Workers’ compensation provides benefits for employees injured on the job, covering medical treatment and wage replacement during recovery. The system is designed to be straightforward, allowing injured workers to receive benefits without proving their employer was at fault. However, insurance companies deny legitimate claims, dispute injury severity, and minimize benefits whenever possible to protect their bottom line.
Our friends at Polsky, Shouldice & Rosen, P.C. help workers fight for the benefits they deserve when insurance companies act in bad faith. A workers comp lawyer understands the administrative procedures, medical evaluation processes, and appeal strategies that make the difference between inadequate settlements and full compensation for workplace injuries.
Situation #1: Your Claim Has Been Denied
Insurance carriers deny workers’ compensation claims for numerous reasons, some legitimate and many questionable. Common denial reasons include arguing the injury didn’t occur at work, claiming you have a preexisting condition, alleging you were intoxicated, or asserting you violated workplace safety rules.
According to the U.S. Department of Labor, workers have appeal rights when claims are denied, but these appeals involve strict deadlines and procedural requirements. Missing a deadline can permanently bar your claim.
We file timely appeals, gather evidence supporting that your injury is work-related, obtain medical opinions linking your condition to workplace activities, and present compelling cases at administrative hearings. Overturning denials requires understanding both the medical and legal aspects of your claim.
Situation #2: The Insurance Company Disputes Your Medical Treatment
Insurance carriers frequently deny recommended treatments, claiming they’re not medically necessary or not related to your workplace injury. They might authorize initial emergency treatment but refuse ongoing physical therapy, specialist consultations, or surgical procedures your doctor recommends.
This practice saves insurers money while leaving you in pain and delaying recovery. You have the right to necessary medical treatment, and doctors treating workplace injuries should make medical decisions, not insurance adjusters looking at spreadsheets.
We challenge improper treatment denials through the administrative process, obtaining independent medical evaluations when needed and presenting medical evidence demonstrating treatment necessity. Sometimes we must take insurance companies to hearings to force approval of legitimate medical care.
Situation #3: You’re Facing Permanent Disability Evaluation
When injuries cause permanent impairment, workers’ compensation systems provide disability benefits based on the severity of your permanent limitations. Insurance companies hire doctors to perform independent medical examinations that often minimize your impairment and reduce benefit amounts.
These evaluations determine your financial future. An insurance doctor rating you at 5% permanent partial disability versus 15% means tens of thousands of dollars in benefit differences.
We prepare you for these examinations, review IME reports for inaccuracies, and challenge biased evaluations with opinions from treating physicians who actually know your condition. Getting accurate permanent disability ratings requires advocacy and medical evidence showing the true extent of your limitations.
Situation #4: Your Employer Is Retaliating Against You
Filing workers’ compensation claims is a protected activity. Employers cannot fire, demote, reduce hours, or otherwise retaliate against employees for making legitimate injury claims. Despite these legal protections, retaliation happens frequently.
Employers might claim they’re firing you for performance issues or business reasons when the real motivation is punishing you for filing a claim. This retaliation creates separate legal claims beyond workers’ compensation itself.
We handle both your workers’ compensation claim and any retaliation or wrongful termination claims arising from your workplace injury. These cases might involve filing complaints with state labor agencies or pursuing civil lawsuits for damages beyond what workers’ compensation provides.
Situation #5: Third Parties May Be Liable
Workers’ compensation is typically your exclusive remedy against your employer, meaning you cannot sue them for negligence. However, third parties who contributed to your injury can be sued in civil court for additional damages beyond workers’ comp benefits.
Third-party claims arise in situations including:
- Equipment manufacturers whose defective products caused injury
- Property owners where you were injured while working
- Drivers who caused vehicle accidents during work duties
- Subcontractors whose negligence injured you on job sites
- Product suppliers of dangerous materials
These third-party lawsuits allow recovery of damages not available through workers’ compensation including pain and suffering and full wage loss without caps. We identify third-party liability and pursue these additional claims while managing your workers’ compensation case.
Benefits Lawyers Help You Obtain
Workers’ compensation should cover all reasonable medical treatment, temporary total disability payments while you cannot work, temporary partial disability if you return to light duty at reduced wages, permanent partial disability for lasting impairments, and vocational rehabilitation if you cannot return to your previous occupation.
Insurance companies routinely undervalue these benefits. They pressure workers into premature settlements, dispute medical necessity, and use biased doctors to minimize disability ratings. Legal representation levels the playing field against insurance companies with teams of adjusters and lawyers working to reduce what they pay.
Protecting Your Rights And Benefits
Workplace injuries affect your health, income, and family’s financial security. The workers’ compensation system should protect you during recovery, but insurance companies treat claims as expenses to minimize rather than obligations to fulfill.
Don’t accept claim denials or inadequate benefit offers without understanding your rights and options. Insurance adjusters are not on your side despite friendly conversations.
If your workers’ compensation claim has been denied, your benefits seem inadequate, or you’re facing retaliation for filing a claim, contact our office to discuss your situation. We’ll review your case, explain your rights, and fight for the full benefits you deserve while protecting you from retaliation and ensuring you receive all necessary medical treatment.