Workers’ Comp Benefits Explained
Workers’ compensation is a form of protection offered by employers to workers who might become injured or ill on the job. Workers’ comp benefits cover medical care to help the employee recover and, in some cases, provide a partial salary until he or she can work again.
Employees who are generally covered for workers’ comp benefits include:
• Full-time workers
• Part-time workers
• Employees who work from home
Independent contractors, freelancers, volunteers, interns, and other non-traditional workers are not generally covered , unless an employer chooses to provide the benefits. In Illinois, companies are required by law to purchase workers’ compensation insurance or self-insure if they have more than one employee. However, there are many exceptions to coverage.
Workers’ compensation benefits vary depending on an employee’s circumstances. Workers’ comp is similar to health insurance but represents a more robust benefits program. Use this section to explain what benefits are available and how injured employees can access them.
The Role of Legal Direction When it Comes to Workers’ Comp Issues
Legal advice is an integral part of the workers’ compensation process and their role cannot be overstated. Workers’ compensation cases can be legally and financially complex. This is especially true for a large number of claims that are time-sensitive (there are deadlines in the system) or face some kind of dispute or denial.
For example, what does a worker do if their claim has been wrongfully denied by an insurance company or is otherwise disputed? If they don’t know their legal rights and obligations within the workers’ compensation system, they may fail to accurately prove their case and get the compensation they deserve.
Or how about this scenario: an injured worker doesn’t take the advice of their attorney and decides to move forward with a settlement agreement that is lower than it should be because they are confused about the legal process or under extreme financial pressure due to lost wages and medical bills. Later, they realize that because of the mistake they made, they are no longer able to get coverage for their medical treatment and cannot receive the disability benefits they need to support themselves and their family. Unfortunately, there’s not much that can be done at that painful point.
Hence why it is so important to work with an attorney who knows your case well and can advise you properly on the full scope of your legal rights and obligations.
Where to Get Free Workers’ Comp Legal Advice
The best place to get free help is through your state’s legal aid services. These are services paid for by taxpayers to help low to low-middle income people with legal issues. Call your local Bar Association and ask them who they recommend. In Illinois, it’s Illinois Legal Aid. We’ve never gotten a more than a 10 minute wait and we’re always connected to a very efficient attorney.
They can’t get into the legal advice that goes with your claim, but they can help you with general advice. So if you just wanted to know what to say to an insurance adjuster or how to get medical bills paid out BEFORE you get the settlement award that is expected at arbitration, they can help you.
Other good options are non-profit legal aid services. They are basically the same idea, although the attorneys are often more recently graduated and fresh out of law school. In Chicago, the Legal Assistance Foundation and Prairie State Legal Services do a lot of great pro bono work.
We’ve also heard good things about the Workers’ Compensation Commission through Google. We’ve never called them ourselves.
Most of these free services are only available if your claim is currently active. If you have already settled or your case is in litigation, you need to go elsewhere for help.
Choosing an Attorney to Handle Your Workers’ Comp Claim
You want to see a wage and price rise? Take a look at legal fees. The lack of attorneys jacking up their prices has led to lawyers having to offer "free" advice to the public in order to get clients in the door. As with anything "free" it is best to not trust in too many myths about this service. But, there is a common sense way to do this.
First, if you are going to get free legal advice you may as well have the best. Pick someone who is well regarded in the area of law you need. If you have a workers’ compensation case you should go with someone who specializes in that and that alone. That is because you need someone who is up to date on all of the changes in workers’ compensation law, which happen too often. If your mother had a heart attack would you trust her heart to a mechanic, even a good one? Probably not. You want a cardiac surgeon. Lawyers are not any different.
Second, experience. When you meet with the attorney you should ask, directly, if they have handled cases like yours. For example, if you were fired when you filed a workers’ compensation claim, ask if they have experience with retaliatory discharge claims. Most lawyers who only practice in one field will have done this kind of claim.
Third, ask what their most recent verdict or settlement was. It should at least be close to what you are looking for or they should have a reason that it wasn’t. Remember though, that workers’ compensation can be very challenging and most cases do not generate multi-million dollar verdicts. At least not without risks of Appeals.
Fourth, ask what percentage of their cases are handled on class actions, summary judgment motions, etc., are. How many attorneys are there at the firm? Does he have a paralegal for every lawyer? A case manager? Who will handle your case?
Fifth, ask for references. If they are not willing to give you the names of people who have sued them, they might be a scam artist. To get a good balance on this you should ask for names of some past clients and opposing counsel.
Sounds like work? It is. You wouldn’t write a six figure check for a home without doing some research. Why should hiring an attorney be any less important?
Common Issues in Workers’ Comp Claims
There are a whole host of hurdles that can pop up when filing for workers’ compensation, and the following list includes some of the most common:
Claim Denials
Not all workers’ comp claims are accepted right off the bat. Some claims are outright denied, others are simply delayed, and yours could fall anywhere on the spectrum. If you find yourself in need of legal recourse regarding a denied workers’ compensation claim, a workers’ compensation attorney can help you get through the next step.
Late Payments
It’s not uncommon for there to be a delay between the time you file your workers’ compensation claim and the time you start receiving benefits. But if you receive a letter stating your claim has been accepted and you still do not receive any benefits after a while , it’s your responsibility to notify your employer. If they do not provide payments, you will have to contact a workers’ compensation attorney immediately to follow up.
Underpayments
You may find that you’re receiving less than what you were expecting in workers’ compensation benefits. If you suspect you’re being underpaid, it’s important that you contact your doctor to find out your average weekly wage and determine if the ratio at which benefits were calculated was correct.
Workplace Retaliation
Some employers may try to deny you can claim retirement benefits, even if you have been injured at work. If this happens (and if your employer is not already just waiting for the issue to resolve itself), it may be time to hire a workers’ compensation attorney.
Preliminary Steps to Consider Before Getting Legal Direction
The very first thing that you should do is get medical attention. While you will probably have a good idea if you need it or not, sometimes you might convince yourself that you are fine and just shaking it off will be fine. Maybe for a bruise or skinned knee, but getting medical attention can also help you document the injury in a more official manner. A doctor will make note of your injury and may even call it by a name that your employer’s insurance company will use instead of the "my foot hurts" description.
Once you visit the doctor, you’ll want to report the injury to your employer. They may have a process for reporting them. If they don’t, they should. Getting your employer involved as soon as possible will help ensure that they fully cooperate with the workers’ comp insurance company.
If your employer has a form that they use for workers’ comp injuries, make sure that you fill it out. Try to be as accurate as possible, while avoiding putting your foot in your mouth by making too many assumptions about the injury when asked to describe it. Make a note to yourself to review what you say with a lawyer before submitting it, so that you can perhaps edit it (with their guidance) prior to submission. It is generally best to have an attorney review these documents prior to submission, but your employer has the right to expect you to turn them in on time.
You should also document the how and when of your injury outside of the employer’s paperwork. This is a good practice whether you hire an attorney or not. Keeping this documentation to the side allows you to review it later when necessary, without a bunch of other matters to review. If there is any question of your version of events, you’ll have the documentation to back you up.
Making the Most of Your Workers’ Comp Benefits
One important step that you can take to maximize your compensation benefits is to maintain up-to-date medical records. If your medical condition or injury progresses, documenting your symptoms and any changes to your treatment can help your attorney build your case for the extent of your injuries. Treatment can include things like attending physical therapy and following your doctor’s instructions to the letter. For example, if your doctor prescribes you a brace for your leg and you abandon this brace because it is inconvenient, the workers’ compensation company or your employer might try to argue that you are not as injured as you say you are and that you are faking your injury in order to get money from them. It is generally a good idea to do exactly what the doctor tells you to do and follow up with him or her for additional care if your symptoms do not improve .
It is also invariably a good idea to ask your treating doctor to document work restrictions. For example, if you are lifting and turning pipes in your job and you should not be doing this due to an injury, your doctor should be very specific about what you are not to do. It is not enough for your doctor to say that you should not do it. He or she needs to say what your restrictions are. Beyond attending medical appointments, getting treatment and following your doctor’s orders, you can do certain things to help yourself. If your employer offers vocational rehabilitation, be sure to go through it. If your doctor thinks you are ready to return to work for restricted duties, you should return to work if at all possible. In some cases, workers’ compensation may pay for a educational program while you are unable to work at your current job.