Questions & Answers

– YOU ASK WE ANSWER –

A If your injury or illness is found to be job-related, you may be entitled to receive medical care for the injury or illness, disability compensation for a portion of your listed wages, rehabilitation services, and, in the event of your death, benefits payable to your survivors. Protect yourself and your family by hiring Stephen Gaubert to represent you in court as your personal injury lawyer. Companies aren’t going to pay without a fight.

AOne option you have is to file a Disputed Claim for Compensation, which is an administrative law proceeding through one of ten offices in the State of Louisiana. This process could take six to nine months, or longer if the case is appealed. Our offices can help you dispute the claim correctly by guiding you through the entire process. We’re a leading Workers’ Compensation attorney in Lafayette.

AWorkers’ Compensation benefits are paid by your employer, if he is self-insured, or by his Workers’ Comp insurance carrier. There are certain exempt employers. No benefits are paid by the Office of Workers’ Compensation Administration (OWCA). Getting Workers’ Comp is a complicated process, so let a professional attorney help you.

AThere are several very important aspects of workers’ compensation claims that I urge you to consider when deciding whether to hire an attorney for legal representation.  If you are ever denied benefits or are asked to appear before a workers’ compensation judge, the advice and representation of an attorney who is experienced in this area of law can be quite valuable.  You may also need an attorney if your employer attempts to terminate, suspend, or modify your benefits; if you wish to have your benefits reinstated after they’ve been discontinued; or if you wish to have your case settled, meaning you would prefer a lump sum payment.  It is important that you do not sign any papers that you don’t fully understand without first showing them to an attorney.

Regrettably, most claimants wait until their benefits are stopped or they are denied essential medical treatment by the workers’ compensation insurance company of their employer before they hire an attorney.  This is a mistake. You will greatly benefit from having legal representation before such an event takes place. An attorney can walk along beside you every step of the way and explain, in detail, the events of your case as they unfold. Your attorney will collect copies of your medical bills, your medical records, your doctors’ narrative reports and your test results as well as information on your employment background and aptitudes. Your attorney will contact the workers’ compensation insurance company to let them know that he is protecting you in case they violate your rights. Having an attorney can keep a workers’ compensation insurance company from cutting off your weekly benefits, refusing to give you medical care, or paying you less than you are due in compensation benefits. This is because the insurance company knows an attorney can force them to pay these benefits plus penalties and attorney fees if they are arbitrary and unfair in their treatment of you. Moreover, your attorney will be ready to move immediately if he was hired early, has developed your file with medical records and employment records and is familiar with your injury and your limitations and restrictions.

With an attorney on board, when the workers’ compensation insurance company violates your rights in some significant way, as they will do in over 90% of the workers’ compensation cases we have seen, your attorney can file suit immediately, be in court within days and move the case forward to trial in far less time than if you were unrepresented when your rights are violated. On the other hand, a client who is unrepresented, and trusts the workers’ compensation company to do the right thing, must seek out and hire an attorney after their rights are violated, which takes considerable time. Then their attorney must build the file, write to all the doctors for medical records and medical bills, write to the employer for job descriptions and otherwise build his case. This can take several months before the attorney is armed with the necessary information to file a lawsuit and prosecute your case. During this delay, you might be without workers’ compensation benefits or essential medical treatment which makes your condition worse.

Additionally, having an attorney involved in your case from early on can keep the employer and his workers’ compensation company from sending you to their choice of a “company doctor” who will say there is nothing wrong and will minimize your injuries, send you back to work prematurely and possibly get you injured further. Attorneys who are experienced in workers’ compensation know who the good doctors are and who to keep away from. They will not let your case be destroyed because you went to the wrong doctor.

Finally, the reputation of an experienced workers’ compensation lawyer and his presence in your case, can be very meaningful to settlement negotiations and the amount you ultimately receive in compensation. Your attorney will know the right time to settle is after you have reached maximum medical improvement and once you are stable medically without a significant risk of relapse. Your attorney will also know that the settlement must be done before all medical treatment is stopped and before you have returned to work, at which time no workers’ compensation insurance company will be likely to settle with you, since they are no longer paying out money on your case. An experienced attorney knows this “settlement window” and can increase the amount of your settlement through negotiations based on the Workers’ Compensation Act and the Schedule of Benefits which allow settlement of cases. No laymen can settle a workers’ compensation case for as much money as can an attorney.

Often, the severity of your injury will dictate whether the services of an attorney are warranted. A minor injury with a minimal amount of medical treatment and no lost time such as bumps, bruises, contusions, lacerations, or even a few stitches which are treated in the emergency room or with one or two follow-up visits to a doctor for care, on occasion may be handled without an attorney. On the other hand, if you have an injury which involves significant pain and suffering, possibly disability and referral to a specialist, such as an orthopedic surgeon or a neurosurgeon, it is generally a good indication your injury is severe enough to benefit from retaining an attorney. An attorney can ensure that you get the proper medical care and compensation which will provide you the best outcome for your injury, both medically and legally.

An employer and his workers’ compensation insurance carrier will sometimes violate your legal rights immediately. Other times, the insurance company may pay you fairly at first and for several weeks or months, and then begin violating your rights at some point during the handling of your case once they realize you are not represented. Usually, your employer cannot protect you from the workers’ compensation insurer since the insurance company makes the decisions on whether or not to accept your claim or to deny it. Do not be lulled into a false sense of security because workers’ compensation is paying you weekly or bi-weekly benefits and paying for your medical bills as they accrue, early in the case. We have found from experience that 90% of the time, the workers’ compensation insurance company will violate your rights at some point during their handling of your case, that they will be arbitrary and unfair to you and that they will mislead you on exactly what your rights are under law. The employer or the insurance company may refuse to send an injured worker to the doctor or refuse to authorize treatment, sometimes because the employer has not reported the accident to his insurance company. Sometimes the insurance company refuses to authorize referral to a specialist, or for diagnostic testing, such as an MRI, or physical therapy, or a pain clinic. Sometimes the injured worker is released by the “company doctor” even though he still has significant problems and is denied a second opinion when he requests it. These are all situations where a client desperately needs legal representation by an attorney and waiting for them to happen in the middle of the case means several months before anything can be done about them.

The employer’s responsibility is to report the injury to their insurance company immediately. The insurance company then “adjusts” the claim and investigates to determine if the injury is compensable and what benefits are owed. If the employer does not report the claim, the insurance company will not be aware of the injury and thus will not begin processing the claim for benefits. This can also cause a variety of problems and delays which an attorney can correct immediately.

An injured worker who is unable to work and is not getting weekly benefits, or whose benefits are stopped for any reason, should consult an attorney immediately, if he has not done so previously.  It is extremely important, for example, that you always ask your treating physician whether he thinks you can work and to what extent, and under what limitations, and to get this in writing so that you can prove your work status to your employer and the workers’ compensation insurance company. Hiring an attorney early in a case allows your attorney to obtain this information for the file so that a lawsuit can be filed immediately if an insurance company does not follow the work status instructions of your treating physician. Even if the employer and the insurance company seem to have treated you right all along, this does not necessarily mean you will be offered a fair settlement.  In fact, the opposite is nearly always true. When an insurance company has treated you fairly, they generally will expect that they can settle the case very cheaply and for much less than it is truly worth.

It is possible that you may have suffered a significant loss of your earning capacity, or you are permanently and totally disabled because of your work injury.  You may not know this at first and the doctors may only conclude this at some time after months or years of treatment. Settling or bringing such cases to a hearing can be very complicated.  There can be confusing issues which are best handled by an experienced attorney.  If you have a permanent problem because of your injury, permanent restrictions or, if you are unable to return to the type of work you did before the accident, you will be more likely to get fair compensation if you have an attorney.  And if you have received or applied for other types of disability benefits, such as social security disability, you will benefit from the services of an attorney in concluding your workers’ compensation claim and in protecting your other disability benefits.

If you have been hurt by someone who does not work for your employer (a third party), you may be able to bring a separate lawsuit against that party in addition to your workers compensation claim.  This would include, among other things, on the job auto accidents and injuries caused by improperly designed or defective machines.  Having an attorney review your case early can determine whether a true third-party negligence case exists in your accident and can maximize both the negligence action and the workers’ compensation case with early investigation and appropriate handling.

Your important legal problem is something that needs discussion and I would love the opportunity to be able to answer any specific questions you have and furnish you with some general information based on the facts of your claim.  If you have never had a workers’ compensation claim before, don’t know your rights, have questions, doubts, fears, or concerns, or just don’t know what to do, I encourage you to contact us.  An attorney can answer your questions, explain your rights, put some of your fears to rest, and help you decide if you would benefit from having representation.  Although you may not have experienced some of the problems addressed in this Q&A, rest assured that having legal representation from the onset of your workers’ compensation case may prevent any such occurrences.

If you have any other questions that come to mind or need any other help either now or in the future, I certainly hope you will do us the honor of calling upon us.  It is the goal of our law firm to always offer you our services in the future when you are in need.  We want you to think of us as your law firm.  We will strive to earn your respect and to produce the answers and the action you need on the legal issues affecting your life and those of your loved ones.  Please know that we are here for you whenever the need arises.  Please give us a call and we would be more than happy to help you.