they don’t stand in the way of the financial benefits you and your family need and deserve.
Generally, before the claim goes to an Administrative Law Judge, a senior Claims Examiner must take a second look at the case.
Quite frankly, this stage is almost always a waste of time. Senior Claims Examiners almost never second-guess initial decisions, unless the first review was clearly wrong.
The environment changes significantly at the final stage. Insurance companies have the advantage at paper reviews, because lawyers cannot advocate for their clients. The advantage goes to the victim at an ALJ hearing. This hearing is a lot like a trial. Therefore, lawyers can challenge evidence, make legal arguments, introduce evidence, and otherwise do their jobs.
Because of this advantage shift, most workers’ compensation claims settle prior to the ALJ hearing. Insurance companies know they face an uphill climb at these hearings. They’d rather not go up those hills.
That’s also the reason most job injury claims don’t settle earlier. Since the insurance company has the initial advantage, an early settlement usually means the victim must settle for less.
Connect With a Diligent Hillsborough County Attorney
Injury victims are entitled to important financial benefits. For a free consultation with an experienced job injury lawyer in Tampa, contact Kobal Law. We do not charge upfront legal fees in these matters.