Workers’ Compensation In-Depth

Workers’ Compensation refers to a system in which employees who are injured would be entitled to certain benefits as required by law. Each state has its own laws governing workers’ compensation. There are also special workers’ compensation laws for certain kinds of employees such as federal government employees and railroad workers.

Filing a workers’ compensation claim may be similar to that of filing for an ordinary insurance claim. The first step is to request for benefits from the employer, and filing a lawsuit against an employer may at times not be necessary.

The Purpose and Effect of Workers’ Compensation Laws

Workers’ compensation laws aim to provide a relief for injured employees, enabling them to get monetary rewards after the incident. This is in a way a protection to employees for those instances that they may be hurt while they are performing their duties connected to their employment.

Just as it benefits the injured employee, most workers’ compensation also provide a certain protection for employers and co-workers by setting a limit on what can be recovered by the injured employee. There may be provisions that would prevent an injured employee to sue a co-worker for the injuries they sustained.

Workers’ compensation operates on a no fault system wherein it is not important to prove whose fault it was that the employee got injured. As long as the injury occurred at work or in relation to work, then they are covered by the workers’ compensation insurance.

Often, the injured employee’s remedy lies exclusively in the workers’ compensation. However, there may be times when a third party may be held liable for their contribution to the injury. Sometimes manufacturers of machine and equipment can be held liable to an employee’s injury when employees seek to get compensation from them too. For such third-party claims, the employers are not usually directly involved.

However, there are also times when the employee may seek to take civil action instead of claiming workers comp. In such cases, the employers may be able to recover their losses from a third party. Some states may have laws allowing the employer to take a lien against the employee. In such cases, the employer and insurer waits until the employee’s full recovery to claim a reimbursement of their expenses, including those received by the employee as workers’ compensation and other benefits.

The Scope of Workers’ Compensation Coverage

Different states may have different laws regarding workers’ compensation.

There are states that may exempt certain employees from being entitled to workers’ compensation such as:

  • Domestic employees
  • Agricultural employees
  • Independent contractors

An experienced workers’ compensation attorney may provide more information as to whether or not you are entitled to the benefit.

Even if you are not covered by workers’ compensation, you may still be able to file a civil suit against the employer or third party.

Workers’ Compensation Benefit Claims vs. Civil Lawsuits

Once you claim workers’ compensation, you are usually no longer allowed to file a civil suit against your employer for the same injury. The beauty of workers’ compensation is that there is no need to prove that the employer is at fault when it comes to why you have sustained your injuries.

Before the creation of workers’ compensation laws, the injured employees’ only recourse is through filing a suit against the employer in order to receive compensation for injuries sustained during work. Because of the workers’ compensation system, such lawsuits have been drastically reduced as most employees are covered by workers’ compensation benefits.

The workers’ compensation system protects employers from being sued by the employee, but it does not prevent the injured employee from filing a lawsuit against a third-party who may have contributed to the injury. Some examples of third-parties in such cases include manufacturers or sellers of defective products

Types of Injuries Covered by Workers’ Compensation

You may possibly be eligible for workers’ compensation for the following injury sustained from work:

  • Injuries caused during breaks, lunch hours, and work-sponsored activities (such as a company picnic), and at-work injuries caused by company facilities, such as a chair in the company lunchroom
  • 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 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
  • Diseases such as lung cancer, if contracted by exposure to toxins at work as a result of normal working conditions

There are some injuries that are not covered by workers’ compensation. Courts may have varying opinions on whether or not injuries sustained from horseplay at work may make an employee eligible for the benefit. There are also a lot of states that do not allow the benefits to be awarded to employees injured while under the influence of alcohol or drugs. Generally, those who are injured while on their way to and from work are not covered, unless the means of transportation has been provided by the employer or if travel is a requisite or included in the employee’s duties.

Employees who live their place of work to perform personal errands may also not be covered by workers’ compensation benefits. But if the employee is injured on their way back from the restroom, a coffee break, or a company-sponsored education class.

What To Do If You Think You Have a Claim

If you think that you may be able to claim workers’ compensation benefits because of an injury at work, follow these steps:

  1. Report the injury to your employer. As much as possible, put the report in writing and keep a copy for yourself.
  2. Complete a claim form. Even if the employer already knew if your injury, fill up a claim form as soon as possible. The employee has no obligation to provide you with workers comp benefits unless you fill out this form. Just like your report, keep another copy for yourself. As soon as your employer receives your claim form, they are responsible for notifying their workers’ compensation insurance company and arranging for your medical assistance
  3. File the claim as soon as possible. This is important to remember because any delay on your filing due to your own acts may result in certain problems and you may not be able to get your benefits until after a while of waiting.

If there is any dispute regarding your claim, ask the help of the workers’ compensation commissioner’s office in your state. You may also want to consider working with an experienced workers’ compensation attorney to work with you in the process. If you are not satisfied with the decision in a hearing for your claim, you may be able to file an appeal. There are states that require the appeal to be filed in the workers’ compensation court of appeals. If you are still not satisfied with the ruling of the workers’ compensation court of appeals or if there is no such court in you state, then you can file an appeal to your state’s court.

Getting Help With a Workers’ Compensation Claim

It is advisable to seek the help of an experienced workers’ compensation attorney because workers’ compensation system can be complex, and varies from state to state. This way, you can be assured that your rights will be protected because your workers’ compensation attorney will know the specific requirements and procedures, and most especially workers’ compensation laws in your state.

If in case your situation is not covered by workers’ compensation, such as cases of independent contractors, you can bring a legal action against the person who you are working for in the same manner that you can sue a person who has caused personal injury to you. In these case, you may be able to recover damages for those that you cannot claim under workers’ compensation, such as punitive damages, compensation for pain and suffering, and attorney’s fees.

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