Have you suffered an injury on the job? Getting hurt at work can be stressful both physically and mentally. On top of dealing with your injury, you may find yourself facing questions about lost wages, medical bills, and more. That’s where workers’ compensation comes in. Workers’ comp is a no-fault insurance system programmed to provide rewards to employees who are injured or become ill due to their employment. However, navigating the complex workers’ comp system can be difficult alone. That’s why it may help to consult with a workers’ compensation lawyer.
What is Workers’ Compensation?
Workers’ compensation is a type of insurance that provides wage replacement and medical benefits to employees who are injured or become ill in the course of employment. The goals of the workers’ compensation system are to ensure workers receive prompt medical treatment for injuries and wages if they can’t work, as well as to support their return to employment.
Workers’ comp is regulated at the state level, so details vary depending on where you live. However, the basic principles remain the same. Under workers’ comp laws, employers are required to carry insurance that provides benefits for on-the-job injuries regardless of fault. In exchange for guaranteed coverage, workers give up the right to sue their employer. This no-fault system avoids expensive litigation costs for both employers and employees.
When an injury occurs, the first goal is medical treatment for the worker. Most states require employers to provide benefits for reasonable and medically necessary medical treatment, including doctor visits, surgeries, medication, and other care. While recovering, workers’ comp also covers a portion of lost wages through temporary disability or impairment benefits. There may also be long-term benefits for permanent disabilities impacting future employment.
The workers’ compensation system aims to make employees financially “whole” after an injury. However, benefits awarded do have limits depending on each individual claim and state laws. Later in this guide, we’ll discuss common benefit types and amounts in more detail. But first, let’s take a look at who qualifies for coverage.
Who is Eligible for Workers’ Compensation?
Not every injury at the workplace automatically qualifies for workers’ compensation. Here are some basic guidelines on who is considered eligible:
- Employees – Typical workers, whether full-time, part-time, or temporary staff, are usually covered unless specifically excluded.
- Independent contractors – Some states may consider independent contractors employees in certain situations. Coverage varies significantly by state laws.
- Volunteer workers – Certain types of volunteers, like volunteer firefighters, may qualify depending on state rules.
- Out of state employees – Workers’ comp typically applies to employees injured while travelling or working temporarily in other states for their employer.
- Death benefits – Family members may receive benefits if an injury causes the death of a covered employee.
To qualify for benefits, injuries generally must arise out of and within the course and scope of employment. Common examples would include accidents using work tools, lifting heavy objects, or trips and falls on the worksite. By contrast, injuries from personal reasons unrelated to work duties may not be covered. Figuring out if an injury meets eligibility requirements can sometimes require legal analysis. A workers’ comp attorney can advise on stronger or weaker cases.
Filing a Workers’ Compensation Claim
If you suffer a work-related injury or illness, it’s important to promptly notify your employer and file a claim. Here are the basic steps involved:
Notify your employer
Verbal or written notice should be provided as soon as safely possible after an incident occurs. The earlier you report, the stronger your claim. Save injury details in writing for documentation.
Get medical treatment
See a doctor right away to correctly diagnose and treat your injury. Employer policies differ, but most require using an approved medical provider at first.
File a claim
Submit formal paperwork with details of your injury, treatment received, and when you became unable to work, if applicable. Claims have filing deadlines that vary by state.
Receive claim decision
The insurance company or state agency managing claims decides whether your case is accepted or denied. Contesting a denial could require a workers’ comp attorney.
Receive ongoing benefits
If accepted, ongoing benefits coordinate with your doctor on medical care and any lost wages owed due to the injury. Notify the insurer promptly of health changes impacting work capability.
Staying organized with treatment records and injury documentation is crucial for supporting your claim. Consult a lawyer if unsure how to navigate the claims process or resolve disputes over eligibility or benefits. Understanding rights upfront helps hold insurers accountable to fair compensation decisions.
Common Workers’ Compensation Benefits
What benefits may you receive through a valid workers’ compensation claim? Let’s explore some frequently covered types and amounts:
Medical benefits
All treatments recommended by authorized physicians should be paid for, including doctor visits, surgeries, prescriptions, physical therapy, and more. Coverage continues until maximum medical improvement is reached.
Temporary disability benefits
Paid as a percentage of average weekly wages, these replace lost earnings while recovering from injuries preventing you from working. Payments may continue up to 2 years or a fixed number of weeks depending on the state.
Permanent partial disability benefits
Compensation for long-term effects limiting job duties after maximum improvement. Rates are set by a schedule based on the body part or function affected.
Permanent total disability benefits
Ongoing lifetime payments for injuries leave you unable to work in any capacity or find substantially similar work. Strict eligibility criteria apply.
Vocational rehabilitation benefits
Funding for education or retraining programs is needed to prepare for new suitable employment if you are unable to return to your old job due to work injuries.
Death benefits
Payments to qualifying dependents of workers fatally injured on the job, including spouses, children, and others partially financially reliant on the deceased.
Keep in mind benefit calculation formulas and caps vary significantly between states. Reach out to an experienced workers’ compensation attorney to understand your unique entitlements under local laws. Proper guidance ensures receiving all compensation owed for injuries suffered at work.
Key Workers’ Compensation Issues
Navigating a workers’ compensation claim presents many complex issues that could impact your rights and benefits received. Let’s examine some common problems workers may face:
Denied or disputed claims
Insurers frequently deny the initial claim or dispute ongoing benefits, often due to contesting eligibility, causation of the injury, or degree of disability. Hiring counsel strengthens your ability to properly challenge unfavorable decisions.
Inadequate medical treatment
Carriers may resist certain procedures, tests, or providers recommended by your doctor as not medically necessary. Consult a lawyer to demand all reasonable and related care owed.
Delayed or unpaid benefits
Late or missing benefit checks are a frequent complaint despite legal deadlines for prompt payments. Attorneys have the tools to investigate and remedy such violations.
Return to work problems
Employers must provide suitable light or modified duties according to your medical restrictions. However unrealistic job offers or failure to accommodate can unfairly cut off wage replacement.
Safety violation exposure
On-site accidents with evidence of applicable OSHA safety standards not followed can lead to third-party negligence claims against responsible parties in addition to or instead of workers’ comp.
Insurance company misconduct
Tactics like coercion, misinformation, or wrongful claim denial may form the basis of additional legal action for bad faith adjustments or even fines against the carrier.
Early guidance prevents issues from festering into greater problems down the road. Consult a knowledgeable workers’ compensation attorney when the first signs of difficulty arise to properly handle your claim according to the law.
When to Hire a Workers’ Comp Lawyer
For most straightforward cases with clear compensability, prompt treatment authorization, and benefits delivery, self-representation may be adequate. But hiring legal counsel should be strongly considered in several scenarios:
- Claim denial or disputes over eligibility, coverage, or causation of injury
- Difficulty accessing or delays in authorized medical treatment
- Problems receiving timely or correct wage replacement or other benefit payments
- Permanent disability ratings are significantly lower than doctor recommendations
- Employer/insurer demands for an unfair return to unsuitable work
- Facing discriminatory retaliation like improper job termination after injury
- Need for vocational rehab funds or assistance complying with the plan
- Pursuing third-party liability or bad faith causes of action
- Settling your permanent disability claim for adequate compensation
Experienced workers’ compensation attorneys know the ins and outs of applicable laws, understand insurer tactics, and have the tools to effectively resolve disputed issues in your favor. Investment in legal representation often provides far greater financial returns through advocacy, yielding higher or earlier payouts for benefits.