In California’s Workers’ Compensation system, two types of attorneys play important roles: applicant attorneys and defense attorneys. Understanding their functions helps navigate the complexities of Workers’ Compensation claims. Although they serve different interests, both work towards resolving cases efficiently. This article explores their roles and responsibilities.
Applicant Attorneys: Advocates for Injured Workers
Applicant attorneys represent injured workers, known as applicants, seeking benefits under California’s Workers’ Compensation system. Their main job is to ensure that workers receive medical care, disability benefits, and other compensation.
Key Responsibilities of Applicant Attorneys
Applicant attorneys manage cases proactively. They:
- Gather Evidence: They collect medical records, accident reports, and employment records to support their client’s claim.
- Guide Clients: They help workers navigate the bureaucratic process and challenge denials of benefits.
- Represent Clients in Hearings: They advocate for workers in hearings before the Workers’ Compensation Appeals Board (WCAB).
- Challenge Defenses: They fight claims that a worker’s disability results from non-industrial factors.
These attorneys ensure that medical evaluations meet legal standards and substantiate the worker’s claims.
Focus and Fee Structure
Applicant attorneys represent injured workers. They work on a contingency fee basis, earning about 15% of any settlement or award.
Defense Attorneys: Protecting Employers and Insurers
Defense attorneys represent employers, insurance companies, and third-party administrators. They aim to minimize financial liability and ensure that only valid claims are compensated.
Key Responsibilities of Defense Attorneys
Defense attorneys protect their clients by:
- Investigating the Claim: They review the accident, medical records, and employment history to challenge the claim’s validity.
- Negotiating Settlements: They work to reduce the claim’s cost through negotiations with the applicant’s attorney.
- Disputing Injury Severity: They argue that the injury isn’t as severe as claimed or that it stems from pre-existing conditions.
Defense attorneys strive to show that claims are exaggerated or fraudulent.
Focus and Fee Structure
Defense attorneys work for employers and insurers. They charge hourly fees, paid by their clients.
The Critical Role of the Qualified Medical Evaluator (QME)
As a QME, your evaluation plays a key role in resolving legal issues. Both applicant and defense attorneys will closely examine your reports. Understanding their strategies helps you maintain impartiality in your evaluations.
Navigating Both Sides as a QME
Knowing both sides’ perspectives can improve your objectivity. By anticipating challenges from either side, you can ensure your reports are thorough and fair. A strong reputation as a QME increases the likelihood of case resolutions. Engaging in professional networks also ensures you meet Continuing Medical Education (CME) requirements.
Conclusion: The Adversarial Nature of Workers’ Compensation Cases
Applicant and defense attorneys play critical roles in the California Workers’ Compensation system. Though they have opposing goals, their work is crucial for fair case resolutions. Understanding their roles helps you navigate the system, whether you’re an injured worker, an employer, or a QME.
For further insight into Workers’ Compensation claims, visit TheGuardian.Group.