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Do I have to sue my employer for Workers’ Compensation benefits?

Employers are required to carry workers’ compensation insurance to cover employees who are hurt at work or become ill due to workplace conditions. This coverage exists to protect the employee, and also to protect the employer from legal action. Due to this, employees are usually barred from suing their employer, and instead will need to file a claim to get the benefits they need while they recover.

While a lawsuit is usually not necessary (unless you have a claim for gross negligence or if a third party like a contractor caused you harm) it is a good idea to get a lawyer involved with collecting benefits from the very beginning of the claims process. Remember, you are merely trying to collect employer-provided benefits in the event you get injured on the job. It is not, theoretically, an adversarial relationship, but you will benefit from having experienced representation on your side.

The process of collecting workers’ compensation benefits has three stages. First, you file a claim with the insurance company related to a workplace injury. It is an excellent idea to have a lawyer help you file your claim.  We know the workers’ compensation system and can research the specific policy you are covered under. We know the right language to use to improve your chances of success with your claim. The insurance company will investigate the claim, including reviewing the incident that led to the injury, work rules at the time of the injury, the medical evidence of the injury, and other pertinent details. The insurance company may determine if the claim is valid and pay you the amount you requested for the injury, or the insurance company may deny the claim. At that point your recourse is to appeal that denial.

The appeals process is complicated and often adversarial, and you will want to be represented by a workers’ compensation attorney. Tactics that insurance companies deploy include delaying necessary hearings, asking for redundant paperwork, and, in general, making the process as opaque and intimidating as possible to the claimant. Though, a lawyer who is experienced in the workers’ comp appeals process will not be intimidated, knows what the rules for the appeals process are, and can argue your appeal effectively.

However, if your appeal is denied, then you may have to file a lawsuit to have the appeal overturned and get your claim paid. This will certainly require a lawyer to be successful. The insurance company has many lawyers working on workers’ compensation claims whose focus is on paying as little on the claims as they can, as late as possible. The civil litigation process is rule-driven and complex. There are many opportunities for the other side to delay and complicate the process, and you need an advocate on your side if your claim makes it to the lawsuit stage.

Hiring an experienced attorney from the very beginning of the workers’ compensation claim process will level the playing field with the deep-pocketed insurance company. We will handle all communications and negotiations with the other side, which is very important. We will cover all the legal costs of your claims process, which we collect after you win your claim.

A workplace injury is a destabilizing event. It impacts your health, your ability to pay your bills, and many other parts of your life. Hiring Spiros Law, P.C. will allow you to recover from the accident while we fight for the justice and fair compensation you deserve. Call us for a free consultation at (217) 328-2828, chat with us live on our site, or fill out a contact form today.