You may think that the odds of encountering a workplace injury are small, but no one is exempt from the risk of a workplace injury. Every seven seconds, a worker is injured on the job. In one recent year, private industry employers reported 2.8 million nonfatal workplace injuries and illnesses.
And injured worker and his or her family often face a loss of income and enormous medical bills. Your job is important, but you shouldn’t have to risk your health, safety, and financial well-being for the sake of your job. The intent of workers’ compensation insurance (also known as workman’s comp or workers’ compensation) is to provide injured employees with a way to receive money for work-related injuries.
If you have suffered a workplace injury or illness, you need information about workers’ compensation as soon as possible. A personal injury lawyer at Sibley Dolman Gipe Accident Injury Lawyers, PA and Sibley Dolman with experience in workers’ compensation law can review your case, answer your questions, and help you obtain the benefits you deserve.
The Purpose of Workers’ Compensation
The idea of workers’ compensation has been around for centuries. However, it began in the United States when Congress passed the Employers’ Liability Acts of 1906 and 1908. Today, most states require employers to carry workers’ compensation insurance for full- or part-time employees.
Workers’ compensation provides the injured worker with a way to pay medical costs and other bills during the recovery period, including lost wages, medical expenses, disability payments, and costs associated with rehabilitation and retraining. Individual states administer the system. It is financed by compulsory payments made by the employer.
There are trade-offs to this system. An injured worker gets payments quickly, but the payments are usually capped. The employer may avoid a lawsuit, but still must provide benefits through workers’ compensation insurance, even if the employer was not at fault.
Keep in mind that workers’ compensation is different from unemployment income and disability insurance. Workers’ compensation law applies only when the worker gets injured or dies while at the workplace or performing job-related duties. However, the unemployment income and disability insurance are paid regardless of whether the injury occurs within or outside the workplace. Workers’ compensation also differs from health insurance. Health insurance covers injuries that are not job-related.
Types of Injuries
Injuries incurred during the performance of job duties, including injuries that occur at an off-site location (for example, during business travel) are usually covered. However, injuries that are caused by employee misconduct, injuries that occur outside the scope of work, and injuries caused by “acts of God” are not covered. Some of the occupations most likely to cause injuries include construction, service jobs (including firefighters and police officers), transportation and shipping, manufacturing and production, installation, maintenance, and repair.
If an employee has been injured, the employer or insurance carrier may request that the worker be examined by a qualified doctor. Failure to agree to the examination may affect the claim.
Common workers comp injuries include:
- Overexertion – Lifting or lowering heavy objects, repetitive movements such as a wrist injury caused by typing
- Contact with objects and equipment – Being struck, caught, or crushed by objects, equipment or collapsing structures
- Slips, trips, and falls – Most of these happen on wet or snowy walkways.
- Electrocution – A high voltage electric shock can lead to serious injuries. Victims may suffer from cardiac arrest, nerve damage, organ damage, brain injuries, and burns. Workers such as electricians, construction workers, utility workers, crane operators may suffer electrocution injuries.
- Respiratory illness related to the use of chemicals – Exposure to dangerous chemicals like lead, asbestos, lead, pesticides, benzene, cadmium, beryllium, mercury, silica, paint, solvents, and acids may result in respiratory illness.
Who Is Eligible?
It is not always clear who is covered by workers’ compensation. A worker’s status usually relies primarily on two factors; whether they are an employee, and whether the injury occurred as a result of their employment.
You must be an employee of a company that has (or should have had) workers’ compensation insurance. Even if you are a seasonal or part-time employee, you are eligible. Some categories of workers are exempt from workers’ compensation requirements. Many state laws list specific types of employment excluded from workers’ compensation coverage. These often include part-time domestic workers, such as maids and nannies. Also, part-time maintenance workers or gardeners employed in the home may be excluded.
If you are an independent contractor, freelancer, or consultant, you aren’t eligible for workers’ compensation benefits. If you have been injured at work and believe you have been misclassified as an independent contractor, you should consult an attorney.
Although some organizations provide workers’ compensation insurance for volunteers, volunteers generally are not covered.
To be eligible, you must have been injured at work or as a result of job-related duties. That means you must have been injured at the worksite or while performing work that is related to your job. For example, if you have a car accident unrelated to your job or are injured performing chores at home, workers’ compensation probably does not apply. On the other hand, if a worker gets injured while operating a forklift on the job, or falling from scaffolding, the workers’ compensation law probably does apply.
The Federal Employment Compensation Act (FECA) covers employees of the federal government, including employees of the executive, legislative, and judicial branches. The main exception is military personnel. It provides benefits such as compensation for wage loss, medical expenses, and payment to dependents of employees who die from work-related injuries or diseases. FECA also provides vocational rehabilitation for partially disabled employees returning to work.
Workers’ Compensation and Subcontractors
Any subcontractor that uses employees is required to have its own workers’ compensation policy. If you are a subcontractor working for another company, you need to know that the IRS and the individual states have different criteria for determining whether a subcontractor is an independent contractor or an employee. Therefore, even subcontractors that qualify as independent contractors for purposes of taxes may still be considered employees under state criteria.
How Does the Workers’ Compensation Claim Process Work?
Workers’ compensation is regulated by individual states. Therefore, the workers’ compensation process can vary depending on where the employee is located. If a worker is injured on the job, there is a limited amount of time to submit paperwork to receive benefits. When an injury occurs, both the injured worker and the employer must fulfill certain requirements or the claim could be denied.
When an injury occurs, the employer must:
- Provide the employee with the appropriate paperwork and guidance
- File the claim with the insurer
- Comply with state law for reporting work injuries
The employee must:
- Provide the employer with a detailed notification of the injury.
- File a formal workers’ compensation claim<
Workers’ compensation provides benefits such as paying the cost of medical treatment, recovery of lost wages and compensation for permanent disability. Some states also provide benefits such as vocational retraining and return-to-work programs. If a worker dies on the job or due to an occupational disease, some states provide financial benefits to surviving dependents.
There are several different types of workers’ compensation benefits. The most common types include:
- Medical care: This includes the cost of medical care such as emergency treatment, hospital stays, doctor visits, nursing care, medical diagnostic tests, medication, physical therapy, and durable medical equipment (like crutches and wheelchairs).
- Rehabilitation: Most states provide some type of vocational rehabilitation to workers who are unable to return to their previous job due to an on-the-job injury. Some also provide psychological rehabilitation if a worker has suffered a work-related mental injury.
- Cash benefits: If you are partially or totally disabled, you may be entitled to workers’ compensation cash benefits for your lost wages. If you return to work, but your injury causes you to earn less than what you made before the injury, then you may also be entitled to reduced earnings benefits.
- Death: If an employee dies due to a work-related injury, death benefits are paid to the worker’s spouse, minor children, and other dependents. Burial costs are also covered.
While you don’t need to prove negligence, the tradeoff is that workers’ compensation benefits are typically capped by law, with the payment amount decreasing over time as the employee heals and begins to resume his or her job duties. Insurance companies, however, may exaggerate the degree to which they are not liable to you. A workers’ comp lawyer at Sibley Dolman Gipe Accident Injury Lawyers, PA or Sibley Dolman can ensure that you recover as much compensation as the law allows, not a lowball offer the insurance company is trying to force you to accept.
Workers who have a valid workers’ compensation claim are guaranteed a range of benefits. In exchange, however, workers are prohibited from suing the employer in court for negligence. However, if the employer intentionally caused the worker’s injuries, the employee can file a lawsuit. In that case, the injured worker may be awarded damages for pain and suffering, punitive damages, and other tort damages not available through a workers’ compensation claim.
In some situations, the injury or illness is indisputably work-related and the claim is paid. If the claim is contested, the matter will be decided by a workers’ compensation law judge. Also, the parties are encouraged to work out a settlement. However, if the parties are unwilling or unable to agree on a settlement, the injured worker and his or her attorney may decide to go to trial, sometimes called a workers’ compensation hearing.
For example, if there is a disputed issue, such as whether the injury occurred at the workplace, or during the performance of job duties, there may be a hearing. Even if the employer or insurance carrier is withholding benefits because they maintain that the injury is not job-related, the injured employee may be eligible for disability benefits. These payments will be deducted from future workers’ compensation awards.
Generally, in a workers’ compensation case, no one party is determined to be at fault and the amount of compensation is not affected by fault. However, the claim may be affected if the injury is the result of the worker’s drug or alcohol use, or the intent to injure himself or another person.
In some situations, an injured worker may choose to receive a lump sum, called a settlement, instead of continuous benefit payments. There are pros and cons to both options. However, accepting a settlement means that you are giving up the right to future benefits, which may not be in your best interest if complications develop later.
Reaching a settlement agreement can be difficult. You want to receive the compensation you deserve, but the insurance carrier wants to offer the lowest possible amount. If you decide to seek a settlement, an experienced lawyer can negotiate the best possible settlement on your behalf. Settling a claim is voluntary, so if you are not happy with the amount offered, you can refuse it. Some states allow a settlement to include a stipulation that the company will not pay extra benefits for the same injury in the future.
How Long Do You Have to Report Your Injury?
To be eligible, you must meet the deadlines for reporting the injury and filing a workers’ compensation claim required by your state. Some states require the incident to be reported in 30 days or less, but you should report your injury as soon as possible. Your employer then has no more than seven (7) days to report the injury to their insurance company. After that, you should receive an information brochure within three (3) days.
How Our Workers’ Compensation Attorneys Can Help You
Although workers’ compensation laws are meant to provide injured workers with fast relief, the long and complicated claim process can create a lot of stress in your life.
If you were injured at work and want to file a claim as soon as possible, consult a workers’ comp attorney at Sibley Dolman Gipe Accident Injury Lawyers, PA and Sibley Dolman. In addition to making sure you file all the necessary forms and meet the deadlines, our experienced attorneys will know how to gather the evidence needed to support your case, engage in productive negotiations with the insurance company, and represent you in any litigation. If you can’t agree on a good settlement, our attorneys prepare for and can represent you at the hearing or trial.
For more information or to schedule a free case evaluation, call Sibley Dolman Gipe Accident Injury Lawyers, PA and Sibley Dolman at 833-552-7274 (833-55-CRASH) or contact us online.
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