When someone reaches out to a workers’ comp attorney, they’re usually hoping to hear “Yes, you have a great case.” But lawyers don’t make that call based on gut feelings or sympathy for injured workers. They’re running through a mental checklist of factors that determine whether a case is worth taking and what the likely outcome will be.
Understanding how attorneys evaluate workers’ comp claims can help injured workers see their situation more clearly and know what to expect. Here’s what lawyers are really looking for when they review a case.
The Basics: Was It Actually a Work Injury?
This sounds simple, but it’s the first hurdle. The injury needs to have happened while performing job duties or at least on work premises during work hours. An accident during lunch break in the company parking lot? Probably covered. Getting hurt while running personal errands on the way to work? Not so much.
Lawyers want to hear a clear connection between the job and the injury. “I was lifting boxes in the warehouse and felt my back give out” is straightforward. “My back has been hurting for a while and I think it’s from work” is much harder to prove. The timing and circumstances matter a lot.
Pre-existing conditions complicate things but don’t automatically disqualify claims. If someone had a bad knee and a workplace fall made it significantly worse, that can still be a valid workers’ comp case. The key is showing that work activities caused a measurable change or aggravation of the existing condition.
Documentation Makes or Breaks Cases
The first question any workers’ comp attorney asks is about documentation. Was the injury reported to the employer right away? Is there an incident report? Did the worker see a doctor immediately? These pieces of paper are what separate strong cases from weak ones.
Missing documentation raises red flags. If someone waited weeks to report an injury or never filed an official incident report, the insurance company will argue it didn’t happen at work. Lawyers know these cases are uphill battles, and some won’t take them at all because the odds are stacked against winning.
Medical records need to show consistent treatment and a clear diagnosis linking the injury to the workplace incident. Gaps in treatment or inconsistent complaints to different doctors create problems. Insurance companies love pointing to these inconsistencies as evidence that injuries aren’t as serious as claimed or didn’t happen the way the worker says they did.
This is often when injured workers realize they need professional guidance. Scheduling a workers’ comp case consultation helps clarify what documentation exists, what’s missing, and whether the case is strong enough to move forward.
Claim Status and Current Problems
Attorneys want to know where the claim stands. Has it been filed? Approved? Denied? Is the insurance company paying medical bills or has it stopped? Understanding the current situation helps lawyers figure out what needs to happen next and how much work the case will require.
Denied claims need appeals, which means hearings and potentially lengthy legal proceedings. Claims where benefits suddenly stopped require investigation into why. Cases where the insurance company is slow-paying or disputing treatment need different strategies than straightforward claims that just need proper settlement negotiations.
The more complicated the current status, the more legal work is needed. Attorneys can explain what’s actually happening with the claim and what options exist for moving forward.
Severity and Long-Term Impact
Here’s the hard truth: lawyers look at potential compensation when deciding whether to take a case. More serious injuries with lasting impacts typically result in higher settlements or awards, which makes them more worthwhile for attorneys working on contingency fees.
A broken finger that heals completely in six weeks doesn’t generate much legal work or compensation. A back injury requiring surgery with permanent restrictions that prevent someone from returning to their previous job? That’s a significant case with substantial benefits at stake.
Lawyers evaluate current medical status and prognosis. Are there permanent impairments? Will the worker need future medical care? Can they return to their old job or will they need vocational retraining? The answers to these questions determine the case’s overall value.
The Insurance Company’s Behavior
How the workers’ comp insurance company has handled the claim tells lawyers a lot. Some insurers are reasonable and pay legitimate claims without much fight. Others deny everything and force workers to appeal even obvious injuries.
If an insurance company is acting in bad faith – unreasonably denying treatment, ignoring medical evidence, or retaliating against the injured worker – that changes the legal strategy and potentially opens up additional claims beyond standard workers’ comp benefits.
Lawyers also look at whether the employer is cooperating or creating problems. Employers who dispute that injuries happened at work, blame workers for their own injuries, or pressure workers to return before they’re medically cleared create legal issues that strengthen the need for representation.
Witness and Evidence Availability
Strong cases have witnesses who saw the accident happen or can verify the working conditions that led to the injury. Co-workers who can testify about what they observed add credibility that helps counter insurance company skepticism.
Physical evidence matters too when it exists. Security camera footage, photos of the accident scene, or documentation of unsafe conditions all strengthen cases. Lawyers want to know what evidence is available and whether it supports or contradicts the worker’s version of events.
The problem is that evidence disappears over time. Witnesses forget details or leave the company. Video footage gets recorded over. The longer someone waits to get legal help, the harder it becomes to gather supporting evidence.
Whether the Case Needs a Lawyer
Not every workers’ comp claim requires legal representation, and honest attorneys will say so. Straightforward injuries with clear work connections, good documentation, and cooperative insurance companies often resolve fine without lawyers.
But cases with denials, disputes over medical treatment, permanent disabilities, employer retaliation, or complex medical issues? Those almost always benefit from professional legal help. Lawyers evaluate whether their involvement will meaningfully improve the outcome enough to justify their fees.
The Bottom Line on Case Evaluation
Workers’ comp attorneys are essentially asking themselves: “Can I prove this injury happened at work, is the documentation solid, what’s the case worth, and will my involvement improve the result?” If the answers line up favorably, they’ll take the case. If too many red flags exist, they’ll likely pass or at least be honest about the challenges ahead.
Understanding this evaluation process helps injured workers see their situations more objectively. It also highlights the importance of proper documentation, timely reporting, and consistent medical treatment – the foundations that make workers’ comp cases winnable.
