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Workers' Compensation: A Complete Guide

An accident takes even the most experienced workers by surprise.

What can you do if hurt on the job? Learn what lies ahead

If you are hurt and someone else is responsible, you can normally file a personal injury lawsuit to recover damages.

However, if the injury happens at work, you will more than likely be filing a worker's compensation case to get your medical bills covered.

Workers' compensation is the general system of laws that provides certain benefits if you are injured while working for an employer, as well as the steps you must take to obtain benefits.

Each state has its own specific workers' compensation laws. It's important for you to check the specific laws in your state. This article will outline workers' compensation principles so you will have a sense of what to do if you're injured at work.

Why workers' compensation?

Workers' compensation laws were set up to make sure that workers who suffer workplace injuries are appropriately compensated. The idea is to get your medical bills paid and to provide a percentage of your weekly salary so you don't have to file a lawsuit against your company (though you still can file a lawsuit in many states, however. We'll cover this later).

Enjuris tip: The idea of workers' compensation is to get your medical bills paid and to provide a percentage of your weekly salary so you don't have to file a lawsuit against your company. You still can file a lawsuit in many states, however.

Workers' compensation is a really important safety net for most workers. It provides you with a certain amount of financial protection, but the employer gets a good deal as well; the laws limit how much you can get from your company, and the laws usually prevent you from suing your co-workers.

Workers' compensation is basically a no-fault set up.

That is, if you are hurt on the job, it is generally not a matter of determining if you were at fault or if the employer was at fault. You simply receive treatment for your medical bills and part of your salary through the workers' compensation program to which your employer belongs.

Exclusive remedy for most workers' comp cases

Usually, workers' compensation is your exclusive remedy for a job-related accident – that is, unless you can prove that a third party caused your injury. For instance, if you work on an assembly line and your hand is mangled in a machine that malfunctioned, you could in theory sue the manufacturer of that machine.

Employers usually stay out of these types of third-party claims, and these actions are civil lawsuits, not workers' compensation claims.

Some states will allow the worker's compensation insurance company and the employer to join a lawsuit that you filed against a third party. This allows the companies to recover the funds that they must pay you in worker's compensation benefits. Other states may allow the employer to get a lien against the amount you recover in the third-party lawsuit.

Workers' compensation scope

Coverage will vary widely depending upon your state and your job. Some states may exempt certain types of workers from workers' compensation systems:

  • Agriculture workers
  • Independent contractors
  • Domestic workers

Other states will mandate coverage if the employer has a certain number of employees.

If you're hurt at work and you are not covered by workers' compensation, you still can talk to a personal injury attorney and file a lawsuit against your company or a third party.

Injuries covered under workers' compensation

You could receive compensation for these types of work-related injuries:

  • Any preexisting condition or injury that your job makes worse, such as a back injury.
  • Injury that occurs during a lunch break, 15-minute break, any work-sponsored event, or any work injuries caused by the employer's facilities, such as a broken chair in the break room.
  • Serious diseases such as lung cancer or mesothelioma, if you can prove it was contracted by your presence on the job.

Injuries that may not be covered under workers' compensation include:

  • Injury sustained when you are doing a personal errand off of company property.
  • Horseplay at work that results in an injury.
  • Some states will not provide benefits to a person who was hurt while intoxicated; however, if the employer provided alcohol at a company-sponsored event, you should speak to a workers' compensation attorney about this scenario.

Expenses covered under workers' compensation

Most workers' compensation insurance will cover:

  • Medical bills from the injury
  • Replacement of part of your income while you recover
  • Retraining costs
  • Partial compensation for permanent injuries
  • Benefits to family of worker who dies on the job

Workers' compensation does not cover your pain and suffering. So, if you have very serious injuries, you may look at filing a personal injury lawsuit. This can be difficult to do, but there are exceptions.

For instance, if you think your employer intentionally caused your injury, you may be able to file a lawsuit instead. The most common reasons for this are:

  • Battery
  • Assault
  • Intentional infliction of emotional distress
  • Fraud
  • Trespass

And, as noted earlier, if you were hurt on the job and you think a third party is to blame, you can sue that party.

What to do if you are hurt on the job

The process for filing a workers' compensation claim will be similar regardless of the state you are in. The time limit within which you must bring a claim may differ, for example. So, be sure to check your state's specific laws, which, again, can be found here.

Step 1 – report your injury

You have a certain number of days after your injury to report it to your company. You must report the injury in writing; a verbal communication is not enough. If you are seriously hurt and cannot report it, your relative or friend should do it for you.

Step 2 – seek medical care

Your company should have a list of health care professionals that can be used under their workers' compensation coverage. You should select a health care provider from this list. Use him or her as your treating physician for your workers' compensation claim and all of your accident-related injuries.

Step 3 – employer files claim with insurance

Your employer has a certain number of days to tell their insurance company about your injuries. If your injuries are very severe and you miss several days of work, your company may need to report the accident to the state.

Step 4 – insurer decision

The insurance company must render a decision within a certain timeframe after being informed of your injuries. The company will either accept or deny the claim.

Common reasons for the claim to be denied are:

  • Lack of information about your injuries
  • Insurance company believes that the injuries were not work-related

Be certain that you get a definitive answer from the insurance company – is the claim accepted or denied? This could be a critical legal point if your injuries are still affecting you months or years down the road.

Step 5 – denied? Talk to an attorney

If your workers' compensation claim is denied, you should talk to an experienced workers' compensation attorney immediately. She can determine if you have a strong case for appeal.

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