How to Win a Workers’ Comp Case

Workers' compensation is a deal made by many employers for the sake of their employees: If you get hurt or sick while working for them, then they will cover your medical bills and living expenses to help you get on track.

Unfortunately, sometimes employers aren't so willing to hold up their end of the deal. Employees find themselves stuck with minimal coverage and forced to struggle financially on top of physical or mental pain. Even worse, workers' comp offered by employers often turns out to be empty promises where instead of supporting the well-being of their workers, they choose to fight tooth and nail to deny compensation altogether, regardless of evidence.

Determine If You Are Eligible For Workers' Comp

You may have workers' compensation at your workplace. Not all states require employers to provide workers' compensation, so check to see if you are covered. Before moving forward in trying to get these benefits, make sure that you actually meet all necessary requirements.

4 basic eligibility requirements

• Be employed by an employer that provides workers' compensation
• Have an injury or illness that happened while you were performing work duties
• Be certain that your injury is covered by workers' compensation in your state.

(Some states will cover stress and psychiatric injuries.)

• Satisfy reporting and filing deadlines

In addition to determining eligibility, it is essential to get a good understanding about what benefits are available to you. They could fall under the following categories:

• Temporary disability benefits
• Permanent disability benefits
• Medical treatment only to cover basic medical care
• Mileage only for doctor's visits

What To Do When You Get Hurt Or Become Ill On The Job

• Notify your employer IMMEDIATELY

Make sure that you report your injury to them before the company deadline. It may be as many as 45 days or as little as 2 days. If you can't report for yourself, make sure that someone you trust tells your employer for you. Failure to report is a large reason why employers resist providing workers' comp. When an insurance adjuster asks you about what happened, be very careful about what you say.  Every. Little. Thing. Will be recorded. It is wise to get legal advice before agreeing to be recorded.

• Cover your bases regarding medical care

Whatever you do, do NOT put off medical care. That alone will be a strong argument against why you deserve certain workers' compensation benefits. They will likely claim that you must not have been hurt that bad if you could just put it off. Also, it is vital that your doctor knows that you were injured while on the job.

• It is possible that your employer or insurance carrier will expect you to go to the doctor of their choice. If the doctor seems questionable, it could be worth the extra effort to go through the necessary procedure to switch doctors. If you already sense something is feeling shady, it could be extremely beneficial for you to get advice from a workers' compensation lawyer straight from the beginning.

• It is also likely that you will need to get an independent medical exam (IME) to satisfy requirements for workers' compensation. You should know that the main reason for this exam is for the doctor to determine their opinion about your condition and report it to the insurance company, not necessarily to treat your condition.
• Take photos and keep all documentation for medical records. It's a good idea to organize it all in a binder or folder. It is even better if you take the time to make a second copy or scan the original copies for digital files. The point is, you don't want to lose these documents, because they can make or break your case.
• Do not simply sign a medical authorization request from the workers' compensation insurance agency. Make sure that you read all fine print and consider the appropriateness of the date ranges that they are requesting what should be limited access to your medical information.
• In addition, make sure you follow all medical advice. This is not only because of the fact that it is probably best for your health and healing, but it is also important for you to get your workers' comp benefits. If your employer insists that you return to work, make sure that your doctor gives you a work release before returning.
• Whatever you do, don't push yourself to do anything you have told your employer you cannot do. Certainly do not post yourself on social media, because it can and will be used against you if possible. Some employers go so far as to have investigators follow their employees and even videotape them. If they catch you doing anything that doesn't match your claims, you could lose any and all benefits.

• Document how the injury occurred or how the sickness developed

Again, put all of this in a binder or folder to organize all of your injury photos and documents associated with this workers' compensation case.

• Take the time to thoroughly write down all the details about how it happened, similar to a diary. Note all key dates (when injured, notified employer, accident report, appointments, absences, meetings). Keep track of phone calls and note what you talked about as well as the name of the people you speak with, date, and time. If there were others that witnessed you get hurt or noticed your symptoms, take note of who they are. Also, make detailed notes about whatever product or work equipment harmed you. (A defective product could qualify for a separate lawsuit. Check out our article “Do I Have A Defective Product Lawsuit?” for more information.)
• Get witness statements written down with consent, and their signatures wouldn't hurt either. It is important to get these as soon as possible so that faulty memory can't be used in the defense.
• Fill out all necessary paperwork that your employer requires injured and sick employees to complete for workers' compensation. Sometimes employers purposely make it difficult to get the forms, but your state workers' compensation agency can help with this issue. A workers' comp lawyer can also help with this as well as help guarantee that all forms are properly filled out.
• Be sure to file your claim by the deadline. Federal employees have three years to file. Otherwise, state laws differ, so be sure that you are certain what the deadline is for filing compensation in your state. Check your state's workers' comp page on our website (go here to search), or ask a local workers' comp attorney what to do. Most of these attorneys offer free consultations to discuss your situation. It may still be okay to file after the statute of limitations, but it is not guaranteed.

• If you are a member of a union, contact them to tell them about your injury.

You may need their help, or you may not, but communicating with them from the beginning is in your best interest. If your workers' compensation ends up resisting or denying your claim, your union can step in to support you.

Denied? Appeal it.

If you are denied, this is where you will definitely want to hire a lawyer for help if you haven't already. It's a complicated process, and although this may be new territory for you, it is likely that a resistant employer or insurance company has been in legal battles in the past.

Truth is, they will likely have their defense assembled before the first hearing. They may come after you with claims that you were careless or neglectful in order to shift the blame to you. If you ending up working at all after your injury (even in a modified position), they could use this against you. If your IME was scheduled after you have significantly improved, they are likely to accuse you of exaggerating your injuries or illness. Surveillance could be used against you. They could have a team of individuals to “help you” get back to work, but really these same individuals are reporting back to the employer in order to help build the employer's defense. Insurance companies are for-profit and the employers (particularly those eager to assume that everyone is lying about the suffering of their injuries) are mainly interested in minimizing costs and meeting their bottom line.

The best way to handle this is to hire a qualified workers' comp lawyer who is already familiar with all of the tricks that could be used to discredit you. Thankfully, many of these lawyers work on a contingency basis, so that means if you don't win your case, they don't get paid, and if you win, they get an agreed upon portion of the winnings. A seasoned lawyer will help you determine the best legal strategy and provide you strong representation so that you have a good fighting chance, even against the big guys. If you have a lawyer, they can attend many legal meetings and appointments, and they will litigate on your behalf. They handle all the hard work while you focus on your recovery. Time is of the essence in a workers' compensation case, so act now and find a dedicated workers' comp lawyer in your area now.