Tag Archives: basics

Tips on Your Workers’ Compensation Claim

Today’s post comes from guest author Thomas Domer, from The Domer Law Firm.

I just returned from New Orleans where I made a presentation to about 150 workers’ compensation lawyers (both for workers and for employers) on “Case and Client Evaluation In Workers’ Compensation”.

Since many in the audience represented insurance companies and employers, I paid particular attention to their response to my presentation. As one would expect, their best chance to win a case on behalf of the employer and insurance carrier occurs when several items come into play:

  1. When there is no actual report of the injury. [Worker’s Tip: No matter how small the work injury, make sure it is reported in some fashion – cell phone, voice recording, or Accident Report and the worker keeps a copy (BEST).]
  2. Failure to report that a work injury occurred to the first treating practitioner (whether Emergency Room, employer-directed medical facility, hospital, or primary care physician). The single most difficult hurdle in a workers’ compensation claim involving a traumatic injury occurs when no report of the injury is found in the initial medical record.
  3. In “Occupational Exposure” cases, no discussion with the doctor about work duties or prior incidents. (In Wisconsin, a worker can recover for workers’ compensation in one of two ways: 
    1. A traumatic injury where a single incident has caused the disability (lifting a box, falling, etc.)
    2. Occupational Exposure, where the wear and tear of a worker’s job causes the disability over time. In this latter category, workers routinely do not indicate with any kind of specificity the type of work they perform when they see the doctor.

These three tips can help us as workers’ compensation lawyers win claims, more so than any “Clarence Darrow” court room techniques or strategies.

Prior results do not guarantee outcomes.
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Workers’ Compensation Basics: Are You an Employee?

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

Here’s the second blog post in a series on the basics of workers’ compensation.

As its name suggests, workers’ compensation compensates employees for on-the-job injuries. About 95 percent of time, the question of whether an injured worker is an employee is a simple “yes.” If you are paid a regular salary or by the hour via a regularly scheduled paycheck where your employer takes deductions out for Social Security, unemployment, Medicare, etc., you are most likely an employee.

But sometimes the issue of whether you are an employee isn’t as simple. Some states may exclude household and farm workers. Some states may exclude employees performing work for the business outside of the regular course of business hours. An employer might try to exclude an employee from workers’ compensation benefits by alleging the employee is an independent contractor.

If you are hurt on the job and your employer or their insurance company is claiming that you aren’t covered by workers’ compensation, you need to contact an experienced workers’ compensation attorney. Laws about which employees are covered by workers’ compensation are very specific and vary by state. You need an attorney who can tell you whether you are in fact covered by workers’ compensation, and, if not, what other possible ways there would be to compensate you for your injuries.

Read the first blog post in the series by clicking on this link: What is Workers’ Compensation?

Prior results do not guarantee outcomes.
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How To Prepare For Your Workers’ Compensation Hearing

If you have a serious injury on the job and file a claim for workers’ compensation benefits you will most likely at some point in time have to attend a hearing before the Workers’ Compensation Board. The hearing process can be daunting to many first time attendees. They don’t know what to expect; what to bring or in many cases even what to wear. Those who have attended hearings are upset about the fact that they have to wait for a long period of time in a huge waiting room only to be rushed in and out of the hearing courtroom or “part” in a matter of minutes. They complain that while sitting inside a hearing “part”, the parties all seem to be speaking in codes and abbreviations and they don’t seem to really understand what has occurred. 

I am hoping that by providing information to you the hearing process does will not be as overwhelming and as confusing as it seems. When I first started in the practice, the board regularly scheduled hearings for any and all outstanding issues including need for treatment and or surgery. Most injured workers had numerous hearings before the workers’ compensation board with the same judge presiding and in many times the same insurance representative. Hearings were scheduled every 3-4 months untill the case was resolved which could take about 2 years.  

Today however things are radically different. Most times medical requests are dealt with in-house. The medical treatment guidelines lay out specifically what is pre authorized if certain medical conditions apply. If the treating doctor wishes to pursue treatment outside the scope of the treatment guidelines he must request it and this may be authorized or denied. These requests and denials are all done through paperwork and the injured worker unfortunately has very little to say in the matter.

The amount of hearings has declined tremendously so if you are not represented by an attorney you need to be prepared. 

  • Put together a file. 
  • Make sure any administrative decisions have established all sites of injury you are claiming. If not, you need to tell the judge that you have a claim for other sites and you will be directed to produce medical where appropriate. 
  • While your treating physician should be submitting regular medical reports to the workers’ compensation board and insurance carrier, you should always have your own copies of your medical records including diagnostic studies. 
  • You are entitled to reimbursement for mileage and prescriptions related to your claim. Bring copies of bills and mileage requests if the carrier has failed to reimburse you for these expenses. 
  • You should bring copies of all pertinent paperwork with you to proceed with your claim. 
  • Do not ever come late to a hearing but bring reading material as many cases rarely start at the time indicated. However if you are late the judge will probably not recall your case and now you must wait for a rehearing. 
  • You should be dressed appropriately and while a suit is not required, be mindful of the fact that you are appearing in a court room. 

The key to being your own successful advocate is to be prepared, be polite and be patient. 

Prior results do not guarantee outcomes.
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