In any given year, hundreds of thousands of workers across the country will get hurt on the job, causing many of them to file a workers’ compensation claim. In fact, according to numbers from the Bureau of Labor Statistics, in 2019 there were more than 888,000 illnesses and injuries reported by private businesses that forced an employee to miss at least one day of work.
But whether the claim will be successful — and how much they will be eligible for — can vary from state to state, even for the same type of injury. The reasons for this can be pinned to many factors including income inequality, but one factor is that there’s no federal standard for workers’ compensation claims (aside from federal employees), says Evans Agrapidis, founder of Agrapidis & Maroules Law Firm, and a personal injury lawyer with offices in Jersey City on John F. Kennedy Boulevard, and on State Highway Route 17 in Hasbrouck Heights, New Jersey.
What constitutes a successful claim is based on state law and the benefits which might be defined in the employer’s contracts. This leads to an inconsistency that can be hard to predict and may unfairly affect workers in certain jurisdictions.
Benefits Can Vary Depending on Location
The list of eligible injuries for which a worker can file a claim can vary from state to state, adds Evans Agrapidis, and not all of them are physical injuries. Mental health conditions and stress-related injuries may also be covered, but it all comes down to the facts of each case.
Workers compensation benefits are generally designed to compensate for a percentage of lost wages and medical expenses. There usually is no compensation for the pain and suffering of the affected worker. However, in the state of New Jersey, an injured employee is entitled to a permanency award by filing a petition in a workers’ compensation court.
The award is based upon the percentage of permanent injury as established by medical experts.
When Should a Worker Hire a Personal Injury Lawyer?
Generally, many smaller claims are easily resolved. However, for cases that cause more serious injuries and more permanent disabilities, getting the right amount of compensation can get trickier, says Evans Agrapidis.
That’s because, with a more serious case, a person might need to have an ongoing treatment that will incur considerable medical costs. In these situations, employers and insurance companies can try to delay addressing medical treatment in order to minimize their liability.
Some workers may attempt to represent themselves in cases involving minor injuries. However, taking on an insurer in a more complicated case is not an ideal scenario for an individual who doesn’t know workers compensation laws inside and out. In these scenarios having an experienced lawyer on your side is necessary.
Another scenario explained by Evans Agrapidis is that the employer may try to deny a claim based on a pre-existing condition. More accurately, an insurer may use a previous illness or injury as an excuse to sidestep benefits, he explains. In this case, it’s important to have a legal representative sort out the details of your injury to help establish that compensation is warranted.
Additionally, an employer may also flat out deny that an injury occurred in the first place, or say it didn’t happen during official duties (which would disqualify a workers’ compensation claim). However, a lawyer can help establish a case that connects the injury with your place of work.
There are several instances where a claim is admitted by the employer, but the benefits fail to adequately cover medical bills and lost wages, explains Evans Agrapidis. In these situations, an experienced attorney can file an application in court for medical and temporary disability benefits.
A judge will decide whether the benefits offered are reasonable.
Matters of Employer Conflicts
Many workers will avoid reporting the injury altogether, for fear of retaliation from an employer. Retaliation by an employer for filing a worker’s compensation claim is not permissible and is grounds for a lawsuit by the employee. Meanwhile, as many as half of employers are failing to report serious injuries due to costs, but there is a penalty for those who fail to do so, explains Evans Agrapidis. Some claims are denied by the employer altogether, but an employee shouldn’t lose the motivation to pursue the matter further with the help of an attorney and the right medical documentation, says Evans Agrapidis. However, those who are awarded benefits could face potential backlash from an employer in the form of verbal harassment, reduced hours, demotion or even unjust termination. In this case, it’s definitely advantageous to consult a lawyer to clarify your rights.
An experienced workers compensation lawyer will help a client gather the evidence needed to make a case, as well as meet deadlines to file the right forms. They will be the negotiator between the claimant and the insurer, who will have its own highly-trained team of lawyers working in the insurer’s best interests, adds Evans Agrapidis. Additionally, the cost for legal consultation for these matters is free and the legal fee for representation is paid from the settlement or award at the end of the case and is only charged if the attorney wins and collects for the client.