What to Expect in a Workers’ Compensation Matter
Above all, job injury victims should expect a fight, especially over damages (amount of lost wages and medical bills). Insurance companies earn almost $1.5 trillion a year. They’re determined to hold onto as much of this money as they can. They’re willing to invest some of it, mostly in legal fees, to accomplish that goal.
A Tampa workers’ compensation lawyer cannot possibly match insurance company resources. No lawyer can do that. But a workers’ compensation lawyer has something insurance company lawyers don’t have, which is dedication to a cause. Dedication to dollars only goes so far. Dedication to victims’ rights goes much further and provides plenty of fuel for the fight ahead.
Claims Examiner Evaluation
A few weeks after injured workers file claims, a Claims Dexaminer usually reviews the available medical records and, based on that paper review, approves or denies the claim.
These medical records are often misleading, especially in states like Florida which force injured workers to see company doctors. These records only include the information the doctor wants to include. So, upon review, the Claims Examiner basically only sees one side of the story.
Furthermore, a Claims Examiner is usually an insurance company employee. Quite simply, insurance companies lose money when they pay claims. And we’ve already discussed how insurance companies feel about money.
Usually, Claims Examiners hope that early denials frustrate victims and prompt them to abandon their claims or settle them for pennies on the dollar. This strategy usually works, unless a victim partners with a Tampa workers’ compensation lawyer and prepares for the next step.
Claims Examiner Re-Evaluation
This section won’t be very long. The next step in the workers’ compensation process is usually a senior Claims Examiner re-review. Sometimes, inexperienced Claims Examiners overlook important facts or make clearly erroneous decisions.
Technically, a senior Claims Examiner usually has broad power to overrule a previous determination and reassign it to another Claims Examiner, where the process starts over. Usually, however, senior Claims Examiners only assert this power in rare instances. No one likes to second-guess their colleagues.
Administrative Law Judge Hearing
To prepare for this hearing, an attorney usually starts by collecting additional medical evidence. These reviewing doctors usually charge nothing upfront for their services. Therefore, when the ALJ reviews the case, s/he has access to much more evidence than was available before.
Sometimes, the ALJ doesn’t review the case at all. Instewad, it settles prior to the hearing. Insurance company lawyers know that the ALJ stage is not a pushover stage, like the first two. They don’t want to cross swords with a well-prepared and determined attorney at an ALJ hearing.
These hearings resemble full-blown trials. Attorneys can introduce evidence, challenge evidence, question witnesses, and cross-examine them. When attorneys are free to do what they do best, good things usually happen.
There is one potential fly in the ointment. Usually, the ALJ is either a paid insurance company employee or an independent contractor paid by the insurance company. However, in most cases, ALJs are also lawyers. So, they know the importance of an independent review, and that’s what they normally provide.
Count on a Dedicated 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.
Source:
iii.org/fact-statistic/facts-statistics-industry-overview
