Workers’ compensation insurance is, generally, no-fault insurance.  That means that once you make a claim that you suffered a work-related injury, your benefits will come through in order to cover your necessary medical expenses and lost wages.  There is no need to prove in a court of law that your injury was work-related.  

Insurance companies, however, do not have the best reputation.  That is because, many times, insurance companies in varying degrees try to find reasons not to pay on a claim.  Insurance companies realize that paying every single claim, without checking for fraud or other nefarious actions, could bankrupt the company.  Thus, there are times when an insurance company may challenge a workers’ compensation claim. 

For example, the insurance company may investigate to see whether the injury actually occurred during lunchtime or when you were not working.  Or, the company may inquire as to whether the injury was the result of a pre-existing condition that had nothing to do with your workplace.  When it comes to making sure that your work-related injury is covered, it is helpful to know how you can demonstrate the validity of your workers’ compensation claim.  

Accordingly, in this article, we will discuss the three-step process to ensure that your claim is deemed valid under the Longshore and Harbor Workers’ Compensation Act (Longshore Act), in case there is any dispute as to whether or not your injury resulted from your work.  

If, after reading this article, you have more questions about your own circumstances, then the maritime attorneys in Jacksonville at RITE Law are here to help.  At RITE Law, we have a group of workers’ compensation lawyers who have your best interests at heart, and who have the training and resources to make sure that you receive the compensation you deserve.  Our number is (904) 500-RITE or you can fill out our contact form online.  We provide a free case evaluation, so call today.

Getting the Proof to Support Your Claim

If you make a claim under the Longshore Act, and you get resistance from an employer’s insurance company, you would be wise to gather all of the evidence to support your case.

Moreover, be conscious of any evidence that might be used against you.  For example, say that you fell on the job, and you forgot to tell the doctor during the first examination that you not only hurt your leg but also your shoulder in your fall.  Failing to mention your shoulder injury early on may be used against you.  Be sure that you know all the facts so that you are prepared to address any credibility issues.

The Three-Step Process Under the Longshore Act

There are generally three steps with regard to proving that your injury was work-related.  Please note that you may not need to go through all three steps.  In many cases, your case may be resolved after just one or two steps.  But, it is good to know all three steps just in case. 

1. Your Claim Creates a Presumption That Your Injury was Work-Related

After you suffer an injury at work and get any necessary medical attention, of course, the first thing you need to do is file a workers’ comp claim.  The Department of Labor has certain forms for those claims under the Longshore Act.

In the claim, identify what happened at work and what injury you suffered.  Once you have completed the claim, a “presumption” goes into effect.  That means that as long as you state that (i) you suffered some harm and (ii) a work-related condition or accident occurred which caused the harm, then your statement of what happened is presumed to be true.  In legal terms, you made out a prima facie case.

Now, if your employer does not challenge your claim, then you are finished at step one, and you will get your compensation.  However, an employer may dispute the claim, meaning that we must move to Step Two.

2. The Employer Will Try to Undermine Your Presumption

The employer who disputes that your injury is work-related must provide “substantial evidence” to show that your statement of the facts should not be presumed as true.  An example of “substantial evidence” to rebut the presumption could be testimony from a physician, stating that there is no relationship between your injury and your working conditions.  

If the employer presents that “substantial evidence,” that does not mean that the case is over.  They have not won the case.  It means that you can go on to Step Three if you so choose.

3. Going Before an Objective Judge

At Step Three, assuming that you are now trying your claim before an administrative law judge (ALJ) from the Department of Labor, the ALJ will weigh all the evidence to resolve the question of whether your injury was caused by your working conditions.  

The ALJ may find that the employer did not provide “substantial evidence” to rebut the truth of your claim.  Then, you are eligible for compensation.  However, if the ALJ decides that the employer has provided “substantial evidence,” then the presumption goes away, and he or she will need to make a decision, which might require an evidentiary hearing. 

Without the presumption in your favor, you need to work more diligently to prove that your injury was work-related.  That requires the help of an experienced Longshore Act workers’ compensation attorney.  

Call the Maritime Attorneys in Jacksonville at RITE Law to Help You.

At RITE Law, we started the firm for one reason – to help those in Florida and elsewhere have the resources of a firm that was “big enough to fight but small enough to care.”  At Rudolph, Israel, Tucker & Ellis (RITE law), we have the resources and experience to go to trial when it is necessary, and we have the wisdom to advise you appropriately.  

Expect lots of attention, passionate representation, and a healthy disdain for big insurance companies. We believe that leads to the best result possible.  Unlike larger firms, your case isn’t handed to a paralegal or assistant to do the heavy lifting. The attorney you meet initially is the one who will be by your side every step of the way. 

We also take pride in creating an atmosphere where every client is treated like family.  Family members stick up for one another no matter what.  You should expect nothing less from the RITE Law maritime attorneys in Jacksonville.

Without help from the RITE team, making your own personal injury claims can be very difficult.  When you turn to our firm, we spring into action, making sure that every detail of your claim is addressed.  Call us for help.  Our number is (904) 500-RITE or you can fill out our contact form online.  We provide a free case evaluation, so feel free to call us today.