Workers’ compensation

If you ask a workers’ compensation insurance company when an injured employee should hire a lawyer to assist with a workers’ compensation claim, the company will probably answer “never.” Insurance companies regard lawyers as the enemy because they equalize the playing field. An unrepresented injury victim has no leverage when negotiating a settlement because insurance companies know that unrepresented victims rarely take their cases to trial before a workers’ compensation judge. The insurer’s superior knowledge of workers’ compensation law makes it possible for companies to take advantage of injury victims.

Still, it is not necessary for every injured worker to hire a lawyer as soon as they are injured. Routine cases involving injuries that are likely to heal completely can often be resolved without legal assistance. All victims of work injuries should nevertheless feel free to seek legal advice when they are uncertain how the system operates.

Workers’ Compensation in Routine Cases

Florida’s Workers’ Compensation law is designed so that simple cases can be handled without a lawyer. In those cases, the system works if injury victims understand the rules and if insurance companies play by the rules. 

The first rule for injured employees is to report a work injury to the employer immediately. Although the law gives injured employees 30 days to make that report, any delay will cause the insurance company to question whether the injury really occurred at work. 

Even if the injury feels like a pulled muscle that the employee might be able to “walk off” without medical treatment, reporting the injury immediately lays the groundwork for a workers’ compensation claim if, as is often the case, the injury becomes more painful over the next few days. Florida law prohibits employers from firing an employee simply because the employee reported a work injury. It therefore makes sense to make an immediate report of any injury that might eventually require medical treatment.

The next rule is to ask the employer (or the employer’s insurance company) for authorization to see a doctor as soon as the injury victim believes that medical care is needed. Employers are required to provide medical treatment for work injuries, but they are allowed to select the physician who will deliver that care. Workers protect their right to receive employer-funded treatment by asking for authorization to see the doctor chosen by the insurance company.

The third rule is to follow through on all recommended treatment. Don’t miss appointments with healthcare providers. Don’t ignore a referral to physical therapy. Do everything a healthcare provider recommends and don’t do anything the provider discourages. Keep in mind that the insurance company is always looking for an excuse to discontinue benefits. Missing appointments and ignoring a doctor’s orders often gives insurers an excuse to pretend that benefits are no longer necessary.

In addition to paid medical treatment, a work injury victim who follows the rules will be eligible for temporary disability benefits after missing work for 7 days because of the injury. Those benefits continue until the physician clears the employee to return to work or until the injury has healed as much as it ever will. Benefits must usually end after two years, but most injuries heal completely or reach maximum healing before employees reach that two-year limit.

The insurance company should pay temporary disability benefits whenever their chosen doctor agrees that an employee is unable to work because of the injury. Partial temporary benefits are paid when an employee is only able to return to work in a position that pays a lower wage. If the insurance company pays the temporary total or partial benefits that Florida law requires, it should not be necessary to hire a lawyer.

When to Hire a Lawyer

Unfortunately, insurance companies are notorious for trying to avoid the payment of benefits. An injury victim who encounters resistance to a request for medical treatment or temporary disability benefits should consult a lawyer immediately.

More complex cases, including injuries that result in permanent disabilities, are not resolved as easily as routine cases. Benefits for permanent disabilities are paid when temporary disability benefits end if the employee has a continuing impairment that is no longer healing. 

The compensation that must be paid for a permanent disability always involves a degree of judgment. Compensation usually requires an interpretation of the facts. Insurance companies always interpret the facts in their favor. Their judgment is biased toward paying minimal benefits to increase the insurance company’s profits.

Injured workers typically benefit by hiring a lawyer when they have a permanent disability. Studies show that hiring a lawyer usually results in a larger payment of benefits that more than offsets the modest fee that lawyers are allowed to charge in workers’ compensation cases. Thus, while there may be times when an injured worker needs a lawyer earlier in the process, it is usually true that an injured worker will want to hire a lawyer if the worker develops a permanent injury based on employment. 

Health conditions that develop over time, such as carpal tunnel or diseases caused by exposures to toxic chemicals, are also outside the universe of routine cases that can often be resolved without a lawyer. Insurance companies often deny that those injuries are work related. In an effort to deny benefits, they also contest the date on which the employee should have reported the injury. Employees can protect their rights by obtaining legal advice as soon as they realize their health condition might be related to employment.

The Insurance Industry’s Anti-Lawyer Propaganda Campaign

When insurance companies and their law firms put on seminars for employers, they routinely disparage lawyers who represent injured workers. They complain that lawyers force companies to pay benefits that would not be paid if the lawyer did not interfere.

The real complaint made by insurance companies is that workers’ compensation lawyers are effective. Their campaign against lawyers is largely directed to the Florida legislature, which too often gives insurance lobbyists everything they want. However, insurance companies have also tried to poison the minds of injured workers against lawyers who want to protect their right to receive full benefits for work injuries. No injury victim should ever be discouraged from seeking legal advice. Too often, the workers’ compensation system doesn’t work until lawyers for injury victims make it work.