How Long Does a Workers Compensation Claim Take?

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 What Is Workers Compensation?

Workers’ compensation is a form of insurance that provides medical benefits and wage replacement to employees who get injured or fall ill as a direct result of their job. This system is in place to ensure that injured workers receive proper medical care and financial support during their recovery without having to file a lawsuit against their employer. The trade-off is that, in most cases, the employee forfeits their right to sue their employer for negligence.

Different states have varying workers’ compensation laws that govern how the system operates, the types of injuries covered, and the benefits an injured worker can receive.

How Long Does a Workers’ Compensation Claim Take?

The length of a workers’ compensation claim varies significantly based on the specifics of the injury, the state’s workers’ compensation laws, and the cooperation of all involved parties. In straightforward cases where the injury is minor, and there’s no dispute about the facts, a claim can be resolved in weeks to a few months. However, in more complicated cases, especially when disagreements about the injury’s severity or the need for certain treatments, claims can take several months to even years to resolve.

Here are some common disagreements and treatments and explanations of how they can complicate cases.

Nature and Severity of the Injury

An employer or their insurance provider might argue that an injury is not as severe as the employee claims, or they might dispute that the injury occurred during work-related activities. This disagreement can require additional medical evaluations and expert testimonies, leading to prolonged proceedings.

Pre-existing Conditions

If a worker had a prior injury or medical condition in the same area of the body, there might be disputes about whether the work-related incident exacerbated that condition or if the current symptoms are mainly attributable to the prior condition.

Distinguishing between a new injury and an aggravated pre-existing condition can be complex and require detailed medical histories and evaluations.

Type of Treatment Recommended

A treating physician might recommend a particular treatment or surgery that the insurance company deems unnecessary or excessive. In such cases, the insurance provider might require a second medical opinion, which can delay the approval of such treatments.

Future Medical Treatments

Predicting future medical needs can be a point of contention. For instance, if a doctor recommends ongoing physical therapy or future surgeries, the insurance company might argue these treatments are unnecessary or should not be covered to the extent proposed.

Return to Work

There might be disputes about when and if an injured worker can return to work and in what capacity. If a worker is deemed capable of light duty but claims they cannot return due to pain or restrictions, this can prolong the claim, as more evaluations and discussions about work accommodations are required.

Permanent Impairment Ratings

Once an injury reaches Maximum Medical Improvement (MMI), a rating might be assigned to indicate the level of permanent impairment. Disagreements can arise regarding this rating, affecting the amount of compensation for permanent disability.

Rehabilitation and Retraining

In cases where an employee can’t return to their previous job, they might need vocational rehabilitation or retraining for a different job role. The necessity, length, and type of retraining can be subjects of disagreement.

Each point can introduce delays in a workers’ compensation claim because they often necessitate additional medical examinations, expert testimonies, and sometimes even court hearings. The more areas of contention in a case, the more complex and prolonged it becomes.

This underscores the importance of having an experienced workers’ comp lawyer to navigate these complexities and advocate for the injured worker’s rights and needs.

Why Do Workers’ Comp Cases Take So Long?

Several factors can prolong a workers’ comp case:

Medical Disputes

Medical disputes arise when there’s a discrepancy between the assessments of the employer’s and the employee’s medical experts regarding the injury’s extent, prognosis, or treatment required. For example, an employee’s doctor might diagnose a herniated disc requiring surgery, while the employer’s chosen medical expert might argue that it’s just a minor strain that can be treated with physical therapy.

Such disagreements can necessitate further medical evaluations, including MRIs, CT scans, or additional doctor visits. The process can be further prolonged if each party remains entrenched, potentially leading to mediation or a hearing before a workers’ compensation board or judge.

Medicare and Medicaid Considerations

When a worker is a Medicare and Medicaid beneficiary, settling a workers’ compensation claim becomes more intricate. Medicare, for instance, has the right to be reimbursed for any medical expenses it pays related to the work injury.

Suppose an injured worker had surgery paid for by Medicare because the workers’ compensation insurer denied responsibility. When settling the claim, provisions must ensure Medicare gets reimbursed.

Parties often establish a Medicare Set-Aside (MSA) arrangement, which ensures that future medical expenses related to the injury will not be unfairly shifted to Medicare. Setting up an MSA requires a detailed projection of future medical costs and Medicare’s approval, lengthening the resolution process.

Legal Disputes

Legal disputes revolve around the nuances of the law rather than the facts of the injury.

For example, an employee might claim a repetitive stress injury like carpal tunnel syndrome from their job. The employer might challenge this, arguing the injury resulted from activities outside of work, such as playing a musical instrument or other hobbies.

In such cases, fact-finding processes, such as gathering evidence, witness testimonies, or surveillance, might be necessary. Determining the line between work-related and non-work-related factors can be a gray area, leading to extensive legal debates and potential court hearings.

Complexity of the Case

In instances of severe injuries, the claim’s complexity usually multiplies.

Consider a construction worker who falls from scaffolding. The injuries might involve multiple fractures, a traumatic brain injury, and internal damage.

Such a case would require consultations with orthopedic surgeons, neurologists, physiotherapists, and psychologists. Each specialist adds a layer to the claim with their medical reports, recommendations, and projected future needs.

The claim can get extended if there are complications in surgeries or therapies. Such cases also often involve detailed life care plans or vocational experts to assess the long-term impacts on workers’ ability to earn and their quality of life, adding depth and length to the claim’s resolution.

Can I Settle My Case Before I Reach Maximum Medical Improvement?

Yes, settling a workers’ comp case before reaching MMI is possible. MMI is when an injured worker’s condition stabilizes, and no significant improvement is expected. While some choose to wait until they’ve reached MMI to get a clearer picture of the total costs and implications of their injury, others might opt for an earlier settlement for various reasons, such as financial constraints.

However, settling before MMI can be risky, as you might not fully understand the future medical costs or the long-term impact of the injury on your ability to work.

Should I Consult a Workers’ Comp Lawyer?

Absolutely. Given the complexities and potential pitfalls of workers’ compensation laws, it’s advisable to consult an experienced workers’ comp lawyer, especially in cases with severe injuries, disputes, or when Medicare and Medicaid considerations come into play.

An experienced attorney can guide you through the process, help you understand your rights, and ensure you get the compensation you deserve.

Looking for a qualified workers compensation lawyer? LegalMatch can connect you with an experienced lawyer to review your case and provide guidance.

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