Jerome, Salmi & Kopis, LLC – Law Firm in Fairview Heights, IL

Why is My Workers Comp Case Going to Trial?

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Why is My Workers Comp Case Going to Trial

Often after an employee is injured at work they can file a workers’ compensation claim and obtain the benefits they need for their medical expenses and a portion of their lost income. Unfortunately, not all workers’ compensation cases proceed this way. Insurance companies and employers often try to deny workers’ compensation claims in an effort to retain their own profits. Insurance companies may not offer the full benefits workers need, while employers may try to deny a worker’s claim so their insurance premiums do not increase. In these instances, it may be necessary to take a workers’ compensation case to trial.

A small minority of workers’ compensation cases go to trial, but they can be intimidating for workers who are not familiar with them. The Illinois/Missouri workers’ compensation lawyers at our firm can help you through the process and give you the best chance of a favorable outcome. Contact us today. 

How are Workers’ Compensation Cases Typically Resolved?

Only a minority of workers’ compensation cases end up going to trial. Most of the time, workers’ compensation cases are resolved in one of the following ways:

  • Uncontested cases: Not every workers’ compensation case involves a dispute. Sometimes, employers readily agree that a worker deserves benefits, and insurance companies pay the full amount without giving reason for a denial, delay, or reduction. In other cases, a workers’ compensation claim is denied, but employees do not appeal the case.
  • Settlement: A settlement is not the same as an uncontested case, even though the insurance company will eventually agree to pay benefits. A settlement is reached once your workers’ compensation lawyer negotiates with the insurance company and the insurer counters the offers. Once an offer is made that is agreeable by both sides, a settlement agreement is drafted and the worker receives their benefits.
  • PreTrials and Mediations: In some instances in which the worker’s attorney and the insurance company cannot reach an agreement, the Arbitrator (in Illinois) or the Administrative Law Judge (in Missouri), will discuss the issues with the parties and provide input to help facilitate settlement.

How Often Do Workers’ Compensation Cases Go to Trial?

The vast majority of workers’ compensation cases do not go to trial. The estimate that is most often used for the amount of cases that do proceed to trial is five percent. However, different states use varying definitions of what a workers’ compensation trial is, and when it starts. As such, it is likely that the number of cases that go to trial is far less than five percent.

The Workers’ Compensation Commission in Illinois estimates that of approximately 40,000 employees who submit an injury report in an average year, only 1,000 of these end up in arbitration, which is the workers’ compensation trial in the Prairie State. This means that just 2.5 percent of workers’ compensation claims in Illinois require an arbitration ruling.

When Will a Workers’ Compensation Case Go to Trial?

There are times when a trial is the only way for injured employees to recover the benefits that are justly theirs. The most common reasons a workers’ compensation case goes to trial include:

  • Settlement is impossible because benefits were denied: The insurance company has unfairly denied benefits. If this has happened to you, the first thing to do is to contact your workers’ compensation lawyer with JSK. We can negotiate with the insurance company to secure the amount of benefits you are entitled to. If a fair settlement is not attained, we will determine whether you should proceed to trial.
  • Discontinuation of benefits: When the workers’ compensation insurance carrier unfairly denies your benefits, your case may need to proceed to trial. There are many reasons benefits can be discontinued. Sometimes, the insurance carrier simply neglects to pay proper compensation and a case must be set for trial to force them to pay appropriate benefits. Also, sometimes an insurance carrier will obtain a medical opinion that you do not need any more treatment for your work injury and will deny additional benefits, even if you and your own doctor believe you need more treatment. You should speak to an attorney if the insurance company is claiming you have reached MMI.
  • You deserve higher compensation: Workers’ compensation trials are always risky because they are win-lose situations. However, there are times when you can obtain a higher amount of benefits by going to trial. If the insurance company has repeatedly made settlement offers that are unfair, and your attorney with JSK thinks you have a strong case, it may be advisable to go to trial and obtain the higher amount of benefits you deserve.

Should You Take Your Case to Trial?

Although any of the above scenarios may be reason to take your workers’ compensation case to trial, it is not always the right solution. It is important to remember that there is an added cost associated with going to trial and it may also drag out your case. If your case has substantial flaws, or you do not have enough evidence, you may not achieve a favorable outcome in court. It is always recommended that injured workers speak to a workers’ compensation lawyer at JSK who can advise on the most appropriate course of action. We will always have your best interests at heart.

How Does a Workers’ Compensation Trial Work?

Workers’ compensation trials do not work in the same manner as civil trials. A trial for an Illinois work injury is known as arbitration. An arbitrator, who is not a judge but who plays a very similar role, will hear your case. The arbitrator, in your case, will listen to both sides and make a decision.

Arbitration does not occur in a courthouse. Instead, you will visit an Illinois Workers’ Compensation Commission at one of their locations throughout the state. Your JSK attorney will attend the hearing with you and the insurance company will also bring their lawyer. Each side will have the opportunity to argue their side and either party can call witnesses if doing so will help their case.

The arbitrator will not issue a decision at the hearing and, in fact, it can take some time before they do. Before making a decision, the arbitrator will review any records submitted for your case, such as your medical records, and they will review all testimony that was heard before and during arbitration. Once the arbitrator does issue their decision, it is final and legally binding. However, that does not mean you do not have the right to appeal the decision. Unfortunately, the majority of cases are not overturned once an arbitrator has decided on the case.

What are the Pros and Cons of Going to Trial?

Again, it is highly recommended that you allow a workers’ compensation lawyer to handle your case. An attorney can determine if going to trial is the right option in your case and can advise you of the benefits and drawbacks of a workers’ comp trial. The biggest benefits of taking your case to trial are as follows:

  • A full recovery: If your employer or the insurance company refuses to act fairly and give you the full benefits you are entitled to, going to trial may be the only way to obtain the full recovery you deserve.
  • An accurate value of your claim: There are times when employees ask for more benefits than they might be entitled to, while the insurance company refuses to offer a fair settlement you deserve. In these situations, an arbitrator can provide a fair value of your claim.

While the benefits of a workers’ compensation trial are appropriate in some cases, it is important to know that there are some drawbacks that come with the process. These include:

  • A longer process: If you can reach a settlement agreement with the insurance company, it may only take a few weeks to finalize your case. On the other hand, if you go to trial, it can take several months before you receive the benefits you need.
  • Added stress: Workers’ compensation trials are very stressful experiences, particularly for those who are not familiar with them and do not know what to expect. Working with a lawyer at JSK will reduce this stress significantly.
  • You may recover less: There is no guarantee that you will obtain a favorable outcome if you go to a workers’ compensation trial. The arbitrator may decide to award you less than what the insurance company had offered as a settlement. If we think this may be the case, we would let you know in advance.
  • Increased tension with your employer: Once you have recovered from your injury, you may have to go back to work. If you have gone to trial, it could increase tension between you and your employer.

Our Workers’ Compensation Lawyers in Illinois Can Advise on Whether a Trial is Necessary

If you have a workers’ compensation case and believe it may have to go to trial, our Illinois/Missouri workers’ compensation lawyers at the Law Office of Jerome Salmi Kopis, LLC can provide the sound legal advice you need. Call us now at (618) 726-2222 or contact us online to schedule a free consultation.

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WORKERS’ COMPENSATION UPDATE

If you have contracted COVID-19 as part of your work environment, please contact us and we can discuss if your condition falls under the Workers’ Compensation Act. If we can prove that you contracted your virus as part of your work environment, you would be entitled to compensation that would include payment of all medical expenses; lost time benefits while you recovery; and a settlement for any ongoing problems after you recover. 

 

Please note that in Illinois, first responders and essential employees are presumed to have contracted COVID-19 at work.  Missouri recognizes that same presumption but limits it to first responders.  Regardless, if believe that you contracted COVID-19 at work, please contact us immediately so that we can inform you of your rights under the Workers’ Compensation Act.

 

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