Workers' Comp: When to Hire a Lawyer

Not every injured worker will need to hire an attorney. After all, the workers' compensation system is an administrative process designed to be relatively easy for workers to navigate. If you have a straightforward claim that is not being disputed by your employer or its insurance company, you can probably handle your own claim.

Unfortunately, the process is not always that simple. Many workers will need to—or can benefit greatly from—hiring a workers' compensation lawyer.

In very few cases, an employee who suffers an injury at work can make a claim outside of workers' compensation, and a personal injury lawyer would be appropriate. For example, if you were injured as a result of your employer's intentional act, or if you're a crewmember on a vessel or an interstate railroad worker, you can usually sue your employer in court for a workplace injury.

When a Workers' Comp Lawyer Isn't Necessary

If you suffer a relatively minor injury at work that completely heals with treatment, you probably won't need to hire a lawyer. Insurance companies are unlikely to dispute claims that:

• involve injuries that are clearly work-related
• don't require extensive medical treatment
• don't involve long periods of time off work, and
• don't result in permanent injuries.

For example, suppose you sprained your ankle after you slipped on some water in the break room. Your doctor ordered you to ice your ankle, take pain relievers, and stay on bed rest for a few days.

However, because you work a desk job, you were able to return to work fairly quickly and your ankle healed within a few weeks. In this case, your trip to the doctor would be covered. You probably wouldn't even receive wage loss benefits in most states because you were only out of work for a few days.

When a Workers' Comp Lawyer Is Typically Necessary

Any time you're in a dispute with the insurance company, you should consider hiring a lawyer to represent you. You will need to gather evidence in order to challenge the insurance company's position, which may include taking depositions, requesting an independent medical examination, and hiring expert witnesses—all of which require legal knowledge and skill.

The following are some examples of when you're best served by hiring a lawyer:

Your Claim is Denied

Insurance companies deny workers' compensation claims for a variety of reasons. For example, the insurance company might claim that your injury wasn't work-related or that you filed your claim too late. (To learn more, see our article on common reasons workers' comp claims are denied.)

You can appeal the denial through the workers' compensation system. While the appeals process varies from state to state, it generally requires you to file formal paperwork, use legal tools to gather evidence, and present your case at a hearing.

Your Permanent Disability Rating is Disputed

The bulk of most workers' comp settlements and awards are for permanent disability benefits. These benefits are calculated based on your permanent disability rating. If the insurance company doesn't agree with the rating assigned by your treating doctor, it can require you to attend an independent medical examination (IME) with a doctor of its choosing.

The IME doctor will likely assign a much lower disability rating, which the insurance company will use to justify paying you less in benefits. A lawyer can be essential to getting you a fair settlement or convincing a judge that you are entitled to the higher rating. (To learn more, see our article on how permanent disability ratings work .)

You Have a Preexisting Condition

If you have a preexisting injury or condition involving the same body part you injured at work, you'll be facing an uphill battle with the insurance company. The insurance company will likely blame your injury on your previous condition rather than your work activities. This is especially true if your injury has developed slowly over time, rather than during a single work accident. (To learn more, see our article on repetitive stress injuries.)

You're Having Trouble Getting the Treatment You Need

Insurance companies often deny—or delay in approving—expensive medical treatments, such as surgery. A lawyer can put pressure on the insurance company to approve necessary medical treatments in a timely manner.

Your Ability to Work Has Been Affected

If you can never work again, you'll need to maximize your workers' comp benefits and structure them in a way to last well into the future. If you need to change careers, you'll need to secure training in a new line of work. A lawyer can help you do both.

You're Receiving Other Government Benefits

If you're receiving Social Security Disability Insurance (SSDI) benefits, these benefits may be reduced if you receive workers' compensation benefits. A lawyer can help you minimize how much your SSDI benefits will be reduced. If you are eligible for Medicare, you may also need to set aside a portion of your workers' comp benefits to pay for future medical treatment. A lawyer can help you do this in the most advantageous way.

You Are Having a Workers' Comp Hearing

If the insurance company refuses to settle—or only makes lowball settlement offers—you'll need to go prove your case at a hearing. Because this is like a mini-trial, you will almost certainly need a lawyer to represent you.

Is a Lawyer Worth the Cost?

Workers' compensation lawyers don't charge in the typical hourly fashion. Instead, they charge a contingency fee: a percentage of any workers' comp benefits they help you recover. Additionally, many states place caps on contingency fees in workers' comp cases.

The percentage varies from state to state, but is generally between 15% and 25%. However, the fee can be as low as 10% and as high as 33% in some states. (For more information about fees, see our article on how much it costs to hire a workers' comp lawyer.)

You're likely to get a much higher settlement offer when a lawyer is involved. Lawyers understand the law, know how to negotiate, and can use various tools to build up your case. Because of this, you will probably receive more in benefits if you hire a lawyer, even after the lawyer takes his or her fee.