Based on our experience, here are some circumstances that are difficult to overcome in a workers’ compensation case. Not always impossible, but difficult.

  1. You lack credibility. Credibility is arguably one of the most important factors in a workers’ compensation claim. Not only yours, but that of your doctor and lawyer as well (see below). If you are honest, you will be credible. The circumstances surrounding your injury, your level of pain, your ability to work or not … all of these things are at the core of your case and if no one believes you, it’s going to be tough. You need your doctor on your side. If your case ends up in front of an arbitrator, their opinion of you will matter a lot. For example, if you’ve filed half a dozen claims in the past, that won’t look good.
  2. Your doctor lacks credibility. Your doctor might recommend surgery, or say you can’t work, or require work restrictions if you can work. The insurance company is going to disagree, because these things cost them money. If there is a dispute, you’re more likely to win if your doctor has a good reputation.
  3. Your lawyer doesn’t know what they’re doing (or lacks credibility). If your case is disputed, you’ll need a lawyer who has significant experience arguing cases in front of an arbitrator. They should be familiar with the arbitrator assigned to your case. They should focus mostly on work injury cases. These things create credibility. (Tip: don’t hire a lawyer suggested by your doctor – this makes them both look bad.)
  4. There was no “increased risk” associated with your injury. Unfortunately, just because your injury happens at work doesn’t mean it qualifies for workers’ compensation. If it is an injury that could have happened just as easily to anyone in the general public, then it’s not considered a work injury for purposes of workers’ compensation. For example, if you have a foot injury because you stand at work all day, that might not be enough. A lot of people stand all day at work. You’ll have to prove that your job created an increased risk of that injury.
  5. Your injury didn’t happen in the course of your employment. Your injury might seem work related to you, but the law might disagree. You aren’t in the course of your employment while you are driving to work in the morning, although there are exceptions. The point here is that if the circumstances of your injury are in a gray area, the insurance company is going to argue that it wasn’t a work injury, and you might have an uphill battle. The best thing you can do is hire a lawyer who knows how to prove your case and ensure that you get benefits.

 If any of these apply to you, we aren’t suggesting you give up. The facts vary from case to case and what ruins one case might not ruin another.

By Michael Helfand