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Workers' Compensation In-Depth

"Workers' compensation" refers to a system of laws outlining specific benefits to which injured employees are entitled, and the procedures for obtaining such benefits. Every state has its own workers' compensation laws, which are contained in statutes, and vary somewhat from state to state. In addition, there are special workers' compensation laws for employees of the federal government, and still others for workers in specific types of industries such as railroad employees.

Under most state laws, every business must have some form of workers' compensation insurance to cover medical care for injured employees. Filing a workers' compensation claim is similar to filing an insurance claim. It isn't a lawsuit against an employer, but rather a request for benefits.

This article discusses workers' compensation laws and outlines the steps you should take if you believe you may have a claim.

The Purpose and Effect of Workers' Compensation Laws

Workers' compensation laws are designed to ensure that employees injured on the job receive monetary awards. These are awarded without having to litigate their claims against their employers. These temporary disability benefits help support the injured worker. In this way, workers' compensation is an important safety net for employees when they endure a workplace injury.

Workers' compensation covers several different expenses for the injured worker. Expenses include medical expenses, vocational rehabilitation, or lost wages. The U.S. Department of Labor administers compensation programs for federal workers. State laws govern non-federal workers' compensation.

Most workers' compensation laws also provide employers and co-workers with a certain level of protection, by limiting the amount employees can recover from their employers, and prohibiting, 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 own negligence, or the negligence of his or her employer or co-workers, is not put at issue. Rather, the injured employee is simply covered for his or her work-related injuries.

Thus, workers' compensation is an injured worker's "exclusive remedy" with respect to a work-related injury. This is unless he or she can point to a third party who contributed to his or her injuries. For example, because workers are often injured by products or machinery they use at work, they may, and often do, seek compensation from the manufacturers of such products.

Employers are generally not directly involved in the third-party claims of their employees. And these claims take place in civil actions, rather than in the workers' compensation system. In most cases, however, an employer can recoup its workers' compensation payments and obligations from the recovery an injured worker obtains from a lawsuit against a third party.

In some states, the workers' compensation insurer and the employer may enter into the lawsuit commenced by the employee and seek to protect their rights to recover the sums. This varies depending on the company's insurance policy. The employer's insurance company may also join.

In other states, the employer is given a lien against the employee's recovery. In those states, the employer and insurer must wait until the employee has made a recovery. Then, they may assert the lien and the employee must then pay back monies that duplicate workers' compensation benefits previously received or receivable.

The Scope of Workers' Compensation Coverage

Workers' compensation coverage varies by state law and by occupation. For example, some states exempt certain categories of workers. These categories may include agricultural employees, domestic employees, and independent contractors, from their workers' compensation systems. Other states require coverage only if an employer employs a minimum number of employees. Also, keep in mind that if you are not covered by workers' compensation, you may have eligibility to bring a civil injury claim against your employer or a third party.

Depending on the state law, you may qualify for a lump sum workers' compensation settlement for your medical bills, lost wages, or both.

Workers' Compensation Benefits Claims vs. Civil Lawsuits

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. Prior to the creation of the workers' compensation system, employees had no choice but to go to court to recover compensation for their work-related injuries. Now, most employees are automatically entitled to workers' compensation. At the same time, the employer is automatically protected from most employee lawsuits.

However, if you file a workers' compensation claim, you still may be able to bring a lawsuit. If your injury was caused by someone other than your employer, by a defective (malfunctioning) product you used on the job, or if the injury resulted from an intentional tort by the employer, you may still bring an action.

Types of Injuries Covered by Workers' Compensation

For a work-related injury, you may be eligible for compensation for any of the injuries listed below:

  • Preexisting conditions that the workplace accelerates or aggravates. Examples may include a back injury, even though you don't notice the pain from the injury until later.
  • Injuries are caused during breaks, lunch hours, and work-sponsored activities (such as a company picnic), and at-work injuries are caused by company facilities, such as a chair in the company lunchroom.
  • Diseases such as lung cancer, if contracted by exposure to toxins at work as a result of normal working conditions.
  • Injuries resulting from mental and physical strain brought on by increased work duties or work-related stress. 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.

There are some injuries, however, that 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 who is 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, he or she 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:

Report the injury to your employer

If possible, report the injury in writing to your employer and keep a copy of the report for personal records.

Complete a claim form

No matter how your employer learns of the incident, it must offer you a claim form immediately. Until this claim form is completed, the employer has no obligation to provide you with benefits. Make sure the claim form is filled out completely and specifically. Keep a copy of your completed claim form. Once your employer receives your claim form, it is then the employer's responsibility to immediately notify its workers' compensation insurance carrier. They will then arrange medical assistance for you.

File the claim as soon as possible

If you are seeking to claim workers' compensation benefits, you should do so quickly. Any delay on your part could lead to potential snags or delays in receiving benefits. Immediately reporting injuries and filing a claim as soon as you decide to seek compensation increases the likelihood that benefits will begin quickly.

If a dispute should arise regarding the claim, you can seek help from the workers' compensation commissioner's office in your state. 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. But it can still get pretty complicated, especially if your injuries are severe.

If your claim is denied or you fail to receive compensation, you may need skilled legal assistance from a specialized personal injury attorney. You may want to have a workers' compensation attorney help you determine your next steps.

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.

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Next Steps

Contact a qualified workers' compensation attorney to make sure your rights are protected.

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