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Workers’ Compensation – Why Would I Need a Lawyer if My Claim Is Approved?

On Behalf of | Mar 6, 2019 | Firm News, Workers' Compensation

Time and time again, we have clients call us and ask why they would need a lawyer if their case is accepted. Their medical treatment is being paid for and they are being compensated for their time off.

There are two main reasons why an attorney is probably still a good idea for most workers’ compensation claims, even if the claim is accepted or approved. First, the status of a claim is not permanent and will change as the case gets passed from one adjustor to another, or as new or different information becomes available to the claims representative. Second, insurance companies very rarely offer a fair settlement to unrepresented workers – an adjustor’s job is to get the claim to go away for as little money as possible – will you know if they are offering a fair value?

Workers’ Compensation Claim Status Is Not Permanent

When a claim’s status goes from accepted to denied there is usually no warning. You will suddenly stop receiving your weekly checks, your medical treatment will be denied, and you will receive very little or no explanation for the insurance company’s reasoning. For example: a client comes to us baffled that suddenly their medical treatment is being denied by the comp carrier, right after they just found out they are going to need a surgery- the very moment they counted on comp paying for the treatment. To make matters worse, the weekly paychecks they were depending on stopped arriving in the mail. When you are represented by an attorney it is less likely that this will happen without good reason and if it does happen, an attorney will already be familiar with your case and be able to respond quickly to resolve the issue.

A workers’ compensation adjustor/claims representative has a number of tools they can use to “turn off” a worker’s benefits. An independent medical exam (IME) can be requested, a utilization review (UR) can be performed, a worker can be surveilled by a private investigator and seen doing something that their doctor restricted them from doing, medical records or medical history alone can be a legitimate basis for an approved case becoming denied.

The Illinois Workers Compensation Act governs the rights and responsibilities of both the injured workers and the insurance companies, and unfortunately the law gives the insurance companies a variety of mechanisms to make approval of medical treatment extremely difficult if not impossible without representation.

The Law Permits the Insurance Company to Deny Medical Treatment

In other words, the insurance company does not have to break or overstep the bounds of the law to stop paying for medical bills and your time off.

As discussed above, under the law, they are afforded a variety of tactics that give them a legal basis to fight and even deny your claim a you need an experienced workers’ compensation attorney who understands the nuances of the law and knows how to make the right arguments to protect your rights and get you the medical treatment you need.

Will You Know if The Insurance Adjustor’s Offer Is Fair?

Our attorneys focus only on representing injured people and have decades of experience in trying cases, research, motion practice, negotiation of settlements, and working with attorneys, adjusters, judges and arbitrators. We have research tools at our disposal to help with case valuation, such as settlement and verdict reports on cases similar to yours. When an adjustor presents us with a bad offer, we are able to hold their feet to the fire and present evidence that they have unfairly valued the file and if that doesn’t work, we can pursue a fair resolution through trial. We then use our experience and knowledge to make sure you are keeping as much of the settlement funds as possible.

A Good Attorney Will Add More Value than Cost to Your Claim

Don’t wait for a rainy day or denial on your claim before consulting with an attorney, as the earlier you have someone protecting your rights and navigating these legal waters with you, the better protected you will be throughout your claim and the more money you will get at the end of your case.

Still Unsure?

Contact our team of experienced workers’ compensation attorneys or call us today for a FREE, no-hassle, no-obligation consultation. We will be happy to answer any of your questions and everything we discuss is confidential. If you still want to handle your own case you will at least have some more information you can use to help you along the way.