Workers' Compensation In-Depth
"Workers' compensation" refers to a type of insurance coverage. This system benefits workers who experience job-related injuries or occupational diseases. Every state has workers' compensation laws, which are in statutes. There are also special workers' compensation laws for federal government employees. Laws for workers in specific types of industries (like railroad workers) also exist.
Under most state laws, every business must have workers' compensation insurance. This insurance covers medical care for injured employees. Filing a workers' compensation claim is similar to filing an insurance claim. It is not a lawsuit against an employer but a request for benefits.
This article discusses workers' compensation laws. It outlines the basics for filing a claim if you believe you have one.
The Purpose and Effect of Workers' Compensation Laws
At its core, workers' compensation is designed to protect both employees and employers in the case of workplace accidents. For the employee, it offers prompt financial assistance. This assistance is used to cover medical treatments if they are hurt on the job. For the employer, it limits their liability. This means they typically cannot be sued for the injury unless there is gross negligence.
The benefits are awarded to the injured employee without having to litigate their claims against their employer. These temporary disability benefits help support the injured worker. In this way, workers' compensation is an important safety net for employees when they suffer workplace injuries.
Workers' compensation covers several different expenses for the injured worker including medical expenses, vocational rehabilitation, and lost wages. The U.S. Department of Labor administers compensation programs for federal workers. State laws govern non-federal workers' compensation. These laws ensure that workers who suffer from a job injury do not lose their earning capacity. If you are a full-time or part-time employee or a self-insured business owner, you are usually covered by workers' comp insurance.
Most workers' compensation laws also provide employers with a certain level of protection. They might do this by limiting the amount employees can recover from their employers. They also prohibit, in most cases, injured employees from suing their co-workers. In essence, workers' compensation is a no-fault system. This means that an injured worker's negligence, or the negligence of their employer or co-workers, is not put at issue. Instead, the injured employee is covered for their work-related injuries.
Workers' compensation is an injured worker's "exclusive remedy" for work-related injuries. This is the case unless they can point to a third party who contributed to their injuries. For example, if workers get hurt by equipment or products they use at work, they usually ask for compensation from the companies that made them.
Employers are generally not directly involved in the third-party claims of their employees. Furthermore, these claims occur in civil actions rather than the workers' compensation system. If a worker sues a third party and wins, the employer can take back the money it paid for the workers' comp claim.
In some states, the workers' compensation insurer and the employer may enter into a lawsuit commenced by the employee against a third party. They usually seek to protect their rights to recover the sums they paid in worker's comp. This varies depending on the company's insurance policy. The employer is given a lien in other states against the employee's recovery. In those states, the employer and insurer must wait until the employee recovers. Then, they may assert the lien. The worker must return any money that's the same as their workers' compensation benefits before they get or are about to get more money.
The Scope of Workers' Compensation Coverage
Workers' compensation coverage varies by state law and by occupation. For example, some states exempt specific categories of workers. These categories may include agricultural employees and domestic employees. Independent contractors are usually excluded from their workers' compensation systems. Other states require coverage only if an employer employs a minimum number of employees. Remember that if workers' compensation does not cover you, you may be eligible to bring a civil injury claim.
Depending on the state law, you may qualify for a lump sum workers' compensation settlement for your medical bills, lost wages, or both. This settlement can cover costs like medical treatment, average weekly wage loss, and even death benefits. Death benefits are offered to dependents. This happens in situations where a job-related injury led to an employee's death.
Workers' Compensation Benefits Claims vs. Civil Lawsuits
One significant difference between a workers' comp claim and a civil lawsuit is the issue of fault. In most injury cases, such as a car accident, you must prove someone else was at fault to receive compensation. With workers' comp, it does not matter who is at fault. You are typically covered as long as the injury or illness is job-related.
Workers' compensation cases are usually considered a substitute for a lawsuit against your employer. In exchange for not suing your employer in court, you are entitled to workers' compensation benefits, regardless of fault. Before creating the workers' compensation system, employees had no choice but to go to court. This was the only chance they had to recover compensation. Now, most employees are automatically entitled to workers' compensation.
At the same time, the employer is automatically protected from most employee lawsuits. However, workers' comp usually does not cover "pain and suffering." This is a term used in civil lawsuits to describe emotional distress caused by an accident. In contrast, it focuses on what are considered to be tangible costs like medical bills and lost wages.
If you file a workers' compensation claim, you may still be able to bring a lawsuit. You can bring an action if your injury was caused by any of the following:
- Someone other than your employer
- A defective or malfunctioning product you used on the job
- An intentional tort caused by the employer
You may want to seek help from a legal professional if you are not sure.
Types of Injuries Covered by Workers' Compensation
Workers' comp covers a broad range of job-related injuries and diseases. This can range from a simple fall resulting in a broken arm to long-term conditions like hearing loss from consistent loud noise. It also covers total disability and permanent disability. However, the injury or disease has to be related directly to your job duties or environment.
For a work-related injury, you may be eligible for compensation for any of the injuries listed below:
- Preexisting conditions you had that the workplace accelerates or aggravates. Examples may include a back injury, even though you do not notice the pain from the injury until later.
- Injuries that are caused during breaks, lunch hours, and work-sponsored activities (such as a company picnic) and at-work injuries that are caused by company facilities, such as a chair in the company lunchroom, may be considered to make you eligible.
- Diseases such as lung cancer, if contracted by exposure to toxins at work due to normal working conditions, may fall under this compensation.
- Injuries resulting from mental and physical strain brought on by increased work duties or work-related stress are also a possibility. In some states, this includes employees who develop a disabling mental condition because of the demands of the job and a supervisor's constant harassment.
Some injuries may not be covered by workers' compensation. State courts are divided on whether an employee can recover for an injury sustained during horseplay at work. Many states will not award benefits to a person injured while intoxicated or who deliberately inflicts injury on himself. If a worker leaves the employer's premises to do a personal errand and is injured, they might not be entitled to workers' compensation benefits.
What To Do If You Think You Have a Claim
Here are the first steps you should take if you are injured on the job:
- If you have suffered a job-related injury, the first step is to report it to your supervisor immediately and in writing. This is crucial for your workers' comp claim. Keep a copy of the report for your records.
- Seek medical treatment right away, even if the injury seems minor. Some severe injuries, like concussions, do not show symptoms immediately.
- Complete a claim form from your employer. No matter how your employer learns of the incident, they must immediately offer you a claim form. This claim form must be completed before the employer can provide benefits. Make sure the claim form is filled out entirely and precisely. Keep a copy of your completed claim form.
- Once your employer receives your claim form, they must notify its workers' compensation insurance carrier immediately. They will then arrange medical assistance for you.
- File a claim with the workers' compensation board. It would help if you did so quickly. Any delay on your part could lead to potential snags or delays in receiving benefits. This process can be complex and time-consuming, but it is necessary to receive your benefits.
Immediately reporting injuries and filing as soon as possible increases the likelihood of getting benefits quickly. If a dispute arises about the claim, you can seek help from your state's workers' compensation commissioner's office. You may also want to contact an experienced workers' compensation attorney.
Get Professional Help From an Experienced Workers' Comp Lawyer
The workers' compensation system provides a method to receive compensation for work-related injuries. Navigating the basics of workers' comp claims can be challenging, especially when dealing with an injury. That is why it is often beneficial to consult a professional.
A skilled workers' comp lawyer can help you understand your rights. They can also help you file a claim and ensure you get the full benefits you are entitled to. If you have any questions at all about your claim, talk to a workers' compensation attorney and put their expertise to work for you.
You Don’t Have To Solve This on Your Own – Get a Lawyer’s Help
Meeting with a lawyer can help you understand your options and how to best protect your rights. Visit our attorney directory to find a lawyer near you who can help.
Contact a qualified workers' compensation attorney to make sure your rights are protected.