You work hard daily to make a living and provide for yourself and your loved ones.

It’s not always easy, but it’s worth your while.

The good news is that many state laws provide legal protections and cover workplace injuries. These rights include everything from being hired and fired, to your rights on the job, to the minimum you’re paid, to safety at work.

If you’re an injured employee or develop some illness caused by conditions at work, you should inform your boss ASAP and file a workers’ compensation claim.

What is a workers’ compensation claim? Well, it’s a system of benefits to help injured employees.

Your boss must give you the appropriate forms that tell you to do so. But what if your boss doesn’t? Most workers’ compensation claims can take many months or years to settle.

That’s why you need workers’ compensation attorneys.

So don’t give up hope if you don’t see the light at the end of the tunnel, and keep moving forward with the right support.

To help you with that, this article covers 20+ conditions in which you must consider hiring a workers comp attorney.

Let’s begin!

Workers’ Compensation Claim and Workers’ Compensation Benefits: Nothing is Simple!

Let’s start with the basics (or not-so-basics) of workers’ compensation claims and benefits.

Your state has established a system to help injured employees by providing them with wage loss benefits, medical costs coverage, and other benefits.

The goal of that system is to make sure that you can get benefits after a workplace injury and, at the same time, prevent lawsuits against your boss.

But it is not that simple. The compensation and benefits aspect is very detail-oriented. So it is wrong to say that you do not need an attorney.

Did you know that your boss or, more often, an insurance company funds a workers’ compensation system? But, in some cases:

·         Your boss, or the insurance company, does not want to pay you. It’s generally because they think it decreases profits and makes shareholders unhappy.

·         The cause of the workplace injury is unclear.

·         There may also be claims that you do not get a workplace injury, or a pre-existing condition rather than a workplace incident was the cause of it.

If any of the reasons above strikes a chord, you must hire a workers’ comp attorney.

So, to start you out, the following list offers a quick rundown of key conditions in which you need an experienced workers’ compensation attorney.

20 Conditions When You Must Hire a Workers’ Comp Attorney

Taking care of yourself after an injury is so important. But it can be tough when you don’t know what to do.

Do you know that you will not get all the benefits you deserve if your injury is minor? It’s not as easy as 1-2-3. That’s why it is always a good idea to have an attorney for legal representation.

Hire a workers’ comp attorney if any of these 20 conditions apply to you:

1. If You Have Any Previous Injury 

Sadly, your boss or the insurance company may try to use it as an excuse. They may argue that your prior injury caused your current illness instead of a workplace mishap.

Remember: No prior injury disqualifies you from getting the benefits.

Don’t let any misconceptions stop you from getting the support you need. 

So, don’t be discouraged. You still have the right to get the compensation benefits.

2. If You Get a Job-Related Injury or Your Employer Denies It 

We know how frustrating it is when your boss says NO to acknowledge your on-the-job injury. Such a situation often results in cases where you may not get the benefits.

If this has happened to you, you must not go through it alone. We know it is hard to establish a clear link between your injury and your work by yourself.

So you should hire a workers’ comp lawyer to protect your rights and get the benefits that are legally yours.

3. If There Are Denials or Delays

Did you know most injured employees fail to pursue benefits because of denials or delays?

If you’re one of them, don’t worry. You can still appeal or turn to legal remedies.

Hire a workers’ comp attorney to guide you through the process and secure the medical records to prove your case.

4. If There Are Miscalculations

Unfortunately, miscalculations can happen, and some of you may end up with no benefits at all.

So it is essential to be aware that such miscalculations of your wage loss benefits could leave you with less than you must get. It could be a significant issue when you must cover your medical bills, deductibles, or other costs.

That’s why you need a workers’ compensation attorney to get the benefits you need to pay for quality medical care and to cover all your expenses.

5. If You Cannot Continue Working Because of a Long-Term Injury 

Sadly, if you cannot continue working, your boss or the insurance company may try to minimize your benefits. They may even refuse to pay your medical expenses if you have any permanent disability.

That’s where you need a workers’ comp attorney who will take care of all your financial compensation. They will work diligently to make sure you receive the fair compensation you need to cover your medical expenses.

6. If You Don’t Know Who Injured You

Did you know that a workers’ compensation system also protects your boss?

You cannot sue your boss if the cause of your injury is a defective or unsafe product. Often an out-of-network payer is responsible for paying you a workers’ compensation claim. It means that you can sue the producer of that defective product.

So, what would you do in such situations? You need the help of an experienced workers’ compensation attorney who will provide you legal guidance on the best way to proceed.

7. If There Is Workplace Retaliation

Retaliation, as defined by the U.S. Department of Labor, is a situation where a “boss (through a manager, supervisor, administrator or directly) takes any adverse action against an injured worker for engaging in a protected activity.”

There are many forms of workplace retaliation, including but not limited to reduction of work hours, demotion, harassment, termination, or any other adverse action. 

So, you should hire an attorney if you face retaliation from your boss after getting a workplace injury.

8. If You Have A Disagreement

Disagreements occur based on the severity of your injury. If you’re injured or can’t work, your boss or the insurance company may suggest or modify your working hours. They generally do it only to reduce or even suspend your benefits.

If that’s the case, or if you disagree with your boss, don’t hesitate to reach out to a workers’ comp attorney. You can still control the situation and get help from an experienced attorney.

9. If Your Boss Thinks that a Workers’ Compensation Program Doesn’t Cover You 

Not every injured worker qualifies for it. Workers’ Compensation in Long Island may not cover you if you are a “domestic worker (who works less than 26 hours per week), sole proprietor, corporate officer, partner in partnership, and s of multi-LLCs.”

Other laws may cover the workers above. If you think you qualify for benefits and your boss does not, you must contact an attorney now.

10. If Your Boss Hasn’t Paid for Insurance 

The law of New York requires all employers to cover all workers. There is no exemption for small or non-profit businesses. 

An Uninsured Employer’s Fund in New York covers workers who get workplace injuries. You may still qualify for benefits under it if your boss hasn’t paid for insurance (as required by law). If you’re unsure of the options available, consult with an attorney.

11. If You Don’t Know How to Navigate the Complex Workers’ Compensation Process 

Most of you do not understand how complex the claims process can be. It is very detail-oriented. And the bigger the workers’ compensation claim, the more complicated it can be to maintain the required paper trail.

It can pose detrimental mental threats if you don’t know how to navigate it. But don’t worry. If you find it intimidating to answer the questions you may have, an experienced lawyer can help.

12. If Your Boss Accuses You of Fraud

You may commit fraud if you falsify a workers’ comp claim. Such practices are common and may include organized crime groups involved in medical treatment, legal work, or other functions related to the claim.

But when you get a real, on-the-job injury, such fraud shouldn’t be a concern. If your boss is still accusing you, you should consult an attorney.

13. If Your Boss Disputes a Decision that Favors You

It happens sometimes when your boss or the insurance company does not honor the decision by the state or a judge that favors you. If that’s the case, you must hire an attorney for legal representation because you can’t float through the required legal measures to get your workers’ compensation benefits.

14. If Your Boss Requests for an Independent Medical Evaluation (IME)

An IME is an in-depth evaluation of your medical history and current health condition. Your boss may request for a reevaluation to determine if you’re still eligible for workers’ compensation and insurance benefits. This report can go on for pages. 

If you think your boss has requested it, you must seek legal counsel to make sure that they do not unfairly reduce or discontinue your benefits. Your attorney can help navigate through it.

15. If a Boss-Approved Medical Provider Clears You for Work But You Disagree

It happens sometimes when you get an injury and don’t want to resume working. But your boss assigns you a medical provider who will clear you for work quickly without referring you to a specialist.  If you disagree with the decision, you may lose your claim. 

If it happens to you, you must hire an experienced lawyer who will help you come to a better agreement. 

16. If You Are Not Careful About Minor Things That Could Hurt Your Claim 

Most injured workers don’t care about minor things that could harm their claims. For instance, they keep posting something and sharing photos of an event on social media.

Beware: Your boss and the insurance company could use them against you.

But don’t worry, a workers’ compensation attorney can help you identify such minor things. They can also guide you on how to make your case strong.

17. If You’re Unsure of Which Healthcare Providers You Must See

Did you know you must see a doctor approved by your employer’s insurance company? But it only applies if there is a list of medical professionals provided by your boss.

But what if they didn’t? You can then have the option to visit your provider.

We know it may confuse you which option works for you. But if you go for your doctor, the workers’ compensation may not cover the costs.

So, it is always advisable to consult with a workers’ comp attorney to make sure you understand which option is more suitable for you.

18. If Your Injury Symptoms Appear Slowly 

It happens sometimes. Your injury symptoms may take time to appear. 

For example, if your disc ruptures and the thick jelly-like substance leaks out and pushes on the spinal canal, your symptoms of pain, weakness, or numbness may take days or weeks to develop. How can you prove that it relates to your work?

That’s where you need a workers’ compensation attorney who has spent years handling such cases. With the help of a lawyer, you can make informed decisions and receive the benefits that are rightfully yours.

19. If You Can’t Navigate the Medicare Maze 

If the claim is in your favor, you (as an injured person) must inform Medicare of the workers’ compensation settlement immediately after it becomes final.

Your case may automatically enter into a WCMSA (or Workers’ Compensation Medicare Set-Aside Arrangement) to manage the workers’ compensation settlement funds effectively. You can use WCMSA funds to pay for the services related to your injury that Medicare would have covered.

Remember: Medicare will not pay a single penny until you have spent your set-aside funds. So, you must keep medical documentation of the expenses incurred to prove that you have used these funds appropriately.

If you can’t do it by yourself, you need an attorney to manage your medical costs and maximize your benefits.

20. If You Don’t Know When You Need a Medical Treatment 

Such cases occur when your doctor may be unable to perform certain procedures successfully. For example, if you have sustained damage to your arm and your surgeon attempts to repair it during the surgery but fails, they may conclude that amputation is necessary later.

What should you do in such situations? You cannot bill for both a fracture repair and amputation. So, you must include these extra costs in your claim. But if you can’t do it on your own, an attorney can assist you in reviewing your case.

Is a Worker’s Compensation Attorney Necessary?

Yes. You can’t do it alone because the whole workers’ compensation process in Long Island is complex. But don’t worry, with the help of an experienced attorney, it can be much easier. So, don’t hesitate to seek help and support from a reliable attorney. They will have your back!

When Do You Need a Workers’ Comp Attorney?

Most claims usually demand upfront work. So you need a workers’ comp attorney now to assist you in:

·         Gathering proofs related to your workplace injury

·         Providing you with medical records

·         Understanding the process of filing a claim

·         Ensuring your paperwork is complete and ready for submission

·         Answering all your questions

·         Visiting doctors (when or why)

·         Advocating for you in case of denials or delays

·         Preparing you for court or any meet-up with your insurer

·         Understanding the worth of your claim

·         Providing evidence to counter any arguments presented in IME

So you must hire an experienced workers’ comp attorney because they have spent years handling such cases and understanding what it takes to secure your compensation benefits.

Why You Can Count on a Workers’ Comp Attorney at the Law Office of Frank A. Cetero?

Are you facing legal problems and wondering where to turn? Look no further than Law Island.

Why? We have workers’ compensation lawyers in Long Island who have been serving injured workers for over  50 years now.

Our law firm understands that every case is unique, and we promise to provide you with the personalized attention you deserve.

Worried About the Cost of Hiring Our Attorney?

Don’t worry. You’ll never end up paying all your benefits.

At Law Island, we understand your pain and believe you should never sacrifice your benefits to get someone for your legal representation.

What Would You Get When You Hire Long Island’s Attorney?

Workers' Comp Attorney - 20+ Key Conditions Where You Must Hire a Workers’ Compensation Attorney

We know you want a lawyer, and we can give you a lump sum settlement. We never charge you anything upfront. That’s why our initial consultation is free. The goal of our law firm is to make sure you have all the information to make an informed decision about your case.

Law Island also offers free case management. It means you can always count on us to answer your questions and provide the facts about your case. Whether you’re preparing for an IRE or IME, reviewing medical records, or examining your collective bargaining agreement, our dedicated team is here to help. Best of all, these services are part of the cost of your workers’ comp attorney who will not incur any extra fees.

If you’re facing a workers’ compensation case in New York and need help navigating the process,  contact us for a free consultation. We can’t wait to see you thrive!