After suffering an injury in the workplace one of the first questions you may have is, “When should I hire a workers comp lawyer?” You may also wonder if an attorney is necessary, what assistance they can provide and how much it will all cost. With so much uncertainty on top of an injury, filing a workers’ compensation claim may feel overwhelming.
In this guide, we’ll discuss some of the questions and uncertainties you may feel when considering hiring a workers’ compensation attorney.
Below we discuss:
- When and why you should get a workers’ comp attorney.
- Specific situations in which a workers’ compensation attorney may be especially useful.
- What a workers’ compensation attorney can do for you.
- What a worker’s compensation attorney may charge.
- How much you may have to pay a workers’ compensation attorney.
How to Determine When and Why You Need to Hire a Workers’ Comp Attorney
The workers’ compensation system is designed to provide wage loss benefits, medical costs coverage and other benefits for those who have been injured in the workplace. Workers’ compensation serves two main purposes: to ensure employees can secure benefits after workplace injuries and prevent lawsuits against employers when a worker is injured.
Because the workers’ compensation system is in place to help injured workers, many injured employees assume they don’t need a workers’ compensation attorney. After all, why hire a Pennsylvania workers’ comp attorney if there is already a system in place to protect you in the event of an accident, injury or work-related condition?
Workers’ compensation is funded either by an employer or, more commonly, an insurance company. Insurance companies and employers may not want to pay out the full amount of compensation possible in every case. To do so shrinks profits and makes shareholders unhappy.
In addition, there are often situations with a lack of clarity surrounding what caused a workplace injury. There may also be accusations that an injury occurred outside of the workplace or was caused by a pre-existing condition rather than a workplace incident. In these and other situations, a workers’ compensation attorney can protect your rights and work to ensure you get the compensation you are entitled to.
Should I Hire a Workers’ Compensation Attorney? – Infographic
Why Should You Hire a Workers’ Comp Lawyer?
In an ideal workers’ compensation case, your injury is relatively minor, and there is no question you will get benefits. But not every workplace accident occurs in an ideal situation. Depending on your scenario, you may need an advocate to make sure you receive the compensation you deserve. You’ll want to consider hiring a worker’s compensation attorney if any of the following apply to you:
1. You Have a Pre-Existing Condition.
If you have any serious underlying health condition, it may be used as an excuse to deny your compensation benefits. Insurance companies and employers may claim your pre-existing condition is what caused your current ailment, and that your injury is not related to a workplace accident. But a pre-existing condition does not disqualify you from receiving benefits.
2. Your Employer Denies an Injury Occurred in the Workplace.
Issues may arise if your employer refuses to acknowledge your injury occurred in the workplace or is due to your work duties. A worker’s compensation attorney can clearly establish the link between your injury and your work. Without this link, you may be denied benefits that are rightfully yours.
3. Your Benefits Are Denied or Delayed.
Eighty percent of employees whose workers’ compensation benefits have been denied fail to pursue benefits. Even if you have been denied or you find your benefits are delayed, you can appeal or turn to other legal remedies. A workers’ compensation attorney can guide you through the process and can secure the medical documents that may be needed to prove your case.
4. Your Benefits Do Not Cover All of Your Medical Bills and Lost Wages.
In some cases, you may have concerns about the way your wage loss benefits are calculated. Incorrect calculations could leave you with less wage loss benefits than you should be getting, which may be an issue if all of your medical bills are not covered, you’re expected to pay a deductible or some of your costs. A workers’ compensation attorney can ensure you get the benefits you need to pay for quality medical care.
5. You Have Been Seriously Injured and Cannot Work for an Extended Period of Time.
If your injury is permanent or long-term, your medical costs and treatment needs might be considerable. In these cases, it’s more likely your employer or its insurance company will fight to reduce your benefits, so they don’t have to pay monumental costs. When you have a permanent or serious injury and cannot work, you shouldn’t have to worry about finances. A workers’ compensation attorney can work to secure the long-term benefits you deserve.
6. You May Have a Claim Against a Third Party.
Part of the workers’ compensation program is designed to shield employers from civil claims. However, some cases may still warrant civil claims. If a defective piece of machinery caused your injuries, you may have a claim against the manufacturer of that machinery. Civil claims may result in larger settlements because you can pursue noneconomic as well as economic damages. An experienced workers’ compensation attorney can help you determine the best way to proceed in these cases.
7. You Face Retaliation in the Workplace Because You Have Been Injured.
If you file a workers’ compensation claim and your employer seems to be retaliating against you, you should speak to a workers’ compensation attorney immediately. This retaliation could take many forms, including reducing your hours, demoting you, harassing you, terminating your employment or engaging in other retaliatory behavior.
In Pennsylvania, employees have the right to collect workers’ compensation benefits. When an employer retaliates against a worker for exercising their rights and filing a workers’ compensation claim, that employer violates public policy. Hiring an attorney can help you right the wrongs invoked through employer retaliation after a workplace injury.
8. You and Your Employer Disagree About Your Ability to Work.
Your employer or their insurance company may claim you can return to work with modified work duties so they can minimize, reduce or suspend your benefits. If you disagree or think you cannot return to work because of the severity of your injury, a workers’ compensation attorney can review your situation and present evidence of your serious medical condition. When you choose attorneys that are experienced, they can work to ensure you are not left without a job and without benefits.
9. Your Employer Claims You’re Not Covered by Workers’ Compensation.
A small number of workers do not qualify for workers’ compensation. Under Pennsylvania law, employees in the following fields may not be covered by the Pennsylvania Workers’ Compensation Act:
- Federal workers
- Railroad workers
- Casual employees
- Domestic workers
- Agricultural laborers
- Employees with personal religious exemption
- Volunteer workers
Pennsylvania law provides more specifications that may cover some employees in the above fields with other compensation laws. If your employer claims you work as an independent contractor and otherwise do not qualify for workers’ compensation — even though you perform the job duties of a full-time employee — contact an attorney. An attorney can look at your employment agreement and field of work to determine whether you qualify for benefits.
10. Your Employer Has Not Paid for Workers’ Compensation Insurance.
By law, Pennsylvania employers are required to pay for workers’ compensation coverage for all qualified workers. This is the case even in small and non-profit organizations. Employers may fulfill this insurance requirement through self-insurance or by going through an insurance company.
If your employer has allowed the insurance to lapse or has never secured insurance for you as required by law, you may still qualify for benefits under the Uninsured Employer Guaranty Fund. Consult with an attorney to find out what options exist for you.
11. You Do Not Understand the Workers’ Compensation Process.
Workers’ compensation can be an intimidating process if you’re unfamiliar with it. You may have questions about ways to fill out forms, your rights, what you can and can’t say, your settlement and more. Even in ideal cases, a qualified attorney can help you with all of these concerns.
12. You’re Being Accused of Fraud.
Workers’ compensation fraud occurs when an employee intentionally receives wages while also receiving total or partial disability benefits that exceed the permitted amount for their situation. While workers’ compensation fraud is a real concern, you shouldn’t be denied benefits if you are legitimately injured. If your employer or their insurance company alleges you aren’t really injured or you are trying to defraud the system, it’s important to consult with an attorney.
13. Your Employer Disagrees With or Disputes a Decision Made by the State Workers’ Compensation Division.
If your employer and insurer are trying to avoid honoring a decision made by workers’ compensation division or by a judge, you may not receive your due benefits. Consider hiring a workers’ compensation attorney to represent you as you navigate the necessary legal measures to receive your workers’ compensation.
14. After Receiving Benefits for Some Time, Your Employer or Its Insurance Company Requests an IME or Other Evaluation.
Even if you have been approved for benefits, your employer or its insurance company may try to get you reevaluated to see whether your injury has become less severe. This is known as an independent medical examination (IME), and it may be performed by a company doctor to show that your injury no longer exists or is not as severe.
Often, an IME is a precursor to terminating, reducing or eliminating your benefits. If you are being asked to submit to additional tests or to a labor market survey, get legal advice to ensure your benefits aren’t reduced or cut off unfairly.
15. The First Doctor You See Has Cleared You for Work Quickly or Did Not Refer You to a Specialist.
Sometimes, if you see an employer-approved physician, they will clear you for work quickly — even if you don’t agree you can return to work. They also may not refer you to a specialist, even if you request it. If you are released to go back to work and decide not to return, you could lose your claim to workers’ compensation.
Your return to work and workers’ compensation claim should support your healing while also complying with relevant laws. An experienced attorney can help you get a second opinion or reach a more suitable agreement.
16. You Don’t Understand What Could Hurt Your Claim.
Many small things can hurt your claim. If you post innocuous pictures on social media, they can be used against you. If you show yourself at a special event on your social media, insurance companies can use this to claim you are not as injured as you reported. A workers’ compensation attorney can advise you of the seemingly minor incidents that could hurt your claim and can coach you on how to strengthen your claim instead. In many cases, these are issues injured workers don’t even think about.
17. You’re Not Sure Which Doctor You Need to See.
In Pennsylvania, for the first 90 days after an injury, you must see a doctor approved by your employer or its insurance company. But this is only the case if your employer posts a list of at least six approved medical providers and meets other requirements. Often, there is confusion about whether you do need to see an approved medical provider or whether you have more options.
If you are required to see an approved medical provider, workers’ compensation may not cover the costs if you see your own doctor. On the other hand, if your employer does not meet the requirements, you may have the option of seeing your own medical provider, which may be more beneficial. A workers’ compensation attorney can ensure you understand which doctor you need to see and when.
18. You Develop Symptoms Gradually Over Time.
Sometimes, workplace injuries don’t create symptoms right away. If you suffer a herniated disc or a soft tissue injury, you may develop symptoms over a period of days or weeks. Even if you suffer a serious head injury, symptoms may not become apparent for hours or days.
This can make it harder to prove a specific injury is related to work. It can also mean an initial medical consultation will determine you were not seriously injured. A workers’ compensation lawyer understands not all injuries present symptoms right away. They can help you get a thorough medical evaluation to ensure your complete physical situation is clear when it’s time to evaluate your settlement offer.
19. You Are Eligible for Medicare or Will Become Eligible Within 30 Months.
If you file a workers’ compensation claim and are Medicare-eligible, your settlement may be submitted to Medicare. In these cases, you may enter into a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA). A WCMSA designates part of a workers’ compensation settlement to cover future medical expenses for your workplace injury. Under a WCMSA, the allocated portion has to be used up before Medicare pays for your workplace injury treatments.
Medicare may deny some of your medical costs unless you proceed carefully. An attorney can work with you to ensure your medical costs are covered and that you benefit as much as possible from any agreements.
20. You May Need Medical Treatment Much Later After Your Injury.
Some injuries will result in a lifetime of care. If you have suffered an injury at work that requires amputation, you may need to replace your prosthetic regularly for the rest of your life. You need to ensure your settlement covers these additional costs. An attorney can review your case and your injuries to help you understand how much money you need to cover all of your current and future medical costs.
21. Your Injury Is Hard to Quantify Medically.
Some injuries are very clear. If you have suffered a crushing injury, a serious laceration or you require surgery, it may be easy to prove you have been severely injured. Other injuries are harder to prove. If you have suffered severe mental trauma as a result of your injury, it may prevent you from working. It can be difficult to quantify the effects of that trauma using medical tests. Soft tissue injuries can be difficult to prove as well because they do not always show up on X-rays. A workers’ compensation attorney can ensure you are evaluated by qualified specialists who can submit compelling medical evidence about your injury.
Is a Worker’s Compensation Attorney Necessary?
While hiring an attorney is completely up to you, keep in mind that Pennsylvania workers’ compensation process is highly complex. A qualified attorney can offer reassurance and can bring you peace of mind. With a good attorney by your side, you can focus on getting better and taking care of your injury. An attorney can guide you through the application, appeal and other processes you may need to secure compensation.
If you have already filed a workers’ compensation claim and something goes wrong or you have concerns, contact a workers’ compensation attorney immediately. If possible, it is best to consult with a workers’ compensation attorney immediately after you have been injured. If you have sustained a serious injury and don’t expect any problems, it can still be beneficial to talk with an attorney to have your case evaluated. An initial consultation with a certified Pennsylvania workers’ compensation specialist at Frommer D’Amico, is free and gives you a chance to ask about your claim.
What Does a Pennsylvania Workers’ Compensation Attorney Do?
If you experience any of the situations described above, a workers’ compensation attorney can:
- Secure evidence that your injury or condition is caused by your work
- Secure medical documentation to prove your injury
- Help you understand what you need to do to file a claim
- Ensure you fill out paperwork correctly and on time to qualify for benefits
- Help you understand which doctors you need to visit and when
- Answer any questions you have about the workers’ compensation process
- Advocate for you if your claim is denied or delayed
- Prepare you for any discussions with an insurer or any appearance before a judge
- Help you understand how much your claim is worth and help you evaluate any settlement offers so you get the fairest compensation possible
- Help offset any evidence presented by “independent” medical professionals approved by your employer or their insurance company
Video – What Does a PA Workers’ Comp Attorney Do?
In short, a Pennslyvania workers’ compensation attorney represents you and your best interests. He or she can ensure you avoid some of the most common pitfalls associated with a workers’ compensation claim and can improve your chances of securing fair compensation. While everyone in your life may have opinions about your injury and your claim, an attorney is a legal professional who has experience with these cases and understands what it takes to secure fair compensation.
Without an attorney, you are relying on your employer and its insurer to give you information, and they have their own interests in mind. You are also relying on your own understanding of workers’ compensation to file your claim, which may leave you vulnerable if you run into any challenges. With an attorney, you have the professional representation and protection you need and are poised to get the best results possible in your case.
Keep in mind that your employer and its insurance company has attorneys on their side. In fact, insurance companies have teams of skilled attorneys to ensure they do not have to pay compensation claims unless absolutely necessary. If you’re an injured worker, you deserve the same legal representation and support. When you consult with a workers’ compensation attorney in your state, you can level the playing field and ensure you get the legal advice you need, when you need it.
What Do Workers’ Comp Lawyers Charge for in Pennsylvania?
If you are considering working with a workers’ comp attorney, you’ll want to consider the fees. The good news is that the cost of a workers’ compensation lawyer will be a percentage of what the attorney recovers for you, so you’ll never have to pay more than you receive or end up having to pay all your benefits for legal costs.
Frommer D’Amico will never charge anything for a consultation. We understand injured workers are worried about finances, and we don’t want you to let concerns about fees get in the way of acquiring quality legal advice. We offer a free initial case evaluation for anyone with a work injury, which will allow you to learn more about how much your case may be worth without having to pay anything.
Frommer D’Amico also does not charge for case management. You can always contact our team to ask questions and get the facts about Pennsylvania rules without having to pay additional workers’ comp attorney fees. This ensures you will always have the information you need from a trusted source.
Free case management means Frommer D’Amico will:
- Prepare you for IREs and IMEs.
- Review injury descriptions, medical records, alternative benefits, injury reports and health insurance.
- Re-check your wage calculations.
- Examine your collective bargaining agreement and FMLA options.
All of these tasks and access to your attorney are included in the cost of your workers’ compensation lawyer and will not incur any additional fees.
How Much Will I Have to Pay My Workers’ Compensation Lawyer, and When Will I Pay?
Frommer D’Amico works on a contingency basis, meaning you will not pay if there is no recovery for you. There are only three ways you ever pay us a fee:
- Your claim was denied, and we win benefits for you.
- Your employer sues you to stop or lower your benefits, and we prevent that.
- You want to settle your case, and we are able to get you a lump sum settlement.
In other words, you don’t have to worry about fees unless we get results. You face no risk because no results will mean no payment. If and when we win in court, when your claim is accepted or when we have protected your benefits, we’ll charge 20 percent of the benefits preserved or earned for you.
If you simply want an attorney to be available for calls or to review your records with you and provide ongoing advice, you will not pay anything.
An attorney from Frommer D’Amico will focus on maximizing your benefits and ensuring that you do not leave money on the table. Without an attorney, you may not be sure whether your wage calculations are correct, whether your injury descriptions are accurate or whether you’re getting a fair offer.
Contact Frommer D’Amico online or call us at 717-400-1000 for a free case evaluation. With no obligation or pressure, we can explain your options so you have a sense of whether an attorney is right for you. We’re very transparent about our costs, so we’d be happy to review how much your total expenses might be once we’ve won benefits for you.
Hire a Pennsylvania Workers’ Compensation Attorney at Frommer D’Amico
When should you hire a workers’ comp attorney? The answer to that question is likely “now.” If you are reading this, you may have questions about your claim or you may have been injured and are wondering how to proceed. Speaking with a certified worker’s compensation expert at Frommer D’Amico can help you get personalized answers.
One reason why many injured workers turn to Frommer D’Amico is because our workers’ compensation experts and attorneys understand what it takes to win a fair settlement. In addition, our firm does not charge case management costs, and we are easy to reach — even on weekends and evenings.
Our commitment to stand by you is evident in our client approach and in the way we structure our fees to ensure you get legal support without having to pay case management fees or upfront costs. If you are concerned about legal costs, rest assured Frommer D’Amico services are free for clients.
If you have questions about your Pennsylvania workers’ compensation case or are trying to determine when to hire a workers’ compensation lawyer and need to speak to someone now, contact us for your free consultation.
Joe D’Amico has more than 20 years of experience fighting for injured workers. He is Certified as an Expert in Pennsylvania Workers’ Compensation Law by the Supreme Court of Pennsylvania. Joe is one of the very few Pennsylvania workers’ compensation attorneys who have obtained a recovery in excess of $1.5 million for an injured worker.
Reviewed by Joe D’Amico.