The bottom line is that most injured workers expect compensation in these matters. They need this money to pay medical bills and replace lost wages. They deserve this compensation because their injuries weren’t their fault. Benefits are available for both trauma injuries, like falls, and occupational diseases, like hearing loss.
Compensation is available, but maximum compensation, or even fair compensation, is a different story. Overall, lost wage replacement benefits have declined 17 percent since 2013. Medical bill payment benefits have declined even further. In other words, these injured victims must work much harder to get a fair-sized piece of a shrinking financial pie.
Additionally, insurance company lawyers bitterly contest these claims if they can. Workers’ comp is no-fault insurance, so they generally cannot contest liability. However, they can try to reduce damages. For example, AWW (average weekly wage) miscalculation is very common. Many adjusters and lawyers only use a calendar, a calculator, and net income. But the AWW is also forward-looking. If John’s injury causes him to miss future overtime opportunities, his AWW should reflect that.
Statistically, job injury victims who have Lexington personal injury attorneys get much larger settlements. Insurance company lawyers know that victims with lawyers aren’t willing to settle for less. They also know that a lawyer usually wins an appeal hearing. Therefore, these lawyers are motivated to make favorable deals.
Evaluation
Workers’ compensation applies to most, but not all, job injury claims in the Bluegrass State. Some injured victims have other options. A lawyer must immediately identify these alternatives.
Usually, workers’ comp pays two-thirds of lost wages along with all reasonably necessary medical bills. Although the compensation is limited, workers’ comp is no-fault insurance. Therefore, victims must only prove their injuries were work-related.
These cases occasionally get a bit tricky. For example, if John got hurt at a company softball game, an insurance adjuster might deny coverage. However, under Kentucky law, John’s injury was usually work-related. Similarly, if John had a bad knee which contributed to the risk and/or severity of his injury, full compensation is usually available.
Workers’ comp doesn’t apply to all job-related injuries. A Lexington personal injury attorney may file a civil damages claim if the employer intentionally or recklessly caused the injury. Sometimes bosses punish workers by making them do dangerous things. Other times, bosses ignore clear warning signs, like OSHA citations that indicate a workplace is unsafe.
These claims have some significant pros and cons. These victims could receive additional compensation, not only for the full amount of their lost wages, but also for their emotional distress and other noneconomic losses. The downside is that these victims must also prove negligence, or a lack of care.
Victims must also go to court and prove negligence if the employer didn’t have insurance, the insurance company refuses to pay, or in other such nonsubscriber claims. The good news is that these employers cannot use the most effective defenses in court. So, it’s easier to prove negligence.
Initial Review
Benefits have declined over the last few years, but the initial denial rate has increased over this same period. Nevertheless, insurance companies eventually pay over two-thirds of job injury claims. More on that below.
Generally, Claims Examiners deny claims without really explaining why. There’s a method to their madness. They hope unexpected denials prompt claimants to settle their claims for pennies on the dollar, or better yet, drop them entirely. Sadly, this strategy often works.
It’s important to remember that a denial doesn’t mean your claim is weak or meritless. Rather, a denial just gives a Lexington personal injury lawyer more time to prepare your case and a better forum to present it in. So, there’s no reason to give up at this point.
As a side note, lost wage benefits are usually retroactive to the filing date. So, job injury victims have nothing to lose by appealing their claims.
Appeals
Administrative Law Judges usually handle workers’ compensation appeals. ALJs aren’t elected judges and they don’t have all the powers these judges have. Additionally, they’re sometimes biased. Many insurance companies pay, either directly or indirectly, many ALJs. Furthermore, there’s never a jury at these appeals. The ALJ is judge, jury, and executioner, so to speak.
Now for the good news. ALJ hearings are a lot like trials. Lexington personal injury lawyers usually get to conduct discovery, so they can probe for weak spots in the insurance company’s case. At the trial itself, lawyers can introduce evidence, challenge evidence, and make legal arguments.
Since attorneys fully advocate for victims at this point, as mentioned, most claims get paid. In fact, most claims settle out of court. Insurance company lawyers know Lexington personal injury attorneys have some key advantages at ALJ hearings. Therefore, they’re motivated to make favorable deals.
Injury victims are usually entitled to substantial compensation. For a free consultation with an experienced personal injury lawyer in Lexington, contact the Goode Law Office, PLLC. After-hours, virtual, home, and hospital visits are available. The post What to Expect in a Workers’ Compensation Case first appeared on Goode Law Office, PLLC.