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What To Expect In A Workers’ Compensation Claim

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One thing you should not expect in a workers’ compensation claim is a fair amount of benefits. Since 2013, wages and medical bills have increased significantly. But the wage replacement and medical bill payment benefits have both declined by double digits over this same period, according to a recent study. In other words, the economic losses are worse and the benefits are lower. Injured workers are caught in the middle.

Before 2013, when benefits were relatively high, an attorney was basically optional in these cases. Things are different today. If you want a fair-sized piece of a shrinking financial pie, a Tampa workers’ compensation attorney is absolutely essential. Insurance company interests dominate the bureaucracy, and insurance company lawyers work hard to reduce or deny benefits in these cases. You need a lawyer on your side to level the playing field.

Types of Workplace Injuries

Generally, Florida workers’ compensation insurance replaces lost wages and pays medical bills related to:

  • Trauma injuries, such as falls, and
  • Occupational diseases, such as hearing loss.

The wage replacement benefit usually pays two-thirds of the victim’s average weekly wage for the duration of a temporary disability. If the injury causes a permanent disability, such as permanent hearing loss, a lump-sum payment may be available. The size of this payment usually depends on the nature and extent of the disability.

Additionally, workers’ compensation pays all reasonably necessary medical bills. That category usually includes all expenses, from the first moment of emergency care to the last day of physical therapy. Ancillary costs, like transportation expenses, are usually covered as well.

These benefits are no-fault benefits. Injured victims need not prove fault, negligence, or anything else. They only need establish that their illness or injury was work-related. Full compensation is usually available even if a pre-existing condition, like a bad knee or prior hearing loss, contributed to the work-related injury.

Initial Determinations

This section will be very brief, because most initial determinations are the same. Claims Examiners usually deny workers’ compensation petitions, regardless of the facts. These bureaucrats hope that an initial denial frustrates claimants and either prompts them to drop their claims or settle them for pennies on the dollar. Frequently, that’s what happens.

So, it’s important not to lose heart. An initial denial is par for the course. The denial does not mean your claim is weak or meritless. It’s simply your ticket to proceed to the next level.

Workers’ Compensation Appeals

The next level is usually a trial-like hearing before an administrative law judge. In many ways, an ALJ is a lot like a state or federal judge. ALJs may consider evidence as well as legal arguments. About the only difference is that ALJs have no authority over nonparties.

Due to the nature of the ALJ hearing, many workers’ compensation claims settle between the initial denial and the appeal date. Insurance company lawyers know there’s a big difference between an initial paper review and a subsequent ALJ hearing. Claimants have almost no chance of winning an initial review, but at the ALJ hearing, the odds are roughly even. So, rather than risk a hearing, the insurance company often settles a claim on victim-friendly terms.

Contact an Experienced Hillsborough County Attorney

Injured workers are usually entitled to substantial compensation. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. We do not charge upfront legal fees in these matters.

Resource:

businessinsurance.com/article/20191101/news08/912331461/comp-benefits-paid-to-workers-continue-decline-study-says

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