A workers’ compensation claim is a civil lawsuit. In all but the most blatant and obvious cases, the defendant is going to engage legal support to show that your claim is frivolous. As in all civil legal actions, you will have to have evidence to present to the hearing.
The evidence you have received, necessary medical attention and rehabilitation.
There are certain ironies in the workers’ compensation system. The system is designed to compensate you for the cost of treatment for your injury. If you have not received treatment or you can’t afford treatment, the workers’ compensation system will not compensate you. The best advice is to receive medical treatment and begin rehabilitation immediately after the injury. If you have not received treatment, the system will assume that treatment was not necessary.
- The most important documentation you need is not the diagnostic information, but evidence that you have received and paid for treatment for the injury.
- Financial information associated with the cost of treatment is the most significant evidence.
- After cost evidence is evidence of income loss due to your injury.
- Medical status reports that show how far you have progressed with treatment and how much additional treatment you will require. The workers’ compensation law calls for payment to continue until you have achieved full recovery.
What kind of evidence do you need?
The evidence you present to the hearing must be substantive documentation. Begin collecting written documentation right away.
- Medical records and reports from a medical professional that describe the nature of your condition, how much it affects your ability to function normally, how it is being treated and how much you have recovered. The effort to get help for your condition is the most substantial evidence that you deserve benefits to compensate you.
- You should collect and have available any accident or incident reports that describe how you were injured or what brought about your disabled condition. Your insurance company, the police, or another investigating body will probably have detailed records.
- Employment and pay records to show how much income and work hours you have lost because of your condition. Worker’s compensation is designed to provide you with income to make up for losses due to your condition. You must support the claim to define just how much income you have lost.
- Collect witness testimony from anyone who saw the incident that caused the injury. At least get their contact information so the hearing can obtain their statements. It is desirable to have all witnesses write, sign and date statements that explain what they saw in as much detail as possible.
- Print and keep all emails from insurance adjusters or from your employer relevant to your injury. You can initiate phone inquiries to people with knowledge of your case as well. Keep a log of any calls you make with date and time of the call, who you spoke with and the nature of the conversation. You have to make sure that you can prove you have upheld your implicit agreement to stay in contact with your insurance company and interested parties in your case.
What Could Happen?
Sometimes workers compensation cases can actually be legal contests.
- In one case, a worker injured the discs in her spine while working in an office environment. She received and documented back fusion surgery for which her insurance company paid. She received weekly workers’ compensation while out of work. Her total compensation amounted to about $17,000. This payment did not reflect her real continued losses. She was receiving a weekly payment less than her wages would have been. The impairment rating from the doctor the company used in her case underestimated the extent of the injury. She took legal action to buttress her case. After a legal battle, the compensation was increased to $130,000, which more nearly matched her real losses due to the injury.
- A construction worker fractured his arm at work. The company told him they would “take care of him” and that he should not report this as a work-related injury. He told the hospital that he injured his arm at a sport. As he recovered, he found he was receiving no weekly income support and no one was paying his medical bills. Because of his statement, the hospital records did not support his workers’ compensation claim. The worker contacted legal counsel who worked with him to find witnesses, obtaining depositions that would hold up in court about the incident and records of his treatment and costs. Eventually, the employer and its insurance company were obliged to pay the complete medical bills and provide weekly compensation.
Freeman & Freeman, Los Angeles personal injury attorneys are on your side in even the most challenging legal situations. Our Los Angeles personal injury attorneys focus on representing injury victims throughout Southern California. Please contact us for a free consultation and to learn more.