Working with the right Santa Rosa workers’ compensation lawyer is the key to winning a workers’ compensation dispute
Every employee who has a work-related injury is entitled to workers’ compensation benefits. Unfortunately, the more serious the injury, the more likely it is that a workers’ compensation claims administrator will contest the payment of benefits. Winning a workers’ compensation dispute often requires injured workers to fight for the benefits they are entitled to.
What Does It Mean to Win?
In the context of workers’ compensation, winning means obtaining the benefits that should be awarded for a work-related injury. Winning isn’t necessarily measured by what an injured worker wants or by what a claims administrator is willing to pay. Rather, the workers’ compensation system defines the benefits to which injured workers are entitled for injuries, and a “win” happens when they receive those benefits.
In some cases, winning is easy. An injured worker who misses work for a month because of a twisted ankle should receive medical treatment and temporary disability benefits. If the injury completely heals, there is unlikely to be any dispute about additional benefits to which the injured worker is entitled. The injured worker “wins” without fighting. That’s how the system is designed to work.
In some cases, however, a “win” can be more difficult to secure. When facts are in dispute for instance, the benefits that an injured worker should receive may not be obvious. When there is a disagreement about the facts, there are two ways to win: by agreeing to a settlement, or by convincing a workers’ compensation judge which facts are correct.
Factual disputes can affect the outcomes of workers’ compensation cases. There are many types of factual disputes, including whether (or how much) a disabling injury is work-related. Another involves disputes about the nature extent of permanent disability and injured worker has suffered.
Resolving disputes about the cause of injury can determine the injured worker’s entitlement to receive any workers compensation benefits at all. Evidence about how the injury occurred is usually the key to resolving those disputes. A workers’ compensation lawyer will gather as much evidence as possible to prove that the injury was caused by work. Some of that evidence might come from coworkers, while other evidence (particularly when an injury could have more than one cause) might come from doctors.
Disputes about the nature and extent of a disability are based on medical evidence. If the treating physician has provided an unfavorable opinion about the degree of impairment, a workers’ compensation lawyer will want to have a Qualified Medical Evaluator (QME) render another opinion.
A Compromise Can Be a Win
A workers’ compensation lawyer can analyze disputed facts to determine what is favorable and what is unfavorable to the injured worker. Strong evidence that favors the injured worker makes it more likely that he will prevail on that issue before a judge. Weak evidence may benefit the claims administrator and prevent the injured worker from receiving the benefits he is seeking.
When the evidence isn’t clear, the injured worker will need to decide whether to risk leaving his or her fate in the hands of a workers’ compensation judge. In some cases, it may better to work out a compromise, or settlement with the claims administrator. Agreeing to a settlement is sometimes better than risking a poor outcome after a hearing before a judge.
In fact, a compromise can sometimes produces a better result than a hearing might. Some settlements provide an injured worker a lump sum of money rather than a payment of money over time. In exchange, the injured worker agrees to be responsible for whatever future medical care she may need as a result of the injury. This allows the injured worker to control her future decisions about medical care, rather than being subject to the decisions of an insurance claims administrator.
Because insurance companies also want to be relieved of that liability, they will often offer a larger cash settlement than would otherwise be available following a hearing before a judge. In many cases, therefore, a settlement can be a better “win” for injured workers than the outcome of a hearing might be.
Winning a Contested Hearing
When claims administrators refuse to be reasonable, experienced workers’ compensation lawyers generally recommend that an injured worker take his or her case to a hearing to present evidence to a judge. The odds of winning a disputed issue before a judge can be maximized by following these simple rules:
- Put the law on your side. The workers’ compensation system is complex. Employers take advantage of that complexity to minimize their payment of benefits. Working with a lawyer who understands California’s workers’ compensation system gives injured workers a better opportunity to win.
- Be honest. An injured worker who lies at a hearing will undermine the case, and they may end up getting nothing. Honesty is always the best policy in workers’ compensation hearings.
- Be prepared. Your lawyer will gather evidence for the hearing, but you may need to testify. Your lawyer will discuss your testimony before the hearing to make sure that you are not surprised by questions and that your answers are clear.
- Hire a lawyer who isn’t afraid to take cases to hearings. Claims administrators keep track of lawyers. They know which lawyers will back down before a hearing. They have no incentive to agree to a settlement with those lawyers. They also know which lawyers have a track record of success at hearings. Those are the lawyers who get the best settlements, as well as the best results from a judge.
Maximizing your chance of winning begins by working with an experienced lawyer who is right for you. In Northern California, the workers’ compensation team at Santa Rosa’s Kneisler & Schondel helps injured workers maximize their benefits by negotiating fair settlements and by representing workers at hearings before judges. To learn how an experienced workers’ compensation lawyer can help you, call us at (707) 542-5132 or ask us a question using our online contact form.