The Handbook to Workers’ Compensation
Suffering an injury on the job is a scary situation for an employee to experience. Employees have many concerns after suffering a workplace injury, including missing work, lost wages, medical expenses, and more. Each state has its own workers’ compensation law to protect workers injured on the job. We try to answer the most common questions arising from a workplace injury.
What is Workers’ Compensation & How Does it Relate to a Workplace Injury?
Workers’ compensation is a term often thrown around but never truly discussed. First and foremost, workers’ comp is a form of insurance designed to cover injuries suffered during employment. Workers’ compensation applies even if an accident at work led to the injury. Once a worker is injured, they can file a claim for workers’ comp benefits.
Workers’ compensation only covers employee injuries arising in the scope of their employment. Scope of employment involves all normal activities associated with an employees’ job. Therefore, unless the employee acted completely outside their daily work activities, they are eligible to receive workers’ comp. As soon as the employee ceases their job duties or exceeds the scope, workers’ compensation no longer applies. A traveling employee has a much broader scope as their job is more involved than an employee working in an office.
What is Provided by Workers’ Compensation?
Workers’ compensation covers a variety of financial areas. First and foremost, workers’ compensation covers a portion of the employee’s lost wages as a result of a workplace injury; the law caps these damages at a set amount. The amount of these payments will also depend on how disabled the worker has become. Furthermore, workers’ compensation pays the costs associated with medical care. Once a worker returns to work, their benefits will change depending on the level they can return to work.
If the accident resulted in the worker’s death, workers’ comp provides death benefits to a workers’ family and survivors. Most states have a strict time limit for filing a claim to receive death benefits, and many states have a one or two-year statute of limitations.
Alternatives to Workers’ Compensation: Suing for a Workplace Injury
Typically, an employee cannot sue their employer for an injury suffered while working. When an employer provides workers’ compensation for their employees, they are protected from defending personal injury lawsuits. However, there are situations when an employee can sue their employer for the employer’s conduct. Employers will typically be responsible when they disregard a known risk to the worker’s safety.
Workers may also be able to sue a third party for a workplace injury. If the third party was responsible for an employee’s injury, workers’ compensation does not prevent an employee from suing them. These cases may arise in defective product cases or a motor vehicle accident. Any damages received through a third party lawsuit are offset by what employees have already received through workers’ comp.
Workers’ comp does not cover injuries suffered as a result of a subcontractor on the employers’ property. An employee who suffers an injury as a result of a subcontractor’s actions needs to bring a lawsuit against the contractor.
Navigating The Workers’ Compensation System
First and foremost, employees with a workplace injury should seek medical treatment. Some workers’ comp policies require injured employees to see a specific doctor, so they should check with a supervisor or read the workers’ comp policy. Next, an employee should notify the employer that they suffered an injury while working. The employer is responsible for filing the employee’s claim with the insurer and the state workers’ comp board office.
The workers’ comp board will approve or deny an employee’s claim. In the case of a denial, the employee provided an opportunity to appeal the decision. When an employee appeals a claim denial, they have the option to request a hearing.
Before the hearing, the sides can settle before going through the appeal process. To assist in the settlement process, the employee and the insurance company will try mediation. A mediator is a neutral third party that acts as a go-between in the parties’ negotiations.
Unlike a lawsuit, a workers’ compensation claim is filed and brought before the workers’ comp board and not a court. While workers’ comp claims are presented to a board, an administrative judge will be the deciding factor in the appeal process. At the appeal process, each side will present evidence and testimony to support their position.
Typical Workers’ Compensation Cases
There are many causes of an injury that lead to a workers’ comp claim. However, some injuries are more common in the workplace than others. For example, construction sites are more dangerous than high-tech office buildings. Below are the most common causes of workers’ comp claims:
Finding the Right Lawyer For Your Workplace Injury Case
Workers’ compensation is a procedure based process. Each state has attempted to streamline the process to provide workers with protection. Because workplace injury cases can involve various procedures and some technicalities, it is smart to obtain a lawyer. If the workers’ comp goes to appeal, a lawyer provides the best opportunity for an employee to succeed. Employees can be hesitant to file a claim as they are concerned about backlash from their employer. There is no repercussion to the employer as a result of a workers’ comp claim. Workers’ compensation is solely for the employee’s protection.