A workers’ compensation claim denial can be gut-wrenching. Not only are you unable to work to support yourself and your family, you are also left struggling to pay for medical bills while dealing with your injuries or illness. Unfortunately, many legitimate workers’ compensation claims are denied for a multitude of reasons despite studies showing just one-to-two percent of workers’ comp claims are fraudulent.
If your workers’ comp claim has been denied, it does not have to be the end of your claim. In fact, you have legal options available to you, including the right to appeal the decision and present evidence of your claim.
Why Are Workers’ Comp Claims Denied?
Workers’ compensation claims can be denied for many reasons, but there are several common reasons for denials:
- There were no witnesses. Unfortunately, insurance companies consider this a red flag for a fraudulent claim, even though you cannot help it if you get hurt when no one is there to see it happen.
- The injury was caused by a preexisting condition.
- A failure to report the incident to the employer in a timely fashion.
- Discrepancies in the claimant’s testimony.
- Insufficient medical care. It’s vital to seek medical attention as soon as possible, follow up all medical appointments with providers, see the doctor often, and follow all doctor recommendations. Failing to do any of these can result in a denied claim as the insurance company may argue the injury isn’t valid.
Appealing Your Denied Workers’ Comp Claim
- When your claim is rejected, you are sent a letter stating the claim was denied and possibly a description of the appeal process. Be sure you read the denial letter carefully and note any deadlines for your appeal. In some cases, the deadline to file an appeal may be as short as 30 days.The letter should explain which benefits have been denied and why. In some cases, workers’ comp claims are denied due to missing or incomplete paperwork, in which case you can contact your employer or insurance company and hopefully clear up the problem. If your employer refuses to allow the claim, an appeal will be necessary. A workers comp attorney can guide you through the process and minimize the risk of a permanent claim rejection.
- The workers’ comp appeals process varies by state, but it usually begins with an administrative hearing before an administrative judge through your state’s labor department or state workers’ compensation board.
- During the hearing, you will need to present evidence to support your claim. This may involve presenting medical records or additional medical testimony offered by your physician. A workers comp attorney is experienced with what is required to build a strong case. He or she can work with you to fulfill the court’s expectations which will greatly enhance your chances of a claim approval.
The Value of a Workers Comp Attorney
If you decide to appeal your workers’ comp claim denial, be prepared for an arduous process. An experienced workers’ comp attorney can help you through this process, including gathering evidence, navigating the many deadlines within the appeals process, and helping you avoid the pitfalls that may damage your case. We recommend speaking with a Palm Beach County workers compensation attorney as soon as possible before filing your appeal to help build the strongest case possible.
Thanks to our friends and contributors from the Law Offices of Franks, Koenig & Neuwelt for their insight into the workers compensation process.
In the majority of cases, a personal injury settlement should not affect an individual’s disability benefits. This is not a hard and fast rule, however, as there are a couple types of disability benefits that could be affected by a personal injury settlement.
Supplemental Security Income (SSI) Benefits
SSI is a needs based program, meaning the income you receive and the status of your finances play a role in determining your benefits. As such, receiving a large personal injury settlement could be construed as income and financial resources. In such a scenario, an individual receiving SSI benefits could have their benefits reduced if they received a substantial settlement.
For anyone who has received a personal injury settlement while also receiving SSI benefits, it is important to talk to a skilled Tampa FL lawyer. The attorney will be able to help you maximize your SSI benefits, even after you received a settlement from your personal injury case.
Disability Insurance Benefits
Disability insurance benefits (DIB) may also be impacted by a personal injury settlement. However, DIB benefits are affected differently than SSI benefits.
Whereas SSI benefits can be affected if the individual receives a lot of money in a settlement, DIB is affected based on the type of case that was settled. Namely, DIB can be affected if the injury settlement was part of a workers’ compensation case. The Social Security Act requires a DIB recipient to report a workers’ compensation settlement to the Social Security Administration.
The recipient is required to do so based on the Act’s “Offset Requirement”, which offsets the individual’s monthly DIB benefits in an amount that approximates their workers’ compensation receipts.
Simply put, recipients of DIB who do not report a workers’ compensation settlement to the Social Security Administration risk having to repay any DIB benefits that should not have been paid to them based on the Offset Requirement. Additionally, these recipients could also have their DIB reduced.
The Majority of Personal Injury Settlements Do Not Affect Someone’s Disability Benefits
While it is always helpful to point out the exceptions to a general principle, most people who receive both a personal injury settlement and disability benefits will not have their disability benefits affected. Social Security Disability Insurance is based on your disability that prevents you from obtaining long-term, gainful employment.
A personal injury settlement does not change these facts in any way. In short, it is highly unlikely that your disability benefits could be affected by an injury settlement, even if the settlement was quite large.
Thanks to our friends and contributors from The McKinney Law Group for their insight into the effects of a personal injury settlement on disabilities.
Negligent construction cases can arise in many different ways, although the most common type of case deals with an improper foundation. An unsuitable foundation can lead to an array of problems, including cracking, structural defects, and even black mold.
In order to prove elements of liability against a contractor or sub-contractor, it will be necessary to hire a couple of experts: (1) an expert in the same field as the contractor, excavator, or foundation subcontractor should be hired to testify as to the applicable standard of care necessary in the industry, and (2) an engineer should be hired to discuss issues of soil tests, soil compaction, load capacity calculations, and load tests.
Soil tests and proper compaction
The most important pieces of evidence in proving negligent construction will often be related to the results of the soil test. The soil test will show the types of soil present, which leads to whether the soil was properly compacted. Proper compaction and testing of the compaction will be key in determining whether failures were directly related to the compaction. The defendant’s deposition testimony will allow you to determine what tests were performed, what steps were taken to properly compact the soil, and the calculations and testing that were performed to ensure that the foundation was ready for the load to be placed upon it in the construction phase. If any of these tests or calculations were not performed, it is evidence of negligence.
Claims: Negligence, Breach of Warranty, Breach of Contract, fraudulent misrepresentation, and defective trade practices
You should consider all potential causes of action against the defendants, keeping in mind that some potential causes of action could cause issues of coverage between the defendant and his insurer. Breach of contract claims may be necessary to preserve damages related to attorney’s fees and the costs of litigation, depending on state law.
Most states will have jury instructions very specific to these causes of action. The instructions related to damages will allow recovery of all necessary repairs if the damage was temporary. Most states will instruct juries in cases of permanent construction damage to determine the difference in fair market value before and after the occurrence. Ensure that the client has documented all possible expenses related to work to repair all defects, along with all resulting damages. A schedule of litigation costs, attorney’s fees, expert witness fees, mental anguish, and loss of enjoyment/loss of income should also be calculated to maximize the amount of recovery.
For these reasons, it is necessary to consult with an skilled personal injury lawyer Little Rock AR counts on in negligent construction cases.
Thanks to Steve Harrelson and our friends and co-contributors from Harrelson Law Firm, P.A. for their added insight into negligent construction cases.
Premises liability is the legal idea that a property owner is responsible for ensuring that their property has no unreasonable or unmarked dangers that may threaten guests or visitors. Examples of these threats include, but are not limited to, slick areas, tripping hazards, or falling hazards. When a property owner fails in this responsibility and one such hazard is the cause of injury to a person visiting their property, the victim of the injuries may have the ability to receive compensation for through the legal concept of premises liability, so long as they themselves were not acting carelessly or dangerously.
The biggest factors that can make or break a premises liability lawsuit are documentation of the incident and the severity of the injuries. The victim of an accident should be sure to complain of injuries immediately after the accident has occurred, and make it very clear to the property owner or business that they are in pain. This can later be very helpful when demonstrating that the injuries occurred as a result of the negligence of the property owner. In most businesses, an incident report will be completed following an accident which will reflect the conditions in which the accident occurred, the time and date it occurred, and any injuries that the victim informs them of. If the victim does not mention any injury to the property owner, and does not seek medical attention following the accident, it can be very difficult to later prove that the injuries occurred on the property.
On private property, an incident report will obviously not be filed. However, it is still important for the victim to inform the property owner of their injuries and immediately seek medical attention. The documentation of the victim’s injuries at the hospital can also serve as crucial evidence in a premises liability case, and can demonstrate where the accident occurred and how bad the injuries may be.
When seeking damages from a slipping or tripping accident, it is important to bring your documentation and evidence to an experienced property lawyer Decatur GA trusts. A skilled attorney will take the evidence brought to them and build a strong claim, removing the stress and heartache of the legal process from the mind of the victim of an accident while ensuring that they will receive the most compensation allowed by the law to help with the healing process.
Thanks to our friends and contributors at Andrew R. Lynch, P.C. for their insight into premises liability.
Almost every state in this country requires a motor vehicle driver to carry insurance, except for New Hampshire and Virginia. Whenever you need to go to the hospital, you expect to utilize the services you pay for to cover your care. But what happens when you seek medical treatment as a result of a car accident? Does your medical insurance still cover this bill, or do you turn to your car insurance for assistance?
While it may be wise to speak with a local attorney for more specific information pertaining to your own situation, here’s a quick look at the basics:
Underinsured Drivers and Uninsured Drivers
For situations where the at-fault party has little to no auto coverage, carrying an insurance policy known as uninsured or underinsured motorists coverage can help alleviate the stress of mounting medical bills. This coverage can allow your motor vehicle insurance to cover the medical portion of whatever the at-fault drivers could not. This can be especially important if injuries have lasting or permanent effects.
Which Insurance Company Pays an Injury Claim?
This question is really quite detailed, and many factors come into play. In most cases, whoever is at fault is responsible for the medical bills. If someone else hits you and is cited for the accident, it is likely that their insurance provider would be responsible for paying for your medical bills. Ultimately, the insurer who is responsible for covering an injury claim will depend on the specific laws of your state.
Remember: Initial Medical Costs Are Not Always Final
When it comes to a car accident and medical costs, the initial costs of treatment may not be the final total on care. Oftentimes, people do not realize how severely injured they are until days or even weeks after the incident. Severe injuries may require extensive medical care, such as physical therapy.
Furthermore, if you have had to take time off of work due to your injuries, or have a possibly disabling condition; you may be entitled to further compensation for those damages as well. A car accident lawyer Memphis TN may stand beside you and fight for a compensation package that accounts for all medical costs, including those that you may incur in the future.
When To Contact a Car Accident Lawyer for Counsel
The typical insurance company wants to settle the claim as quickly and as quietly as possible. They do not want to go to court, and do not want to pay a dime more than they have to. Your best interest is not their priority; their main focus is to protect their bottom line.
An attorney may be able to help combat attempts to settle your claim with a low-ball offer, expedite the settlement award process, and offer peace of mind by professionally managing all of the complexities of your case.
An experienced attorney should be able to examine your potential case and determine the path to compensation. They may also be able to assist in determining who is responsible for the medical bills based on your unique situation. There are always loopholes and all sorts of red tape when it comes to an auto accident; which is why having legal counsel can be so beneficial.
Thanks to our friends and contributors from Wiseman Bray PLLC for their insight into insurance involved in car accidents.
To protect employees from unscrupulous employers that might have a hidden agenda behind firing someone, federal and state governments have instituted laws that dictate how and why employers can terminate employees. If you feel you have been terminated under suspicious or confusing circumstances, you may be within your rights to file a “wrongful termination lawsuit” against your employer.
According to the Department of Labor, employees have certain rights, even upon termination of their employment. You have a right to keep your job unless your employer has reasonable cause or other legal reason for firing you. After termination, you may be entitled to continued healthcare protection and unemployment benefits. The reason for termination is often a deciding factor as to whether or not those benefits will be granted to you.
10 Critical Deposition Questions in Wrongful Termination Cases
In wrongful termination cases, we may use depositions of employer’s representatives as part of our investigation into the circumstances that led to our client’s termination. In this deposition, a skilled court reporter Livingston NJ trust will record everything, and very often we find that the employer’s underlying reason(s) for firing our client did not qualify as reasonable cause. In some cases, the termination has been in direct violation of specific labor laws. Based on our years of experience, here are the 10 questions that we find most critical in the discovery process.
- Has the employee made complaints about working conditions? An employee has the right to make valid complaints about safety issues, work conditions, and/or potential illegal activities without impunity.
- Was the employee on the verge of qualifying for, or vesting in, company benefits? More than a few employers have used the termination process as a way to avoid giving tenured employees access to benefits such as bonuses, vacation pay, a 401(k) plan and/or stock ownership in the company.
- Were promises made to the employee? When employers make wild promises to motivate existing employees or recruit new ones, employees might quit when things don’t materialize. This could be what is called a constructive discharge. In some of these circumstances, the employer could have some liability.
- Have other employees been terminated under the same or similar circumstances? Employers are often judged by the consistency of their actions. If others have not been terminated after acting in the same fashion, the employer could be liable.
- Has the employee recently returned from an approved leave? The termination of an employee for taking unpaid time off under the Family and Medical Leave Act or military leave is a serious offense and the employer can be liable and face serious legal consequences.
- Did the employee make any disability accommodation requests? Disabled persons are entitled to certain accommodations under the Americans with Disabilities Act. The termination of an employee who has made such recent requests is unethical and illegal.
- Has the employee complained about harassment issues? The termination of an employee who complains about harassment can be considered suspicious and questionable.
- Has the employee complained about being discriminated against based on a legal classification or status? Employees can only be terminated for their actions, not based on their age, sex, race, religion, national origin, disability or any other legally protected status.
- What actions were taken to remedy the employment problem prior to termination? In many cases, employers are required to try to remedy employee problems prior to termination.
- What documentation is available? In many situations, employers are required to provide very detailed documentation related to the termination and prior interactions with the employee.
If you feel you have been victimized by a wrongful termination, we encourage you to contact us for a consultation. As an employee, you have certain legal rights and protections. We can work with you to determine if you have a valid wrongful termination case.
Thanks to our friends and contributors from Veritext for their added insight into depositions for a motorcycle accident.
Reaffirmation agreements can be tricky, and to know whether you should enter into one, you need to get the advice of an experienced bankruptcy attorney. In order to understand what a reaffirmation agreement is, you need to understand that there are two types of liability when you finance big purchase items like vehicles and homes. The first type of liability is called personal liability. This is the liability that you assume by signing the contract to purchase whatever it is that you are purchasing. The second type of liability is called in rem liability. This is the liability that is created when you agreement to give a security interest in the property that you are purchasing. When you give a security interest in the property you are purchasing, you agree to continue making payments on the property, and if you stop making payments, the property can be repossessed in the case of a car, or foreclosed upon in the case of a house.
Understanding that there are two types of liability is important to understanding what a reaffirmation agreement is, and what it will do. When you file for bankruptcy and receive a discharge, all of your personal liability for all of your debts is discharged. That means that the first type of liability on the car that you purchased, or on your home, is discharged in the bankruptcy. This does not mean you can stop making payments though. If you stop making payments, you still have in rem liability on that property, and the property can be repossessed or foreclosed. If your car is repossessed after you receive your discharge, the creditor is going to most likely sell the car or home at an auction. If the creditor receives less than what you owed on the property, this is called a deficiency balance. Since your personal liability was discharged in the bankruptcy, you are not liable for this deficiency balance your personal liability on the debt was discharged.
Entering into a reaffirmation agreement with a creditor means that you agree to remain personally liable on the debt. If you enter into a reaffirmation agreement, and later your car is repossessed, or your home is foreclosed, you will still owe the deficiency balance if there is one. One of the purposes of filing bankruptcy is to give you a fresh start in your financial life, so entering into a reaffirmation agreement should not be done without understanding the full ramifications of doing so. An experienced bankruptcy lawyer Arlington TX trusts can help you determine if entering into a reaffirmation agreement is right for you.
Thanks to our friends and contributors from Brandy Austin Law Firm PLLC for their insight into reaffirmation agreements.
A “wrongful death” is any death caused by a wrongful act, as a wrongful death lawyer Miami FL trusts might explain. It can be criminal such as homicide or manslaughter, and it can also be a civil action involving damages and not incarceration. Every death caused by a criminal act is a “wrongful” death and carries with it the right to bring a civil action for money damages. However, deaths caused by ordinary or even gross negligence do not normally bring criminal charges. Deaths caused by “culpable” or “willful and wanton” negligence giving rise to punitive damages however, can result in criminal charges for manslaughter. When one discusses a “wrongful death claim” it usually is in reference to a civil action for money damages arising from an act of negligence not resulting in criminal charges.
Our legal system was imported from England as the “common law”. It is an organic philosophical concept of community customs and traditions interpreted and added to by the judiciary in an evolving process as distinct from “civil law” which is based upon statutes and codes passed or enforced by legislative bodies or monarchs. At common law, there was no right to sue someone for causing the wrongful death of another through negligence. When someone died through the negligence of another there was no right to sue for damages for that death- the action ended with that death. As industrial society emerged in the early 18th century Parliament passed the Fatal Accidents Act of 1846 commonly known as “Lord Campbell’s Act” which gave the right to sue for damages for wrongful death.
The concept of the wrongful death act spread across the Atlantic until each individual state within the United States had passed their own “wrongful death act”. Therefore, when we question the possible civil actions available for a wrongful death, the particular statutory law of each state must be examined.
In some states, the action is brought by a Personal Representative appointed by the Court. This Personal Representative is the sole plaintiff and brings the action on behalf of specific individuals designated by the statute as “survivors” as well as on behalf of the Estate. The damages that each type of survivor and the Estate is designated in the statute. The damages that can be claimed are set forth in an arbitrary scheme based upon legislative design and the statute must be carefully read to determine the particular type of damages available to the particular class of survivor and the Estate.
Thanks to our friends and contributors from Needle & Ellenberg, P.A. for their insights into wrongful death claims.
If you look around the internet, you’ll see a lot of people advising you to look for a local personal injury lawyer if you’ve been hurt. They’re right, but no one explains why. So that’s what this blog post is about.
The Law is Different Everywhere
This is the biggest reason you need a local personal injury lawyer. In America, each state has different laws. Specifically, the law about personal injuries is almost entirely based on state law instead of federal law. That means you need a lawyer who knows the law of the state where your case is in. That’s why lawyers are licensed by the states. For example, I’m licensed in Colorado, Wyoming, and Montana. By law, I can’t give anyone advice about the law in any other state. So if a California client wants me to represent her on a California case, I can’t do it.
Judges are Different Everywhere
Even if the law is the same within a state, how it is enforced varies by the area of the state you are in. For example, in Fort Collins, Colorado, where I practice, the judges don’t set trials until halfway through a court case. But 70 miles away in Denver, they set trials right at the beginning of the case. A local personal injury lawyer in Fort Collins will know the differences between the local judges and judges in other parts of Colorado. If you’ve been injured, you want a personal injury lawyer who knows how the law is enforced in the place your case is going to be litigated.
Juries are Different Everywhere
In the end, your case is as valuable as a jury in your locality thinks it is. Although only a small percentage of cases go to trial, every case depends on jury verdicts. If you’re in a jurisdiction that has historically had very generous juries, your case is worth more. The opposite is also true, if your jury pool is very anti-plaintiff, your case is worth less. A local personal injury lawyer will know what a local jury is likely to do so is in the best position to evaluate your case.
So that’s it, three very good reasons to hire a local personal injury lawyer. If you want more information, please feel free to contact me at the link below.
Thanks to our friend and blog author, Sam Cannon of Cannon Hadfield, LLC for his insight into personal injury cases.