| Do I need a lawyer? You may need a lawyer and you may not, every situation is different. As a general rule, if things are going ok with your case and you are receiving the benefits that you are entitled to then you may not need a lawyer at this time. Some things to look for when answering this question would be to evaluate how the employer, the doctor and the insurance company are working with you. Let's start with the employer. The only thing the employer is required to do is document your claim of a work injury and to forward the information to the insurance company, who in turn forwards it to the Division of Workers Compensation under the Texas Department of Insurance. If an employer who has workers' comp insurance fails to report your injury they can get fined. Additionally, the employer is to comply with your doctor's restricted duty or off work recommendations. It is important to note however that Texas is an at-will state and thus the employer may terminate you. Typically a bonifide offer of employment is made after a period of time post- injury with a deadline to accept and return and if declined or still unable to perform the duties then the company can release you and fill the position. The company can't technically fire you for filing a workers' comp claim but they can release you for not returning timely subject to their policies. If you have been fired immediately upon filing a work comp claim or have received notice in writing that you are terminated because of filing a work comp claim then action may be considered against your employer for potential wrongful termination. The next thing to look at is your doctor. Is it a company selected doctor or a doctor that you chose? Does the doctor understand the workers' compensation process. Has the doctor and staff communicated with you effectively regarding your rights to healthcare as it relates to your diagnosis or condition? In other words have they told you what is wrong and what the treatment plan is and how long you can expect to be in pain or off of work? Has the doctor been willing to refer you to other specialists and other testing to see why you are still in pain if your injury is not getting better? If not then you may have the wrong doctor! A lawyer's responsibility is not to dictate medical care, but if you have answered no to some of these questions perhaps you should consider exercising your right to a change of treating doctor. Last but not least let's look at your friendly insurance company. If you are indeed lucky then you have been receiving your benefits, both financial (if off of work) as well as healthcare, in a timely professional manner. If this is not the case it may be time for legal assistance. If the insurance is slower than establishing a claim and paying you within 7 working days from date of injury with a doctor's note of being off of work then this is a big red flag. A common insurance tactic is to simply drag their feet, claim they didn't get phone calls or faxes and thus effectively delay your checks in hopes that you will give up and go back to work against your doctor's recommendations. This may be a time for legal help. If your case has been fine and then you or your doctor receive notice that there has been a dispute filed by the insurance for relatedness or extent of injury. Basically what the insurance is saying is we will pay for your 4-6 weeks of medicine and therapy but now we see additional imaging (MRI,EMG,NCV) and maybe you need injections or a specialist (orthopedic or neurosurgeon) and that is too expensive and not in the budget, so they are looking for an excuse not to pay. This is a time for legal help. If a dispute has been filed you need help. If your doctor is unwilling to provide you clinical documentation to fight for you then you need a new doctor. Regardless, the Benefit Review Conference (BRC) or upon appeal Contested Case Hearing (CCH) are somewhat informal court proceedings that involve you and the insurance, and the insurance high paid attorneys that understand work comp law very well and do these hearings daily. The state will assign or appoint you an ombudsman, who is not an attorney and not familiar with your case, to assist you with the proceedings if unrepresented. Guess who usually wins even if the medical evidence is in your favor? The bottom line is this... if things are going as well as can be expected and you are receiving your benefits then hiring a lawyer is probably premature. If your doctor insists that you hire a lawyer in order to accept your claim even if there is nothing wrong with your claim then they are more concerned about getting paid than getting you well and it's time to find another doctor. |
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