Workers' compensation insurance provides benefits to people who were injured at work. Learn more about when and how you can receive workers' compensation following a work-related injury.
Hello! Welcome to Enjuris.com.
We're going to talk today about workers' compensation laws and how you can receive workers' comp benefits if you were injured at work.
First, what does it mean to be "at work"?
For the purposes of workers' compensation laws, you're "at work" if one of the following two conditions is true:
- An injury that happens when you are physically present in your workplace.
- You are not at your workplace, but you are someplace you need to be for the purpose of performing tasks related to your job, and you are engaged in duties required for your job at the time when you are injured.
So, how does this work?
If you are at your place of work and you become injured, it doesn't matter whether the injury was related to your actual job function or not. So, for example, say you slip and fall on a puddle of water on the bathroom floor at work. The injuries resulting from that accident would qualify for workers' compensation benefits.
Likewise, if you work in an office and you trip over a phone cord or electrical cord on the ground, strain your muscles reaching for an item on a high shelf, or suffer some other type of injury, those would be covered because you were at work at the time.
If you are outside your regular workplace but are performing tasks necessary or required for your job, an injury that happens during that time is covered, too. For instance, if your job requires you to provide a service at a customer's home, or if you're on a construction site or even if your boss asks you to run out and pick up lunch for your team… an injury that happens while you're someplace you need to be for your job would be covered under a workers' compensation claim.
While workers' compensation has numerous benefits for the injured employee, there's also an important benefit to the employer, which is that workers' compensation is an exclusive remedy.
That means that if you file a workers' compensation claim for a work-related injury, you're not permitted to file a personal injury lawsuit against your employer for that injury. There are a few very limited exceptions to this rule. One is that workers' compensation insurance doesn't cover pain and suffering, so if you experienced extreme pain and suffering and believe you're entitled to compensation for that, you might be permitted to file a lawsuit for those damages.
Second, you could sue your employer if your injury was intentionally caused by your employer or a fellow employee (in other words, not an accident). This might include fraud, assault and battery, or intentional infliction of emotional distress.
But there's another nuance to the law, which is that you could be permitted to file a third-party personal injury lawsuit.
If your injury was caused by the negligence of a person or entity other than your employer, you could sue that defendant for your injuries.
For example, if you're at work on a construction site and you fall from a scaffold because it was defective and collapsed, you could file a product liability lawsuit against the manufacturer of the scaffold. This would also be the case if you were injured because of a defect in any other type of personal protective equipment.
You can read more about this in the Enjuris guide to defective product lawsuits.
You can also file a third-party lawsuit if you were injured because of a hazardous condition on the property where you're working. For example, if you provide services at a customer's home and you were injured because you fell on broken stairs, you might be able to file a premises liability lawsuit.
But back to workers' compensation…
We talked about where and how injuries can happen. The next important point about workers' compensation is that it is no-fault insurance. That's another major difference between the workers' comp system and traditional personal injury lawsuits. You don't need to prove that anyone was negligent or at fault for your injury. It doesn't matter if you caused your own accident — as long as it was an accident and not intentional. In some states, you cannot collect workers' compensation benefits if you were consuming alcohol at the time of the accident, either.
The two things you do need to prove are:
- The injury happened either in your workplace or while you were doing your job someplace else, as we discussed.
- You do need to prove actual injury and that the injury has cost you money.
While specific benefit amounts from a workers' compensation claim vary from state to state, these are the benefits you can recover from workers' comp insurance:
- Costs for medical treatment
- Ongoing rehabilitative therapies
- Transportation/gas mileage reimbursement for medical treatment visits
- Retraining to return to work
- Percentage of lost wages
- Partial compensation for a permanent injury or disability
- Survivor benefits for the family of a worker who died from a work-related injury
Again, your state laws will govern the exact percentage of wages, survivor benefits, and who qualifies as a surviving dependent. To learn more about what your benefits would be, you can contact a workers' compensation lawyer in your state.
So, what should you do if you were injured at work?
First, be sure to notify your employer. If possible, provide written notice to your supervisor, manager, or human resources office. This should happen as soon as possible after your injury.
Second, get medical treatment. Even if you think that the injury is minor and might resolve on its own, it's essential to have a medical evaluation and diagnosis. This is because sometimes an injury can become worse over time if left untreated, and because there are injuries that might not have many symptoms immediately but that could appear days or weeks later. One of the only ways to prove that the injury was the result of a work accident is if you have a documented medical chart specifying what happened, the date of the injury, and the doctor's assessment. When you go to a doctor or other medical provider, be sure to tell them that you're there for a work-related injury so that they can include that information in the chart.
Third, although state rules vary, each has a certain amount of time in which a claim must be filed to the state's workers' compensation board. Sometimes it's the employer's responsibility to file the claim, and other times it's up to the injured worker. Either way, you should make sure that this is done properly by checking with your state workers' comp board so that you don't lose the right to make a claim.
Then, you wait.
Hopefully, the workers' comp board will provide you with a settlement that covers your expenses in full, you've recovered and can return to work, and you're ready to move on.
But that's not always how it works.
If your claim is denied, or partially denied, you should contact a workers' compensation lawyer for assistance on your appeal.
You should seek the services of a workers' compensation lawyer if:
- Your claim is denied. You can get an appeal, but the process is complicated and requires the assistance of an experienced workers' comp attorney.
- There's a dispute about your permanent disability rating.
- You have a preexisting condition that might appear related to your injury. The workers' comp insurer will likely deny your claim on the basis that the injury was not caused at work. However, you are entitled to workers' compensation if an injury received at work worsened or complicated a preexisting condition.
- You are unable to get treatment quickly because of slow insurance approvals.
- The injury left you unable to return to work at the same job or pay rate that you had previous to the injury.
- You are receiving other government benefits like Social Security Disability Insurance or Medicare, because these benefits could be reduced by workers' compensation benefits.
- You're going to have a workers' comp hearing. This is a complicated process, similar to a trial and it benefits the claimant to be represented by a lawyer.
Really, if you've not fully recovered or received the full extent of medical treatment that you will need for your injury, you should contact a lawyer for assistance. If there's a possibility that you will require future medical treatment related to your work injury, your lawyer is the best person to assess what your future financial need will be. Your lawyer will work with medical and financial experts to ensure that the settlement will be enough to cover not just your needs now, but your future needs as well. Once you accept a workers' compensation settlement, you can't go back for more if you learn later that there's additional medical treatment necessary.
For all of these reasons, if you have any questions about whether your claim amount is sufficient, if you'll require more money in the future, or if your claim was denied, call a workers' compensation lawyer right away.
If you need a workers' compensation attorney in your state, please feel free to use the no cost Enjuris law firm directory at www.Enjuris.com - slash - directory.
Thank you and best of luck with your recovery.