An average insured worker may not seek professional legal help after a workplace accident, simply because many people assume they can manage the workers’ compensation process easily on their own. Often, it is true, especially in minor incidents.
However, there are instances when even the most friendly employers become uncooperative, your calls remain unreturned, and the medical bills continue to pile up. That is why it is so important to learn when to get a workers’ comp attorney.
There are a few common and quite critical indicators when to get a workers’ comp lawyer immediately:
- Your employer or their insurance company denies your workers’ comp claim
- You’ve sustained severe injuries that may lead to permanent disability
- The insurer offers compensation that barely covers your needs
- There are other parties involved in the accident
Keep in mind that whenever you feel you do not understand what is going on, you are at a disadvantage. A skilled attorney can help you grasp the matter and turn the tables in your favor when contacted on time.
When Do You Need a Lawyer for Workers’ Comp?
If your claim is delayed, denied, or you’re being pressured to return to work, talk to us now. A quick review can save your benefits.
What Can a Workers’ Comp Lawyer Actually Do for You?
On paper, a workers’ comp process looks like a two-step deal: you report your injury, and the workers’ comp insurance covers your medical and income-related losses. However, in reality, the system includes multiple steps and details, where something can go wrong at any turn. This is precisely when to get a workers’ compensation lawyer on your side. The process has plenty of points where things can unravel, and that’s where they come in:
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Paperwork and deadlines
Not only does an employee have to fill out the paperwork, but they must do so within a state-defined timeframe. A mistake at any of these stages can cost you your settlement. A legal representative makes sure forms are filed correctly and on time.
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Medical evidence
An experienced workers’ compensation lawyer helps gather the right medical records, doctor statements, and reports that connect your injury to your job.
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Benefit calculations
Lawyers understand all the calculation intricacies and ensure nothing is miscalculated, so you get what you are owed.
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Settlement review
It is in the insurance company’s interest to persuade you to accept a quick, often lowball offer. A workers’ compensation attorney, in turn, will review the compensation and push it back if it doesn’t cover your actual losses in full.
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Hearing preparations
Sometimes claims get disputed, and negotiations bring no positive result. That is when the case may go to trial. A personal attorney will represent your interests in front of the judge and instruct you on how to behave and what to say so as not to hurt the outcome of your claim.
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Third-party claims
In some instances, the employer isn’t the only potentially liable party. If other parties have contributed to the accident, an attorney will evaluate them and decide whether you should pursue compensation from other sources, too.
These are a few important aspects to consider when you are thinking, “Should I get a lawyer for workers’ compensation?”
Do I Need a Lawyer for Workers’ Comp in a Simple Claim?
Before we answer the pressing question, “When do you need a lawyer for workers’ comp?”, it’s vital to emphasize that every workplace injury case is different. Some are more straightforward than others, which means it is absolutely possible to handle the claim on your own and not lose anything in the process.
What are the main indicators that you can proceed with the process on your own? Typically, it is one or a few of the following:
- You’ve suffered a minor trauma, and the doctors have cleared you of possible lasting implications
- Your medical treatment was instantly approved, and you’re not denied access to required medical care
- You receive all necessary checks on time, and the payouts are covered in the expected amount
- The insurance agents aren’t trying to convince you to accept a settlement that you fear may not cover your losses
When to Get a Workers’ Comp Attorney Right Away?
Sometimes the question “Should you get a lawyer for workers’ comp?” answers itself — because there’s simply no time to weigh it. These common red flags will tell you when to hire a workers’ comp lawyer right away:
- Denial: When your initial claim is denied, that is the clearest sign that you need help. After denial, the process becomes even more tangled and complex, which means there’s even more room for error if you lack experience in the field.
- Delays: If your checks or your medical treatment are delayed and you do not know why, you need to call an attorney.
- Severe traumas: The more serious your injury, the higher the payouts. The insurer does not want to part with their money easily, so they will try to reduce or deny your compensation twice as hard as they would otherwise.
- Long-term impairment: If you require surgery or lengthy rehabilitation, your claim will entail long-term financial consequences. It may be challenging to estimate future expenses without a proper background, but once you agree to a certain settlement, there will be no way of recovering more.
- Employer retaliation: Although it is illegal, some employers may try to reduce the worker’s hours or change their duties after the claim is filed. These shifts must be traced and documented to ensure they don’t compromise your benefits.
- IME (Independent Medical Exam): An insurance provider may ask you to head for a checkup with a specialist of their choosing. It typically means your injury is about to be downplayed, thus resulting in reduced payouts.
- Return-to-work pressure: Returning to work too soon can negatively affect your condition. That is precisely what insurance providers expect since it gives them the green light to deny further benefits.
- Third-party liability: If other parties contributed to your injury, our personal injury lawyers can help you seek and recover additional compensation.
If any of these red flags apply to your situation, you may stop wondering when to get an attorney for workers’ comp and focus on whom to hire.
When to Hire a Workers’ Comp Attorney After a Denial or Delay?
When a claim gets either delayed or denied, it does not necessarily mean that your case is a lost cause. However, this increases the risk of losing your compensation. After a denial, the routine claim turns into an open dispute where your injuries, the severity of the condition, and your workers’ benefits are in question.
An insurer may not be allowed to reject your claim because they do not want to issue a payout, but they can say there isn’t enough reliable evidence to back up your claim. Missing medical records, weak proof that your trauma happened at work, and even incomplete or incorrect paperwork can become that evidence gap that will be used against you.
When to hire a workers’ comp lawyer in cases like that? As soon as you can. The sooner your attorney can identify what’s missing, the faster they will find the missing pieces of the puzzle and put the claim back on track. Besides, after a dispute, there is a tight deadline to meet if you want to appeal the denial, request a hearing, and submit additional evidence.
Remember that it isn’t too late to introduce legal representation to the case after denial, but keep in mind that you don’t have an unlimited amount of time to do so either.
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What Is a Reasonable Sum for Workers’ Compensation Settlement?
Many injured employees wonder how much they can recover after a workplace incident. However, the settlement isn’t static. It depends on various underlying factors, including but not limited to:
- Injury severity: The less serious the injury, the smaller the compensation. A sprain can heal without a long-term effect on your life, but a serious back injury would have lasting consequences.
- Medical expenses: Some traumas entail substantial future costs, such as ongoing rehabilitation, so workers’ comp will be higher than for an injury that does not incur additional expenses.
- Loss of income: If you can go back to work after your injuries heal, the settlement will cover the actual wages you lost over the rehabilitation period. However, if you can’t resume your usual work activities, the compensation must also cover the loss of your earning potential caused by the trauma.
- Disputes: When a claim is disputed or denied, it may result in reduced payouts.
Also, the state regulations may cap the amount of compensation you receive. For instance, in Massachusetts, there isn’t a lump-sum limit to worry about, but there is a State’s Average Weekly Wage (SAWW) rule. For instance, a temporarily incapable employee can’t recover more than 60% of their weekly wages after the accident.
Timeline of a Workers’ Compensation Claim in Boston
The workers’ compensation claims process includes steps that must be taken by the worker, the employer, and the employer’s insurance carrier.in
Here’s what to expect as part of the workers’ compensation claims process:
| Action | Deadline | Who does it | What you keep (proof) |
|---|---|---|---|
| You must get medical treatment. Your health is the most important factor after any accident. Get the care you need to prevent your injuries from becoming worse or complicating your claim later. | Immediately | Employee + medical providers | ER/urgent care records, diagnosis notes, work restrictions, receipts, appointment dates |
| Notify the employer as soon as the injury or illness is diagnosed. You must report the injury or illness immediately. The employer has seven days to notify its insurance company of the injury. | Employee: Immediately
Employer: Within 7 days after a 5-day employee disability |
Employee + employer | Written notice (email/text), incident report copy, witness list, date/time details |
| The insurance carrier has 14 days to make a decision. They may agree to pay the workers’ comp claim or reject it. If benefits are denied, you must receive a letter explaining the decision. The insurance company must also inform the Department of Industrial Accidents of its decision. | 14 days to decide | Insurance carrier | Decision letter, claim number, DIA notices/filings, adjuster contact log |
| Benefits are paid on a schedule. If your claim is accepted, the insurance company must pay you lost wage benefits every two weeks. Your doctors and other healthcare providers will receive their benefits directly. The insurance company must notify the Department of Industrial Accidents if it stops paying you benefits, or if there is any change in the number of benefits you are receiving. | Wage benefits paid every 2 weeks (if accepted) | Insurance carrier + providers | Pay stubs/benefit checks, EOBs/billing statements, notices of reduction/termination, correspondence |
When Should You Hire a Workers’ Comp Lawyer?
Types of Benefits You Can File for in a Workers’ Comp Case
Workers’ comp is designed to cover a portion of a person’s losses resulting from a workplace injury. Since it does not compensate for all types of damages, you need to be 100% aware of which benefits you are legally entitled to:
- Medical benefits: If you need medical care after the accident, the workers’ insurance will cover it all. Doctor’s visits, prescriptions, and even travel to and from the hospital are all covered. There are no limits as to what you can recover.
- Lost wages: You can’t obtain the full amount of your wages after an injury at work, but you can still recover around 60%–75% of your income based on the type of your incapacity.
- Permanent disability: In case you can’t return to work because of the severity of your condition, you can claim around 2/3 of your weekly wages for as long as it takes you to heal.
- Death benefits: When an injured worker dies because of the workplace injury, their immediate family — children and spouse — can recover around 2/3 of the deceased’s weekly wages as long as they remain dependent.
When Is It Too Late to Get a Workers’ Comp Lawyer?
People who are wondering when to hire a workers’ comp lawyer often fear they may be too late. In fact, they are right to do so because Massachusetts has strict official deadlines. For instance:
- Claim deadline: You have 4 years from the day of the accident to file a corresponding claim and recover fair compensation. If you do so even a day later, you’ll lose your right to any settlement.
- Denial deadline: If your case is denied, you have 4 more years to file an appeal. This seems like a lot of time, but the longer you wait to appeal, the greater the chance that critical evidence disappears and your claim gets even weaker.
- Insurer’s response deadline: An insurance provider has 14 calendar days from the date they receive your injury report to notify you of their decision. Within the period, they either issue an acceptance check or send an official denial note.
Keep in mind that you should inform your employer of the injury as soon as you get it. However, the employer can report it to the insurance only after 5 calendar days of your accident. If you can’t return to work after 5 days, the employer has another 7 calendar days to report the accident to the insurance.
Conclusion
When do you need a lawyer for workers’ comp? The answer typically lies on the surface. All you need to do is evaluate how smoothly your claim moves. If you feel there are more roadblocks than there should be, contact an attorney. Many law firms in Massachusetts, including Michael Kelly Injury Lawyers, offer free case reviews so you won’t lose anything in the process.
Trust your instincts. Contact our workers’ comp attorneys today, ask all the questions you have, and make sure you are not about to leave your money on the table!
