The Big 13 Signs – You Need to Call A Workers' Compensation Lawyer
Some of the signs below happen before the claim is ever denied. Others happen with accepted claims. Read this blog article to learn all the signs that you need to call a workers' compensation lawyer for help with your claim. By identifying issues early, you have the greatest chance of success in overcoming them.
The Workers' Compensation Insurance Carrier Denies Your Claim
The most common sign that you need to call a workers' compensation lawyer is your claim is denied. If your claim is denied, then you need to speak with a workers' compensation lawyer for sure. If your claim is being wrongly denied, then you need to appeal the decision which requires a court process.
Your Claim Has Been Placed on “Delay” or Delayed Status” By The Adjuster
If you have been injured at work and filed a claim, but the adjuster has placed your claim on hold or “delay” status, this is a sign that you need to speak with an attorney. Insurance companies do this when they want more time to investigate the claim or they are waiting for more information from the employer or treating doctor. If your claim has been on hold for more than a couple of weeks, it is time to call a work injury lawyer.
You don't get paid temporary disability payments while your claim is on delay. If your claim is ultimately denied, then you could end up never paid. You need to apply for State Disability through the California Employment Development Department (EDD). This is a safety net that protects you if your claim is ultimately deemed not work related. But if the employer loses the appeal, then the employer must pay the money back into your EDD Disability account.
You Are Experiencing A Workers' Compensation Injury From Repetitive Work Activities
The claimant did not know that the incident occurred at work and so does not report it. This is frequently the case when a minor injuries happens at work over time and is not reported. The injury gets worse by continuing to work, and the employer/carrier claims that the initial injury didn't happen on the job.
You Have Developed Disease Due To Toxic Exposure At Work
Toxic Exposure can happen at once or over a period of time. Toxic exposure is similar to a repetitive work activities claim where exposure happens in smaller increments over a period of time. The worker develops serious and debilitating injuries due to this exposure at work.
Unfortunately, these types of work comp. claims also go unreported for many years just like injuries due to repetitive work activities.
Your Injury Happens Without Any Witness Except For Yourself
Employers and their insurance carriers often question the validity of injuries that happen when no one is around. This could be because you are working a remote job site, graveyard shift, or other situation where no one is around to see the injury.
The adjuster might choose to deny your injury due to a lack of factual evidence to support the claim. Of course you have your own testimony and other corroborating evidence.
Your Employer Refuses to Provide You With A Workers' Compensation Claim Form
It often happens that the employer refuses to provide the employee with a claim form. The claim form is the document that starts your claim with the insurance company. If you haven't received a claim form, then it's a red flag. You are not being treated properly unless your employer provides you with a claim form, reports it to the insurance, and helps you get medical treatment.
Sometimes the employer will send an injured worker to the doctor and pay for it out of pocket. This is not correct. Your employer is to report the claim to their insurance carrier. An insurance adjuster should be assigned who starts benefits.
Your Insurance Adjuster Is Not Paying You Benefits
The insurance adjuster assigned to your workers compensation claim is in charge of paying you benefits if you are off work due to work-related illness or injury. If it's been more than 14 days and you haven't received a check, then it could be late payment.
In California, you must miss more than three consecutive days before your benefits start. If you miss more than 14 days, then the three day waiting period does not apply. If your adjuster is not on top of it, then you aren't getting what you need. Consider speaking with a workers' comp. lawyer for help.
Serious Injuries Resulting In Permanent Disability
If you have a permanent disability that will keep you from ever fully resuming work – insurance companies are more inclined to fight such claims because they are the most expensive. They will do everything they can to avoid or minimize the amount they have to pay you. This is especially true if you are seeking a lump sum settlement for your injuries.
If you are permanently disabled and unable to return to work, the insurance company is likely to deny your claim. They will try to find some way to say that your injury is not work-related or that it happened outside of work. If you are unable to return to work, then you need the help to get the benefits you deserve.
Injuries that Require Surgical Procedures to Cure
Surgery is often needed in cases of serious injuries. The problem is that insurance companies will do everything they can to avoid authorizing surgery. They will try to find another way to treat your injury that is less expensive. If you need surgery, then you might need the help of a workers' compensation lawyer to get the insurance company to pay for it.
Pre-Existing Conditions That Might Conflict With Your Workers' Compensation Claim
You have a pre-existing condition – If you had neck problems previously and lifted a heavy item, your employer is likely to blame your current discomfort on the pre-existing condition. They will try to deny your claim or minimize the benefits you are entitled to. If your pre-existing condition is related to a prior workers' compensation claim or recent automobile accident, then you definitely should be looking for professional guidance.
Employer Retaliates Against You For Reporting The Work Injury
Your employer retaliates against you for reporting the work injury. If you feel that you were terminated, demoted, or negative employment action, then you might have a discrimination claim. California employees are protected by Labor Code section 132(a). If you are disabled due to your injury, then you are also protected by the Fair Employment Housing Act (FEHA) and the Americans With Disabilities Act (ADA).
You Expect to Apply for Social Security Disability Payments
If you expect to apply for Social Security Disability, then you should consult a lawyer first. Social security, or SSDI, is a plan that covers Americans who become disabled. This type of federal social insurance coordinates with workers' compensation. You should consult with a work comp attorney for help structuring a settlement to eliminate credits and offsets.
Negligent Acts of Someone Other Than Your Employer
Also known as a ‘third-party claim” – this happens when someone other than your employer or co-worker negligently injures you at work. The most common example is a car accident while making a delivery. It could also happen on a construction site by a different contractor, or a slip and fall while making a delivery at a warehouse.
If someone other than your employer caused your injuries, you can file a civil claim against them. Pro Tip: Your employer has a right to reimbursement for anything you collect on the civil claim.
You Need to Call A California Workers' Compensation Lawyer
All of the above signs were developed through the real-life practice of workers' compensation law in California. Remember, legal blogs are general information only. They are meant to help you, but they are not legal advice. For legal advice, you need to call a California workers' compensation lawyer. Call us at 866-NAPOLIN for a free consultation pertaining to your case.
- The Big 13 Signs You Need to Call A Workers' Compensation Lawyer - November 9, 2022
- The Ultimate Qualified Medical Evaluation FAQ (Frequently Asked Questions) - November 2, 2022
- Workers Compensation and Working From Home: What You Need to Know - October 26, 2022