When do I need a Lawyer for my Workers Compensation Claim?

This is a question asked quite frequently amongst injured workers. In fact, it's a question I am asked nearly every time I meet with someone about a work comp claim. An easier question to answer would be, “when is it a good idea to talk to a lawyer about my work comp claim?” Talking to a lawyer is not necessarily the same as hiring a lawyer. The easiest answer is: it is never too early. The sooner you speak to an attorney the better.

Often, injured workers wait too long to contact a Workers Comp Attorney, and the attorney has to play catch up, rather than leading the claim. Reaching out early allows the injured worker the benefit of having an attorney on their side from the beginning. Remember you are dealing with an insurance company which handles hundreds of claims daily. They have experienced claims adjusters and attorneys managing their files. Shouldn't you consider the same? The following can help guide you of when to consider contacting a work comp attorney.

You’ve been hurt or have a medical condition you feel is related to your work or job duties, but don't know if you have a claim against your employer. This often is the case with cumulative trauma injuries and injuries which you don't feel the effects immediately.


You aren't sure whether to file an injury report:

The insurance company has denied your claim. Claims are denied for a variety of reasons. Just because a claim is denied does not mean you do not have a work injury. This is one situation where you definitely need to speak with a lawyer, and the sooner the better since claims have deadlines. Don't give up your claim without talking to an attorney.


Your claim has been denied:

Temporary disability benefits paid to you are based upon your "average weekly wage" on the date of the injury. Calculating the average weekly wage can be complicated and may include overtime, bonuses, and commission. If the insurance company gets this wrong, they may be paying you less than they should.


You think the insurance company has calculated your wages wrong:

Your temporary disability or permanent disability benefits have been discontinued and you disagree. Definitely give us a call. We need to get on this A.S.A.P. Temporary disability payments only last 104 weeks. If you are getting close or out of these weeks, you need to act; fast!


Your benefits have been discontinued:

The insurance company may send you to their doctors for a Qualified Medical Examination (or a QME). Often, the doctor will disagree with your treating doctor about everything from diagnosis to treatment and restrictions. The insurance company will then use the QME doctor's report to cut off your wage loss and/or medical benefits.


There is a dispute over your work restrictions:

This can occur for many reasons but often occurs shortly after you receive the QME report. In addition, they often will not pay medical bills which they owe because of the date of treatment. If you are receiving medical bills for treatment from your work-related injury please let us know.


The insurance company won't pay a medical bill:

The insurance company will not agree to authorize surgery, injections, physical therapy, an MRI, a second opinion, a change of treating doctor, a referral to a specialist, etc. As of Jan 2013, the medical approval process is standardized. You only have 30 days to appeal a Utilization Review (UR) denial.


The insurance company won't approve a medical procedure:

An insurance company is far more knowledgeable about workers' compensation than you are. They have an army of lawyers, adjusters, and specialists working to get them the best deal possible. The insurance company's goal is to save money, not spend it! Consult an attorney to ensure you are getting the best possible settlement.


The insurance company offers you a settlement:

California Workers' Compensation laws are constantly changing. Our job is to provide you with the most up-to-date information regarding any law change and to provide you an analysis of your possible benefits.


There are other questions you have regarding your California Workers' Compensation Claim:

A workers' compensation claim can be a confusing, frightening and frustrating ordeal. Please don't be afraid to contact us if we can answer some questions for you. Even if you don't need a lawyer at the moment, a little information about how the work comp system works can make a big difference. There are no upfront charges and our office only gets paid when a case is settled.


Get a free consultation to discuss your injury, work comp benefits, and if you need representation:

© 2020 Riley & Associates. Representing Injured Workers with offices in Redding, and Susanville.

The materials on this website do not, nor are they intended to create an attorney-client relationship or constitute legal advice. All California Workers' Compensation claims are different.

For advice regarding your claim, please contact a workers' compensation attorney.