You got hurt at work and are unable to do your job. You’re experiencing pain which makes it hard for you to sleep and prevents you from doing activities around your home. You have seen one doctor after another to receive treatment for your injuries and also have undergone diagnostic tests – x-rays and MRIs. In a nutshell, your life has been turned upside down. Your employer has workers’ comp insurance so you assume that the process of getting money for your lost wages and having your medical bills paid will be a breeze. Sorry to say it, but you assumed wrong. There are many potential obstacles you may encounter during your workers’ comp claim that prevent the process from running smoothly. Here are a few reasons why a workers’ compensation case can be hard to deal with.
The Ignorant Insurance Company – Once you notify your employer that you sustained an injury at work, your employer will submit a claim to its workers’ compensation insurance company. Within 21 days, the insurance company is required to: (1) accept your claim and pay you money for your lost wages, as well as your medical bills; or (2) accept your claim in part and agree to pay your medical bills but deny your claim for wage loss benefits; or (3) deny your claim altogether. Even though it’s obvious to you that your work injuries have rendered you unable to do your job, and you need money to pay your bills, don’t be surprised if the insurance company, without any particular reason, denies your claim for lost wages. They are interested in saving money; they don’t care about your welfare.
The Angry Adjuster – In the early stages of your claim, while you’re waiting to see if your claim has been accepted, you may be dealing directly with the claims adjuster from the insurance company who is assigned to your case. You may have questions about your claim – “When will I start to get a check? What doctor should I see?” Your adjuster may or may not call you back and may or may not be nice if you get this person on the phone. Adjusters can be overworked and cynical and as a result have a nasty attitude. The adjuster could play a role in the decision to deny your claim. Once you hire a lawyer to represent you in your workers’ compensation PA claim, however, your life will be easier because you will not have to deal with the stress of interacting with the adjuster.
The Difficult Defense Lawyer – If your claim is denied by the insurance company and you hire a lawyer to file a claim on your behalf, the insurance company will assign a lawyer to defend your claim. At some point, you will testify by deposition and/or a hearing before the Workers’ Compensation Judge, which could be by video or in person. Your lawyer will ask you questions about your job, how you injured yourself, what medical treatment you have received, and how your injuries have affected your ability to work and perform your activities of daily living. The insurance company lawyer — also called the defense lawyer – will then have the opportunity to ask you questions on cross-examination. Most defense lawyers are polite and respectful, but some are not. You may be grilled by the lawyer about prior injuries that you sustained or any disciplinary issues you have had with your employer to try to show you were a disgruntled employee. The lawyer may challenge your version of events as to how you injured yourself and suggest that you’re not as badly injured as you contend. The lawyer may attack your veracity in other ways. For example, if the insurance company has conducted surveillance on you, the defense lawyer may ask you questions designed to show that, based on your activities while under surveillance, you are able to carry out your job duties. You need a highly skilled lawyer in your corner to go square off with the defense lawyer.
The Jaded Judge – Ultimately, the Workers’ Compensation Judge who has been randomly assigned to your case will issue a decision based on all the evidence, deciding whether or not you are entitled to workers’ comp. benefits. In so doing, the Judge will make a determination on whether your testimony and that of your doctor are credible or not credible. Some Judges have the reputation for ruling in favor of the injured worker; some have the reputation for coming down on the side of the insurance company. It depends on the Judge’s background and life experience – a Judge with a conservative upbringing who worked as an insurance company lawyer before becoming a Judge may be more inclined to find against you. On the other hand, a more liberal judge who did work for an injured workers’ firm prior to taking a Judge’s position may be more likely to see the case your way. So this is another factor in your case that you should be aware of. All you can do is testify honestly, and your lawyer will do their best to convince the Judge to rule in your favor.
Make no mistake about it, a workers’ comp. case is no walk in the park. Don’t worry, though — we’re here to help. At Pearson Koutcher Law, workers’ comp. is all we do. Every lawyer in the firm has more than 25 years’ experience representing injured workers. We’re accustomed to dealing with unforgiving insurance companies and hard-nosed defense lawyers and that hasn’t stopped us from winning cases and obtaining nice settlements for a lot of our clients. So if you have been injured at work, please call us today for a free, comprehensive consultation.