A worker's compensation lawyer either works with employees who have suffered a work injury or works for worker's compensation insurance companies who are facing claims from employees. Their goal is to help facilitate the administration of the state worker's compensation program and to ensure that employees receive appropriate recovery and compensation. They generally do not appear before courts frequently, since worker's compensation is handled on a state specific basis by administrative agencies.
Within the United States, worker's compensation is a compulsory alternative to the tort system. Those who employ more than one individual may be required to purchase a worker's compensation policy on all eligible employees. The specific rules for when an employee must be covered by worker's comp vary by state, but generally all workers must be covered with limited exceptions for agricultural workers or corporate executives.
When an employee is part of the worker's compensation system, he is not permitted to sue for his injuries in court. Instead, if he is injured at work, he must recover damages through the worker's comp program that is in place. The benefit to the employee, however, is that the system is a no-fault system. This means that the employee does not have to prove the employer was negligent in order to recover damages; if he is injured at work, he is entitled to payment as long as he wasn't drunk or under the influence of drugs or expressly violating official company policy.
When an employee is injured, he thus must follow the requirements to make a worker's comp claim. Those requirements vary by state, but usually involve reporting the injury and undergoing medical exams. The insurance company will review a worker's claim for compensation and then either accept it or reject it.
A worker's compensation lawyer may become involved early in the injury process. He may help the employee file his claim, assisting the employee in filling out the required paperwork and complying with the state-specific claims process. If he works for the insurance company, he may also assist the company in determining whether the employee meets the legal requirements for recovery, which mainly involves determining whether the injury occurred in the course of a work related duty.
If the worker's claim is denied, a worker's compensation lawyer is generally employed by the worker to appeal the denial, first to the insurance company and then to the state worker's compensation board, if necessary. This means the worker's compensation lawyer may file notice of appeal to the insurer or to the agency, depending on the laws of the state. If the insurer does not overturn the denial, a hearing may be scheduled in front of an administrative judge who is part of the worker's comp agency in the state. The worker's compensation lawyer for the plaintiff will then present evidence at that hearing to convince the administrative judge or panel that the claim was denied improperly.
