What to Expect in a Workers’ Compensation Matter

Most job injury victims can expect a workers’ compensation settlement. About 90 percent of civil claims, including workers’ compensation claims, settle out of court. These resolutions greatly benefit victims, mostly because a settlement is a final resolution. When the insurance company settles a case, instead of tying the matter up in appeals courts, it immediately writes a check. However, as outlined below, settlement is a process, not a result.

Workers’ compensation settlements, which usually include money for lost wage replacement and the payment of reasonably necessary medical bills, are available to trauma injury and occupational disease victims, as long as the illness or injury was work related and a narrow defense, such as intoxication at the time of injury, doesn’t apply. A Tampa workers’ compensation lawyer carefully navigates a claim through the complex process to obtain maximum compensation. Indeed, the average attorney-negotiated settlement is over three times higher than the average non-attorney-negotiated settlement.

Filing the Claim

As mentioned, workers’ compensation applies if the illness or injury was work-related. The pre-existing condition rule often comes into play at this point.

Maximum benefits are available if a Tampa workers’ compensation lawyer proves that the job injury or illness aggravated the pre-existing condition, instead of vice versa.

Assume Janet hurt her knee playing college basketball. When she graduates and gets a job, she injures her knee at work. If her bad knee contributed to the risk of re-injury, maximum benefits are available. Usually, an attorney partners with an independent doctor who reviews records and/or examines the victim to provide the necessary evidence. This step is especially critical in Florida. Most job injury victims must see company doctors.

Hearing loss, perhaps the most common work-related occupational disease, is another example. Most people hear loud noises all the time and not just at work. Once again, only an experienced doctor can draw the line between substantial cause and contributing cause.

Initial Review

At an initial review, which usually happens shortly after victims file claims, Claims Examiners usually deny claims, often for technical reasons.

These technical reasons include a failure to file in the proper format, missing a filing deadline, or missing a scheduled medical appointment. Claims Examiners usually have zero tolerance. Because workers’ compensation insurance premiums have consistently dropped over the past several years, there’s less money in the system, and more pressure on Claims Examiners to deny claims.

Victims should not let denials get them down. More than likely, they have strong, meritorious claims. An attorney simply needs to fine-tune them and prepare them for the next level.

ALJ Appeal

Claims Examiner reviews are paperwork reviews. Administrative Law Judge appeals, on the other hand, are essentially trials. At these hearings, attorneys have the chance to introduce evidence, challenge evidence, and make legal arguments.

So, the environment changes radically, and in favor of the victim. Most insurance company lawyers know they’re in trouble at this point, and they’re motivated to make victim-friendly settlement offers.

 Connect With a Tough-Minded 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.