Plaintiff workers compensation attorneys will tell the general public their purpose is to assist the injured employee. However, plaintiff attorneys are in business to make a profit. If there is no money in it for the plaintiff attorney, their willingness to assist the injured employee vanishes. In order to earn service fees there must be some conflict between employer and employee. If the employee does not have any issues with the employer, the employee is highly unlikely to hire an attorney (assuming the employee is not bringing the workers compensation claim for the purpose of self enrichment).
Plaintiff attorneys know that without issues between the employee and the employer, or between the employee and the employer's insurance adjuster, they make no fees. Therefore, it is incumbent on the plaintiff attorney to encourage conflict between the employer and the employee. Attorneys also understand employees may have feelings of loyality. To overcome the reluctance of many employees to have conflict with their employer, the plaintiff attorney's approach with the employee is to emphasize the conflict and perceived wrong the employer or the adjuster has done. By driving a wedge between the employee and the employer, the plaintiff attorney can earn the service fee from the employee.(WCxKit)
Eight things plaintiff attorneys have been known to tell employees in an effort to create issues and conflicts and to sign up the employee as a new client are as follows:
1. The insurance company has a team of lawyers on its side; you need someone to protect your interest. The reality is the workers compensation adjuster almost never hires an attorney for a workers compensation claim unless the employee has obtained an attorney. Even then, the work comp adjuster will not hire a defense attorney unless the plaintiff attorney files a motion for a hearing or trial.
2. Attorney's tell clients they take a tremendous risk if they don't have an attorney “protecting their rights” or “by your side” or “on your claim” or “guiding you through the complicated process with skillful representation” or “you won't receive fair compensation without an attorney.” In truth, the workers compensation statutes of every state have clear cut guidance to the insurance companies on how they must handle claims. All states require all reasonable and necessary medical expenses to be paid. All states define exactly how temporary total disability indemnity benefits will be calculated and paid. All states define how permanent partial and total disability will be calculated and paid. All states define how death benefits and vocational rehabilitation will be handled.
3. Attorneys tell clients “we don't charge a service fee unless we collect benefits for you.” What is not said, is they will not accept the employee as a client if they do not think the employee has a valid workers compensation claim. The plaintiff attorneys also do not emphasize that the service fee comes out of the money the employee would collect anyway for temporary total disability or permanent partial disability or permanent total disability.
4. Attorneys say, “We believe that quality representation is a basic right and should be available to everyone, not just the wealthy.” When plaintiff attorneys take this approach, they are playing to the employee's feelings of being treated unequally by the “big, bad insurance company”. A skilled workers compensation adjuster who contacts the employee promptly, answers all the employee's questions completely and accurately, and makes sure the employee is obtaining all medical care needed, will prevent this plaintiff' attorney's approach to creating a feeling of conflict.
5. Plaintiff attorneys say that the workers compensation system is complicated, difficult to understand and can be overwhelming. Here, attorneys are able to play on the employee's fear of the unknown. Of course, for their service fee, they will guide the employee through the state workers compensation statutes. The sad part is often the employee does not need their guidance, as the state statutes mandate what the employer and/or the insurance company adjuster can and can not do on the work comp claim.
6. Attorneys say the insurance company will deny you the benefits you are entitled to if you have a big claim. The size of the claim has nothing to do with the payment of benefits. The insurance company must pay the benefits mandated by state work comp statutes. The only claims for denied benefits are those where the medical documentation does not justify what is being claimed, whether it is additional medical care or additional indemnity benefits.
7. They tell potential clients insurance company adjustersoperate illegally or act maliciously under the assumption that most employees pursuing workers compensation claims are malingerers or frauds.In real life, the large majority of workers compensation claims are routinely handled by the adjuster. The adjuster pays the temporary total disability benefits until the employee is back at work and pays the medical benefits until the employee no longer needs medical care. The only claims the adjuster ever considers the employee malingering is when the employee is taking longer to recover than normal and the medical information provided does not justify the delayed recovery. As for fraud, unfortunately there are some employees who will attempt to take advantage of the workers compensation system and when the adjuster sees a highly questionable claim, the adjuster should check its appropriateness.
8. They say that employers encourage the insurance company to deny your claim so they can keep their workers compensation insurance premium down. If the employer has information that a work comp claim is bogus or fraudulent, the employer should advise the adjuster so the appropriate investigation can be completed and a case built to justify the denial of compensability of the bogus or fraudulent claim. If an employer was to tell the adjuster to deny a valid claim, the underwriter of the insurance company would be notified and the employer would be facing cancellation. The employer would probably have higher insurance premiums from the next insurance company who picks up the employer for work comp insurance coverage.
There are some valid reasons an employee will obtain an attorney. If the employer or adjuster is non-responsive to the employee when the accident occurs, or during the course of the medical recovery, often the employee will get an attorney because they don't know what to do and have not received the guidance they need from either the employer or the adjuster. If the medical provider is unresponsive to the employee's concerns about their medical care, and the adjuster is also unresponsive to the employees concerns about their medical care, the employee will often obtain an attorney, and they should. (WCxKit) If the employer promotes a caring atmosphere and is responsive to injured employees, the employees will have no reason to hire an attorney. Once an employee hires and attorney, the cost to settle the claim will increas.
There are also the unsavory reasons an employee will obtain an attorney such as a desire to “milk the system,” to have an extended stay off work, and to “hit the work comp lotto.” There is little the employer or the adjuster can do to stop the employee who has a desire to “get something for nothing” by obtaining an attorney. However, as the large majority of employees are ethical and honest, their claims can be kept out of the hands of the plaintiff's attorneys by the proper handling of their claim by the employer and the adjuster.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
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