Do you need a workers’ comp lawyer? Factors to consider
If you have been injured on the job in Georgia, you may be wondering if it’s okay to represent yourself. You may even be pressured to work it out with your employer and the insurance company on your own.
The good news is that it’s your choice.
If you decide to work with an attorney, you may get more workers’ compensation benefits. In addition, you’ll have your own legal representative to help you file for additional medical expenses, financial compensation and approval for ongoing care. After all, your employer probably has its own legal team—or at least an insurance company with a legal team.
Are there any cut and dry workers’ compensation claims?
In some cases, employers work hard to take care of their employees. In other cases, they place profits above the welfare of their staff, or they may have a particularly aggressive insurance company that won’t recognize an injured worker’s full claim.
Most people aren’t quite clear about what their rights are after they have been hurt on the job. Often, they rely on their employer to tell them what they can and cannot do. However, this is never a wise practice. If, for instance, you were to get in a motor vehicle accident, would you rely on the person who hit you to take care of your injuries and look after your legal rights? Of course not! So why would you trust your employer in the event of a workplace accident?
When things get complicated in a workers’ compensation case, you should hire a lawyer immediately. Just like there are rules and regulations regarding how much an attorney can charge (which we’ll discuss below), there are also rules and guidelines throughout the entire workers’ compensation process. Hiring an attorney can help you navigate all of these complex rules.
For these reasons and more, it’s almost always a wise decision to hire (or at least consult) a workers’ compensation attorney if you’ve been seriously hurt on the job.
However, here are some specific examples of when you can most benefit from professional legal counsel:
Your employer denies your claim or doesn’t pay upfront.
Your employer has a duty to respond to your claim right away. Some employers don’t believe claims and simply deny them out of principle at first, hoping that they will go away. This is when you need to hire an attorney to make sure that you get benefits through a settlement in a timely fashion.
Your employer’s settlement offer is too low.
A lawyer can negotiate to bring up the amount of your settlement and work with a compensation judge to ensure that you get the right amount for your injury. While workers’ compensation settlements need to have judicial merit, judges typically sign off on any agreement as long as it’s grossly unfair. An attorney can show that your injuries require more coverage due to wage loss, ongoing care problems or gross negligence that led to the worker’s death.
Medical issues prevent you from returning to work.
These cases are difficult, and it’s often a tough fight to get benefits for ongoing wage loss and medical care. However, if your injuries led to a permanent handicap, and you are now disabled, then you may be entitled to weekly payments or one large lump sum settlement to make up for these lost wages.
In many of these cases, insurance companies don’t want to compensate the worker because of the cost. A knowledgeable workers’ injury lawyer can help you get organized and secure the benefits owed for your permanent injury.
You plan to apply for Social Security disability.
If you don’t receive a settlement that is structured to cover you without affecting Social Security benefits, you could actually reduce your Social Security disability payments. Experienced attorneys understand how to structure settlements so that your SSI benefits are not affected.
Your employer retaliates after you file a claim.
Did you return to work after filing a claim only to be fired or demoted? You can seek compensation for a reduction of hours, slashed pay, demotions, termination or any other action taken against you after returning to work. You should contact an attorney immediately if you experience any discrimination upon filing a workers’ compensation claim.
The injury occurred as a result of a third party’s actions or employer’s gross misconduct.
The workers’ compensation system is designed to handle straightforward cases. If you fall because there was a leak in the roof, it can be documented and proven that there was a problem.
How do you prove that another employee purposefully sprayed water in an area that led to your slip and fall? Who is at fault? You are allowed to sue outside of workers’ compensation in certain cases where there was someone else or other actions that took place that contributed to you suffering an injury.
Your employer doesn’t have insurance.
You’ll definitely want to contact a lawyer if your employer doesn’t have workers’ compensation insurance as legally required, as this will lead to a lawsuit where you will need to file the right paperwork to sue your employer. In most cases, this ends with a settlement offer, but the employer may also face fines and other penalties.
Your employer wants you to return to work after your injury.
There are certain requirements that an insurance company must meet before you have to return to work if you are presently receiving benefits. It’s important to understand that you don’t have to return to work if the authorized treating physician hasn’t released you to normal duty work.
Just because your employer asks you to come back, doesn’t mean you have to.
There is a very specific procedure that must be followed when it comes to bringing an injured employee back to work, and strict consequences if these procedures aren’t followed. Furthermore, if you do return to work, your ability to receive benefits in the future may be compromised. It’s vital you hire an attorney at this point in time — or least consult one.
You have received medical treatment, but remain in pain.
Medical treatment plays a crucial role in workers’ compensation claims. Your authorized treating physician determines the course of treatment and your work status. Georgia law (O.C.G.A. 34-9-200) requires the insurance company provide the injured worker with medical care for their work-related injury. The injured worker can select a doctor from a panel of physicians. Some of these doctors specialize in different areas, and some are better than others.
Many times, injured workers are steered to an industrial clinic by their employer. These industrial clinics rarely serve the injured workers’ needs. They are ill equipped to handle serious injuries. Our client’s complaints of pain are frequently ignored and they are returned to work.
The good news is that injured workers are entitled to a one-time change in authorized treating physicians.
The doctor in a workers’ compensation case controls the work status of the injured worker. Therefore, they are essential to a claim and choosing the right one is extremely important. A lawyer can help you choose a doctor who is going to actually listen to your complaints of pain and provide appropriate treatment.
A doctor has determined that you have reached maximum medical improvement (MMI).
There is a point when the insurance company thinks your case is coming to an end. Maximum medical improvement means that your injury has healed as much as it’s going to according to the doctor. At that time, you will be assigned a permanent partial disability rating.
There are 2 important factors to consider here.
First, your benefits will not be cut off just because you have reached MMI. Some states do this, but Georgia is not one of them. Second, just because a doctor states that you have reached maximum medical improvement, doesn’t mean that you actually have. An attorney can assist you if you are still in pain. Additionally, a lawyer can help you get a proper PPD rating from a doctor who may be more sympathetic to your permanent disabilities.
The insurance company makes an offer to settle your case.
Remember, insurance companies are for-profit entities. It’s their job to make money for their shareholders and owners. They make money, in part, by collecting premiums and paying out as little as possible to injured workers.
If an insurance adjuster or other representative makes an unsolicited offer to you, be mindful that there’s likely a financial, business-motived reason behind it. Don’t take the offer immediately. Instead, hire an attorney who can help you get the most money out of your claim and ensure you aren’t getting scammed or underbid by the insurance company.
You have a workers’ compensation hearing pending.
The request for a hearing may have been made by the insurance company and their attorney. It greatly benefits claimants to have experienced representation at any such hearing. There are rules of evidence to be followed and pre-hearing discovery that takes place. Navigating this complex process and avoiding a hearing is something our attorneys specialize in.
Do I need a workers’ compensation lawyer or can I represent myself?
Immediately after you are injured at work, we recommend consulting with an attorney. Even if you don’t hire them at this time, it can be immensely valuable to get a lawyer’s perspective on what has happened, and what is going to happen in the weeks and months ahead.
An experienced attorney will most likely have dealt with an injury similar to yours, and can help you get treatment with an appropriate doctor. There are a number of important decisions that must be made at the outset of a claim. Lawyers can also work to ensure that indemnity checks are properly started and that there is no loss of income.
Hiring a lawyer at the beginning of a claim can make the entire case run smoother.
If you’ve already received an offer from the insurance company or your employer, consider whether the amount is enough to cover your full lost wages and pay your medical expenses. You may want to consult with a lawyer if you’re unsure of the laws or how much you could receive for your injury.
In many cases, you could be owed hundreds of thousands of dollars more than the insurance company initially offers. That’s why you should talk to a lawyer to evaluate the offer. Don’t miss out on the benefits and wages owed to you.
But what if I can’t afford to hire an attorney?
The first thing that every injured worker should know is that it doesn’t cost any upfront money to hire many reputable lawyers to handle a workers’ compensation claim. Lawyers in the workers’ compensation arena work almost exclusively on a contingency fee basis. This means that they don’t charge the injured worker any money up front, and only get paid if they recover money for that individual.
Considering that fact, the next obvious question is:
What contingency fees do workers’ compensation attorneys charge?
Georgia law (O.C.G.A. 34-9-108) establishes how much attorneys can get paid in a Georgia workers’ compensation case. It states:
The fee of an attorney for service to a claimant in an amount of more than $100.00 shall be subject to the approval of the board, and no attorney shall be entitled to collect any fee or gratuity in excess of $100.00 without the approval of the board. The board shall approve no fee of an attorney for services to a claimant in excess of 25 percent of the claimant’s award of weekly benefits or settlement. (Emphasis added).
This rule has 2 effects.
First, it caps an attorney’s fees in a workers’ compensation case at 25 percent of the settlement or weekly benefits. This means that an attorney who is assisting an injured worker on a workers’ compensation case cannot charge more than 25 percent of the settlement. This is significantly lower than in a personal injury setting, where the percentage is usually 33 to 50 percent.
For example, if your workers’ compensation case settles for $100,000, you would receive $75,000 and the attorney would be paid $25,000. If, however, the same individual was injured in a slip and fall outside of work and obtained the same $100,000 settlement through a personal injury attorney, they might only receive $50,000 after paying the lawyer.
The second effect of Georgia law is that all fees over $100 must be approved by the State Board of Workers’ Compensation. There has to be official documents signed by all parties and submitted to the State Board.
The only way to close a workers’ compensation case in Georgia is to let the statute run or to sign an agreement that is approved by the State Board of Workers’ Compensation.
This means that an employer cannot just close your case by giving you cash and telling you to be quiet. It also means that just because an insurance company has “closed their file,” doesn’t mean that you don’t still have a viable claim.
Also, and just as importantly, agreements to resolve an issue that is related to a workers’ compensation claim are not enforceable without approval from the State Board of Workers’ Compensation.
Still have questions?