Workers’ compensation is designed to provide financial and medical support to employees who suffer work-related injuries or illnesses. While many claims are resolved efficiently through settlement or administrative processes, some cases go to trial. Why do workers’ compensation cases go to trial, and how often? Here’s what you need to know.
Reasons Workers’ Compensation Cases Go to Trial
- Claim Disputes. While some cases resolve quickly, others may be disputed by the insurance provider for various reasons. They may question your eligibility, the severity of your disability, or the amount of compensation you’re entitled to, leading to a trial.
- Rejection of Claims: Insurance companies may question the validity of your claim and outright deny it. However, just because your claim is denied does not mean that you don’t have a valid case. Sometimes, mistakes made throughout the application process can compromise your case. You have the right to appeal this denial and pursue a trial if necessary.
- Disagreements Over Settlement Amounts. Settlements are common in workers’ compensation cases, where the injured party receives either a lump sum or a structured settlement payment from the insurance provider. These agreements come through negotiations between your attorney and the insurer. If you cannot reach an agreement and feel the compensation is inadequate, you may take the case to trial.
- Legal and Factual Conflicts. When there are disputes about how the injury occurred, the extent of the injuries sustained, or the application of relevant laws, a trial may be necessary to resolve these issues.
- Insufficient Medical Evidence. A trial may be needed if your case lacks adequate medical documentation. For instance, if there are differing medical opinions regarding your injury, court proceedings can provide a platform for further evaluations and expert testimony.
- Termination of Benefits. If your benefits suddenly stop, you may have to return to court to have them reinstated. This situation often arises when insurance companies believe you have reached Maximum Medical Improvement (MMI) and no longer require treatment.
How Often Do Workers’ Compensation Cases Go to Trial?
Nationally, only a small percentage of workers’ compensation cases reach trial. Estimates suggest that less than 5% of claims proceed to trial. This low percentage reflects the efficacy of administrative processes and settlement negotiations in resolving most disputes before they escalate to a court trial. The frequency of workers’ compensation cases that go to trial varies widely based on a number of factors, including:
- Impact of Legal Representation. The quality of legal representation can influence the likelihood of a case going to trial. Workers who hire an attorney may be more likely to challenge denied claims or contested benefits in court if settlement negotiations do not produce a satisfactory outcome.
- Regional variations. The frequency of trials can vary by state due to differences in workers’ compensation laws and practices. Some jurisdictions have more streamlined and efficient processes for handling claims, leading to fewer cases going to trial. Conversely, areas with more complex legal environments or higher dispute rates might see more court cases.
- Case complexity. More complex cases involving significant disputes or intricate medical issues are more likely to go to trial. Simple, straightforward claims with clear-cut evidence of work-related injuries are less likely to reach court, as they can often be resolved through negotiation or administrative review.
Our Workers’ Compensation Lawyers Put You First
While most workers’ compensation claims resolve without a trial, several factors can push a case to court. Understanding these factors helps employees and employers navigate the workers’ compensation system more effectively and prepare for the possibility of a trial if disputes cannot be resolved through other means.
If you were injured at work and are seeking workers’ compensation benefits, the workers’ compensation attorneys at Henson Fuerst are here to help. Contact us today by submitting a form online or calling our office at 919-781-1107 for a free legal consultation.
