Often, when an employee is injured at work, they file a workers’ compensation claim to receive the necessary benefits for medical expenses and lost income. However, not all cases proceed smoothly. Insurance companies and employers sometimes attempt to deny these claims to protect their own profits. They may not offer full benefits or deny claims altogether to avoid increased insurance premiums. In such situations, taking your workers’ compensation case to trial may be necessary.
How Are Workers’ Compensation Cases Typically Resolved?
While only a small percentage of workers’ compensation cases actually go to trial, most are resolved through one of these methods:
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- Uncontested cases: Some cases do not involve any dispute. Employers readily agree that the worker deserves benefits, and insurance companies pay the full amount without delay or denial. In other cases, a workers’ compensation claim is denied, but the employee does not pursue an appeal.
- Settlement: A settlement is different from an uncontested case. It occurs after negotiations between the worker’s compensation lawyer and the insurance company. Once both parties agree on a fair offer, a settlement agreement is drafted, and the worker receives their benefits.
- PreTrials and Mediations: When the worker’s attorney and the insurance company cannot find common ground through negotiation, the Arbitrator or Administrative Law Judge steps in to discuss the issues and provide input to facilitate a settlement.
How Often Do Workers’ Compensation Cases Go to Trial?
The vast majority of workers’ compensation cases do not go to trial. Statistics suggest that around five percent of cases proceed to trial, although this estimation may vary depending on different state definitions and starting points for trials. For instance, in Illinois, out of approximately 40,000 employees who file an injury report each year, only 1,000 end up in arbitration, equivalent to just 2.5 percent of workers’ compensation claims in the state.
When Will a Workers’ Compensation Case Go to Trial?
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There are several situations where a trial becomes necessary to secure the benefits an injured employee deserves. Some common reasons for a workers’ compensation case going to trial include:
- Denial of benefits: When an insurance company unfairly denies benefits, it is crucial to contact a workers’ compensation lawyer to negotiate on your behalf. If a fair settlement cannot be reached, proceeding to trial might be the next step.
- Discontinuation of benefits: If the insurance carrier unjustly stops providing benefits, a trial may be necessary. Reasons for discontinuation can vary, such as negligence in compensation or refusal to provide additional benefits despite medical opinions recommending further treatment.
- Desiring higher compensation: Although workers’ compensation trials can be risky, there are instances where going to trial can result in obtaining a higher amount of benefits. If the insurance company consistently offers unfair settlements and your attorney believes your case is strong, proceeding to trial may be advisable.
Should You Take Your Case to Trial?
While the scenarios mentioned above may warrant taking your workers’ compensation case to trial, it is not always the best solution. It is important to consider the added costs and potential delays associated with going to trial. Additionally, if your case has significant flaws or lacks sufficient evidence, a favorable outcome in court may be unlikely. Therefore, it is recommended to consult with a workers’ compensation lawyer who can provide guidance on the most appropriate course of action based on your specific circumstances.
How Does a Workers’ Compensation Trial Work?
Workers’ compensation trials, also known as arbitrations, differ from civil trials. During an arbitration, an arbitrator, who fulfills a role similar to a judge, will hear the case. The hearing takes place at an Illinois Workers’ Compensation Commission location, involving your attorney, the insurance company’s lawyer, and any witnesses as necessary.
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The arbitrator does not issue an immediate decision at the hearing. Instead, they review all records and testimonies before making a final and legally binding decision. While it is possible to appeal the decision, the majority of cases are not overturned once an arbitrator has reached a verdict.
Pros and Cons of Going to Trial
It is highly recommended to have a workers’ compensation lawyer handle your case and evaluate whether going to trial is the best option for you. Here are some benefits and drawbacks to consider:
Pros:
- Full recovery: If your employer or the insurance company refuses to provide the full benefits you are entitled to, a trial may be the only way to obtain the comprehensive recovery you deserve.
- Accurate claim evaluation: In situations where employees request more benefits than warranted, or the insurance company offers an unfair settlement, an arbitrator can provide a fair evaluation of the claim.
Cons:
- Lengthier process: Settling with the insurance company can take a few weeks, while a trial may extend the timeline to several months before receiving the benefits.
- Increased stress: Workers’ compensation trials can be stressful, especially for those unfamiliar with the process. Working with an experienced lawyer can help alleviate this stress significantly.
- Possibility of recovering less: There is no guarantee of a favorable outcome in a workers’ compensation trial. The arbitrator may award less than what the insurance company originally offered as a settlement. Your attorney will inform you in advance if this situation is likely to occur.
- Tension with employer: Returning to work after recovery may lead to increased tension between you and your employer if the case proceeds to trial.
Our Workers’ Compensation Lawyers in Illinois Can Provide Guidance
If you have a workers’ compensation case and are considering trial as an option, the Law Office of Jerome Salmi Kopis, LLC can provide you with sound legal advice. Our Illinois/Missouri workers’ compensation lawyers are experienced in handling such cases and can offer a free consultation to discuss your situation. Contact us now at (618) 726-2222 or reach out online to schedule an appointment.
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