Why Workers’ Comp Claimants Hire Attorneys

By Denise Johnson | May 17, 2012

  • May 17, 2012 at 4:11 pm
    Exadjsuter says:
    Like or Dislike:
    Thumb up 1
    Thumb down 1

    Fear of claim denial, ya, that’s it. Nothing to do with all those TV ads, full page yellow page ads and magnetic refer tags or bill boards. Fear, who’d thought.

  • May 17, 2012 at 4:19 pm
    MaryAnne McGinley-Slick says:
    Like or Dislike:
    Thumb up 1
    Thumb down 0

    Sometimes the claimant will get an attorney, no matter what. They are frequently advised by friends and neighbors that they need an attorney, and mistrust of the insurer or TPA is also rampant. This is why it is so critical to open communication with the claimant as quickly as possible. Establish trust. And also sometimes they think they are sticking it to their employer. The longer a claimant is home without communication, the worse everything gets.

  • May 18, 2012 at 8:36 am
    Rich says:
    Like or Dislike:
    Thumb up 6
    Thumb down 0

    As an ex workers’ comp adjuster in MD, DC, DE, NJ, and PA I’ve seen all types of injuries. I saw all types of injured workers. From kids in their 20’s to men/women in their 70’s. The one’s who became attorney represented were 1) the ones who were unfamiliar with the system 2) career claimants 3) felt that they were being treated unfairly.

    Your always going to have career claimants, it’s human nature. The employers just need to find a better way of weeding them out during the hiring process.

    Dealing with the ones who are unfamiliar and who thinks they are being unfairly is simple. Take the time to talk to the injured worker. Whether you are the employer or adjuster you have to be there for them. They have to feel that someone is sitting in their corner.

    There have been to many times when I have heard from the injured worker that the employer is treating them differently, doesn’t even call to see how they are, etc. Little do they know that behind the scenes the employer is following up with the adjuster weekly to make sure the treatment is going smoothly.

    If you want lower attorney rep rates: SHOW THE INJURED WORKERS YOU CARE

    • August 4, 2012 at 7:59 pm
      Darrin says:
      Like or Dislike:
      Thumb up 0
      Thumb down 0

      Hi Rich, you are absolutely right when it comes to a lack of communication between the employer and the injured worker. I injured myself in June 2012by slipping and falling resulting in a dislocated finger on my left hand (my writing hand) and a radical fracture on the right arm and didn’t want to hire an attorney to get at least my medical bills paid. As soon as there was an issue unrelated, I was laid off the schedule, but wasn’t fired. I felt that by being with the organization for 6 years, it would not look good to still hire an attorney, but I was getting to the point of doing so because my employer wasn’t communicating with me.

      Strangely enough I went to pick up my belongings today and there was a letter waiting for me. It was from Progressive Medical selected by the employers Insurance company to administer a prescription drug program for my workers’ compensation prescription plan. Enclosed are two Workers’ Compensation Prescription Drug Cards.

      I never filed the claim and know that my employer did on my behalf. What would be my next steps to insure that I am compensated for my injures, pain and suffering, and medical bills? Do I need to hire an attorney of do I have the option of making a demand for settlement myself or through a representative?

      Thanks!

      • August 6, 2012 at 10:51 am
        Rich says:
        Like or Dislike:
        Thumb up 0
        Thumb down 0

        Hi Darrin,

        While it’s not a surprise to me that your employer filed the claims, it’s surprising they didn’t advise you. A lot of times, the employers will try and pay for the bills themselves until they realize the true cost medical bills.

        This is what you need to do (keep in mind this is my opinion):

        1) Talk to your HR, boss, workers’ comp coordinator – somebody who handles the workers’ comp at your employer. Find out the internal process of your employer. Determine who the workers’ compensation insurance carrier is and the adjuster handling your claim. Was their an incident report filed with your company?

        2) Contact the adjuster, aspa. The adjuster is their for you. Keep in mind they are very busy, so treat them with respect and you will get it back. Advise them of all the places you treated. Depending on the state where you were injured, the moment the doctor knows its workers’ comp they wont treat you until they have authorization from the adjuster. Find out the mailing address to send medical bills and reports.

        3) Call the doctor and advise them where to send the medical bills and reports, your claim number, and the adjusters name

        4) Not knowing your full status, it’s hard for me to give you any much advise other then the above. Some follow up questions I would ask you is if you have been paid lost wages? Who has been paying the medical bills? Your status of treatment? Did you have hardware put into your arm? The results of the treatment? Your type of job?

        5) It is always my opinion to stay away from an attorney. Of course their are situations where you would want an attorney, but in you case, I would say no. Settlement’s occur at the end of the claim, when your treatment has concluded. The type of settlement depends on the state you were injured. Settling a claim involves the insurance carrier obtaining an independent medical exam to rate your injury. You would have to do the same. (You could obtain your rating from your treating doctor). The settlement amount would usually fall in the middle of the two rating whether you have an attorney or not. The difference is that the attorney will obtain 20% of your settlement.

  • August 6, 2012 at 10:50 am
    Rich says:
    Like or Dislike:
    Thumb up 0
    Thumb down 0

    Hi Darrin,

    While it’s not a surprise to me that your employer filed the claims, it’s surprising they didn’t advise you. A lot of times, the employers will try and pay for the bills themselves until they realize the true cost medical bills.

    This is what you need to do (keep in mind this is my opinion):

    1) Talk to your HR, boss, workers’ comp coordinator – somebody who handles the workers’ comp at your employer. Find out the internal process of your employer. Determine who the workers’ compensation insurance carrier is and the adjuster handling your claim. Was their an incident report filed with your company?

    2) Contact the adjuster, aspa. The adjuster is their for you. Keep in mind they are very busy, so treat them with respect and you will get it back. Advise them of all the places you treated. Depending on the state where you were injured, the moment the doctor knows its workers’ comp they wont treat you until they have authorization from the adjuster. Find out the mailing address to send medical bills and reports.

    3) Call the doctor and advise them where to send the medical bills and reports, your claim number, and the adjusters name

    4) Not knowing your full status, it’s hard for me to give you any much advise other then the above. Some follow up questions I would ask you is if you have been paid lost wages? Who has been paying the medical bills? Your status of treatment? Did you have hardware put into your arm? The results of the treatment? Your type of job?

    5) It is always my opinion to stay away from an attorney. Of course their are situations where you would want an attorney, but in you case, I would say no. Settlement’s occur at the end of the claim, when your treatment has concluded. The type of settlement depends on the state you were injured. Settling a claim involves the insurance carrier obtaining an independent medical exam to rate your injury. You would have to do the same. (You could obtain your rating from your treating doctor). The settlement amount would usually fall in the middle of the two rating whether you have an attorney or not. The difference is that the attorney will obtain 20% of your settlement.

  • June 21, 2016 at 11:53 am
    Beth says:
    Like or Dislike:
    Thumb up 0
    Thumb down 0

    We have an employee who hired an attorney but never reported an injury to his manager or anyone.
    The first we heard of this was the attorney demand letter. My question is simple but here are the details.
    if the company has to go through the legal process and prove, they were never notified of an injury, when notified by attorney letter filed a notification with the legal time frame and can prove this due to time off requests records, witnesses etc. Who ends up the winner here?
    1)The employer has lost time and money,
    2)the employee doesn’t get a thing (if the system works)
    3)and the employees attorneys lost the case.
    Does the employer still have to pay their WC company for the legal fees, even though the employee’s case was denied or invalid?

    It just seems like such a wide open scam for Workers Comp Attorneys to use. They can talk someone into filing a case, regardless of validity, and it is a 50/50 for them and the employee has nothing to loses (pay if you win most likely, but the employer gets stuck with legal fees even though they did nothing wrong. I’m just trying to figure out how this could help eliminate or even reduce FRAUDULANT claims if the employee and the hired(pay if you win) attorney basically have nothing to lose.
    Please tell me this is NOT how it works.

    Thanks

  • June 14, 2017 at 2:03 pm
    Like or Dislike:
    Thumb up 0
    Thumb down 0

    Great article on the differences from state to state on who requests an attorney for workers comp. I did find it interesting that Maryland was the highest. Why do you think studies found that older workers were more likely to get attorneys? Interesting findings!

  • July 6, 2017 at 1:26 pm
    Derek Dewitt says:
    Like or Dislike:
    Thumb up 0
    Thumb down 0

    Excellent article on workers comp attorneys and processes! I really like how Savych mentions that an employee is more likely to hire an attorney when he or she feels threatened. I think it’s important that employers take all the steps they can to make sure employees don’t feel like this. Thanks for sharing!



Add a Comment

Your email address will not be published. Required fields are marked *

*