The Role of an Attorney in Workers' Compensation Appeals

Filing a workers’ compensation claim is stressful. Receiving a denial letter after a workplace injury can be overwhelming. But a denied claim isn’t the end of the road—you can appeal the decision.

Legal representation by an experienced workers’ compensation lawyer can be the difference between a favorable and unfavorable appeal decision. Working with a workers’ comp attorney can significantly increase your chances of winning your appeal. Consult with a worker’s comp lawyer for help with the denial of your workers’ comp claim.

Workers’ Compensation

Workers’ comp provides benefits for workers injured on the job in an accident or who have a work-related illness. It’s employer-paid insurance that provides injured workers with lost wages, medical care, and rehabilitation training. If you’re hurt on the job, report the incident to your supervisor and seek medical treatment. Your employer’s insurance company will review the claim and determine your eligibility for benefits.

Some claims aren’t approved at the initial stage. According to a leading study, 7% of workers’ compensation claims are initially denied. But these percentages vary by state. In Oregon, for example, 12% of workers’ comp claims are denied. 

Common reasons for claim denials include:

• A preexisting condition caused the injury
• Insufficient medical documentation
• Missed appeal deadline
• Dispute about whether the injury is work-related

You can challenge the decision if your workers’ comp claim is denied. An appeal is often worth your time and effort. Workers who appeal a claim denial have a significant chance of approval. According to the study, about two out of three rejected claims are eventually paid within the year. Payouts are often higher on appeal. On average, the award amount for appealed claims is 55% higher than the original claim. 

Workers’ Compensation Appeal Process

If your claim is rejected, read the denial notice carefully for the following information:

• An explanation of why your workers’ comp claim was denied
• The steps you must take to appeal the decision
• The deadline to appeal the decision

Workers’ compensation attorneys usually become involved when initial claims are denied, or disputes arise about the extent of injuries or available benefits.

Importance of Legal Representation in Workers’ Compensation Appeals

An experienced lawyer can help you with the following:

• Improving your chances of a successful appeal
• Knowing workers’ compensation laws and how to apply them to your claim
• Evaluating your case, assessing its strengths and weaknesses, and grounds for an appeal
• Ensuring you file the necessary forms and meet deadlines
• Gathering evidence to support your case, including medical records, witness statements, expert testimony, and other documentation
• Negotiating effectively with the insurance company

An experienced lawyer is also familiar with administrative hearings and the appeals board. Your lawyer can represent you at your hearing or trial if you can’t agree on a settlement.

When To Hire a Workers’ Comp Attorney

You should hire a lawyer for several other reasons besides claim denial. Generally, you should hire a lawyer if your case has any complexity, such as:

• Your benefits aren’t promptly paid
• The settlement offer doesn’t properly cover wage loss or medical bills
• You’re receiving Social Security disability benefits
• Your boss retaliates against you for filing a workers’ comp claim

Federal law limits the combined amount of Social Security disability insurance (SSDI) and workers’ compensation benefits you can receive. An experienced lawyer will know how to handle this offset.

How To Choose the Right Lawyer

You should look for a lawyer who’s an experienced workers’ compensation practitioner. Workers’ comp is a specialized area of the law. So, your interests aren’t served by a lawyer who only practices workers’ comp as one of several legal areas.

Ideally, your worker’s compensation lawyer should have experience with appeals, not just claims.

They should also have a reputation for treating clients respectfully. This includes returning calls promptly and clearly explaining what’s going on and the next steps.

Cost of Hiring a Workers’ Compensation Attorney

Free case evaluations are common—there’s rarely a charge for the initial consultation.

Lawyers generally handle workers’ comp cases on a contingency fee basis. If you win your case, your lawyer receives a percentage of your workers’ comp award. If your claim is denied, there’s no fee. State law sets the rate. Most states place a cap on the amount a lawyer can charge.

Workers’ comp cases also involve expenses such as fees for legal filings and medical records, postage, and deposition costs. Most law firms pay these expenses as they occur and only ask for reimbursement if you win your case. However, some lawyers charge you for expenses even if you lose your case.

Before hiring a worker’s comp lawyer, understand the legal fee payout and how expenses will be handled.

Speak With a Lawyer Who Can Help

Insurance carriers prefer to deal with individual claimants because they know it’s rare for injured workers to be as knowledgeable about the workers’ compensation claims process as a seasoned attorney. Claim denials are increasing. Talk to a workers’ compensation lawyer to understand your right to workers’ compensation benefits and fair compensation.