Everyone knows that certain occupations are inherently more dangerous than others—a construction worker faces more potential perils on a day-to-day basis than the typical office worker. Even so, injuries can happen in any workplace and these often bring up questions about workers’ compensation.
So, what legal protection exists for workers who sustain significant injuries while on the job? One valuable program that has been instituted for employees is worker’s compensation. If you’re like most people, you probably already know a little about worker’s compensation, but, unless you’ve gone through the process of applying for these benefits, it’s likely that your knowledge is hazy beyond the basic generalities.
With that in mind, let’s take this opportunity to answer some of the more common questions about workers’ compensation that we get.
Frequently Asked Questions About Workers’ Compensation: The Basics
So what is worker’s compensation, anyway? It’s basically a type of insurance that employers take out. It enables their employees to receive financial benefits from the state in the case of a workplace accident that leaves them incapable of performing their usual duties.
Worker’s compensation is sometimes known as workman’s comp or worker’s comp. Most employers have to carry worker’s compensation for their employees. But, as we will see later on, not every employee will qualify to receive these benefits.
What Kinds of Worker’s Compensation Are There?
Again, we have to emphasize that each state has its own rules and regulations pertaining to the administration of worker’s compensation. There are certain broad trends, however. For the most part, this type of benefit falls into one of four distinct types:
- 1. Medical: This type of worker’s compensation benefit will cover medical expenses including medication and hospital stays. It may cover medical equipment used by the worker during the period of recovery.
- 2. Rehabilitative: This type of benefit covers medical therapy intended to enable the worker to recover his or her health and full use of their physical abilities. It also covers training programs that allow the worker to relearn specific skills used in their old job.
- 3. Disability: This type of benefit falls into various subcategories, depending on whether the injury/illness is temporary or permanent in nature and whether it’s partial or total. The disability benefit gives the worker a reliable income during the period of their absence from the workplace.
- 4. Death: This type of benefit is intended to compensate the surviving immediate family of a worker who died as a result of a workplace-related illness or accident. Depending on the state responsible for administering the worker’s compensation claim, it may or may not cover funeral expenses.
Also, states have varying standards regarding which kinds of relatives can receive this compensation (e.g., dependent parents may or may not qualify).
Do I Qualify For Worker’s Compensation?
This is the big question. To simplify the matter, we can fairly say that an employee must fulfill all three of the following requirements in order to be eligible for these benefits:
- 1. The employer of the worker has worker’s compensation insurance (or, if this is not so, is required to carry it).
- 2. The worker is an employee of the employer.
- 3. The injury sustained by the worker is related to the responsibilities of their job.
What Kinds of Employees Do Not Qualify?
Independent contractors are usually excluded from qualifying for worker’s compensation as they are technically not true employees of the company. Bear in mind, however, that some independent contractors are intentionally misclassified by their employers. They pull this trick in order to save on payroll taxes and related expenses.
If this is the case, then the employee may qualify once all the applicable facts have been properly reviewed. In addition, agricultural employees, undocumented personnel, and seasonal workers are usually exempt as well.
What Kinds Of Accidents Does Worker’s Compensation Cover?
Generally, anything that leads to a serious injury while on the job can qualify an employee for worker’s compensation. The injury does not need to result from a single, isolated incident. For example, repetitive stress injuries (e.g., carpal tunnel syndrome) also receive cover.
Injured personnel can qualify even if it’s determined that they were at least partly at fault for the accident. However, true gross negligence, such as flouting an explicit workplace safety rule or operating machinery while intoxicated, might disqualify an employee from these benefits. Intentionally injuring oneself while on the job is another disqualifier.
How Much Will I Get from Worker’s Compensation?
As we’ve already mentioned, workers’ compensation claims fall into multiple categories. That’s a big factor in determining how much money you will get and how you can expect to get it (e.g., scheduled payments or lump sum).
If the nature of your illness or injury keeps you out of work for a significant length of time—the exact amount of time is another varying factor—then you will likely receive benefits calculated at or around two-thirds of your normal salary, payable for as long as you conform to the qualifications.
How Long Can I Collect Worker’s Compensation?
Assuming that the stricken worker fulfills the requirements—that is, they’re still legitimately sick or injured—they can continue to receive worker’s compensation benefits on an indefinite basis. However, the worker should return to their workplace as soon as they are able. Their refusal to do so may endanger their right to further benefits.
Can I Collect Worker’s Compensation Benefits Even If I Was Injured Outside the Workplace?
This is yet another question that has no simple clear-cut answer. This is partly due to variations in state law and partly because of the ambiguities that sometimes arise in these cases, requiring detailed analysis.
The short answer though is that you probably have cover if you were performing duties for an employer as part of your job responsibilities. For instance, if you were injured in a car accident while on a road trip to pick up office supplies at your boss’s behest, then it’s likely that you qualify for worker’s compensation.
Can I Sue My Employer In Addition To Collecting Benefits?
Essentially, worker’s compensation provides employees with financial benefits. This means they don’t have to turn to the courts to sort through the legal mess often seen in personal injury cases. For that reason, you can generally not sue an employer. There are exceptions, however.
If your employer did not purchase worker’s compensation insurance when required by law, then you can turn to the courts for relief. Additionally, if you can demonstrate that your injury or illness was caused by a third party, such as a workplace visitor from an outside company, then you may be able to sue them.
Can I Choose Which Doctor to See?
Sometimes yes, sometimes no. Much of the time, you will have to see a doctor selected by your employer.
Do I Need to Contact an Attorney If I Have More Questions About Workers’ Compensation?
The short answer is no, but there are definitely cases where it’s best to have a lawyer in your corner. As you’ve probably guessed by now, worker’s compensation isn’t always a matter of black-and-white clarity. There are difficult issues that can arise.
Do you suspect that the severity of your injury has been underestimated by the state? Does the doctor insist that you’re capable of returning to work while you still have lingering physical issues? Is your claim in danger of being denied altogether due to your employer’s misrepresentation of the facts?
Issues such as these do sometimes arise. Therefore, when they occur, it’s best to have an attorney with substantial experience in all aspects of worker’s compensation law.
Is It Possible To Obtain Workers Compensation For Contractors?
Is worker’s compensation for contractors an option? It’s not. Workers’ compensation laws in most states require that an employer have workers compensation insurance for their employees only. The primary reason for workers’ compensation insurance is to ensure that workers are provided with the medical care that they need when they suffer an on the job injury .
If a worker sustains an injury on the job at a business without workers’ compensation insurance, and that business failed and had to close, then the worker wouldn’t have anyone to pay their medical expenses.
This is why most states require most companies to carry workers’ compensation insurance. Helping to cover lost wages is a secondary concern. The primary concern is dealing with medical treatment and any long-term care you may need due to a permanent disability.
A Business May Try To Classify Employees As Independent Contractors To Avoid Having To Provide Workers Compensation Insurance
There have been many cases over the years where businesses have attempted to avoid having workers compensation insurance. They do this by claiming that an employee was actually an independent contractor. Since worker’s compensation for independent contractors isn’t necessary, this was a cost-cutting measure to increase company profitability at the expense of worker’s rights.
This is especially problematic once an employee suffers an on the job injury. Then, discovers that there isn’t any insurance coverage. This means that he or she may not get the medical care that they need.
What is the difference between an independent contractor and an employee? The simplest difference between an employee and an independent contractor revolves around how each receives compensation for the work that they do.
Employees receive a paycheck on a set schedule due to an hourly wage. Or, due to the salary that they receive. Independent contractors receive payment on a per-job basis. Plus, their pay dates fluctuate since they only receive payment when they perform work for the company.
What If Your Employer Claims That Your Injury Isn’t Covered Since Workers Compensation For Contractors Isn’t Required?
If you sustain an injury on the job and your employer claims that you are an independent contractor and cannot receive workers’ compensation, what should you do? First, you should look at the criteria for being an employee.
Do you get a regular paycheck via a set wage per hour or salary? If so, then you are an employee and can receive workers’ compensation for your work injury. Unfortunately, the fact that your employer is taking this stance means that trying to negotiate with them isn’t going to go well for you.
They aren’t simply going to change their minds because it’s the right thing to do. You’ll need someone to fight for your rights and force your employer to give you the compensation and care that you deserve. That means that you will need to find an experienced workers compensation lawyer to represent you.
Can You Claim Workers Compensation For Stress?
Can you claim workers’ compensation for stress? You can in some cases, but proving that you have suffered a mental injury due to work-related stress is more difficult than proving you have a physical injury. If you asked 100 people if they ever felt stress on the job, you’d probably have 100 people tell you yes.
Life is stressful and jobs are stressful. Jobs have rules you have to follow and benchmarks that you have to reach. You’ll have to pick up extra work when people call in sick and if you work with the public, you’ll have to navigate all of the negativity that people hurl in your direction.
The point here is that a job is stressful by nature. You have to perform so you can keep your job, and you have to keep your job so you can pay your bills and eat.
You’ll Need Medical Documentation To Back Up Your Claim Of Workplace Stress
If you are trying to file workers’ compensation for stress you are going to need a doctor to back up your claims. How should you proceed with this type of claim? First, you need to report your stress-related injury to your supervisor. Then, you’ll need to follow up with whatever type of paperwork your employer requires you to fill out.
If you are claiming your stress injury happened at work, then by law, you have the right to medical treatment. A mental stress injury is no different here than a physical injury. Your employer has to provide you with medical treatment if you request it.
Your Claim For Workers Compensation For Stress Could Be Difficult To Prove
You probably have bills to pay, family commitments, and various other things going on in your personal life that causes you to stress, right? The point here is that you have a lot going on in your personal life that causes you to feel stress.
So, how can you prove that it was work-related stress that caused your injury and not stress from your personal life? When you suffer a physical injury on the job, that’s something that you can see, that can be documented and that a doctor can verify.
A mental stress injury lacks the ability to be measured in this way, making getting approved for workers’ compensation for this type of injury challenging.
You Could Try To File A Claim Under Personal Injury Laws
If claiming workers’ compensation for stress doesn’t appear to be a viable option, you could also attempt to file a claim under personal injury laws. Unfortunately, pursuing this course of action can be just as difficult as pursuing a worker’s compensation claim.
If you want to claim damages for personal injury on the job, you’ll need to prove that your employer or a co-worker, engaged in egregious behavior that caused you to suffer mental stress and injury.
You may also be able to file a claim for disability. Especially, if you are able to prove that the mental stress injury you have now makes it impossible to work a full-time job.
Contact A Lawyer To Assist You
In any of the above scenarios, it’s imperative that you contact a lawyer. Especially, one who has experience in both worker’s compensation and personal injury claims. You’ll have a much better chance of a positive resolution to your claim if you have a lawyer on your side.
Do You Have To Visit A Workers Compensation Doctor To File A Claim?
Do you need to visit a worker’s compensation doctor to file a worker’s compensation claim? Yes. That doesn’t mean that you need to go to a doctor when you fill out a workers compensation report.
When should you fill out an accident or injury report at work? Anytime you have an injury of any kind, even one that seems to be minor, you should fill out an accident report with your supervisor immediately. You never know whether or not an injury that appears to be minor could end up causing you complications in the future.
For example, what if you get a splinter in your finger? That’s minor and you probably won’t have to visit a doctor if you can pull it out. But, what if that finger later becomes infected? If you fail to report the injury when it happened, you’re going to have a much more difficult time filing a worker’s compensation claim.
Minor Injuries May Not Require You To Visit A Doctor
Every employer is different, but most employers will not want to waste resources sending you to the doctor for a minor injury that can usually be effectively treated using basic first aid techniques. Most companies have some kind of policy in place to evaluate injured workers before determining whether or not they need to be seen by a medical professional.
In these cases, as long as you never need to go to the doctor or suffer any lingering injury issues, you won’t need to file a worker’s compensation claim. But, you should still fill out an accident report as a precaution. You never know when an injury could turn out to be more serious than you first thought that it was.
You’ll Need To See A Doctor If You File A Workers Compensation Claim
Why would you file a worker’s compensation claim following an accident? You’d file a claim because you need any or all of the following:
- Medical care and treatment
- Compensation for lost wages
- Compensation for temporary or permanent disability
If you’re claiming any of these types of damages, you’re going to need a doctor to verify that you have suffered a serious injury that deserves compensation. No employer is going to write you a check when you tell them you’re injured and can’t work, but you refuse to see a doctor.
How Does Medical Treatment Work With A Workers Compensation Case?
If you’re injured on the job you have the right to medical treatment. Does that medical treatment have to be at a doctor of your employer’s choice? That varies from state to state. But, in most cases, you will have to see a company appointed doctor. At least initially.
However, following your initial evaluation and treatment, you can usually visit a doctor of your choice for a second opinion or for continuing treatment. That means that if you aren’t happy with the company doctor, you have the right to find a doctor that you’re more confident in.
What To Do If You’ve Been Denied Workers Comp
If you’ve been denied workers comp benefits for an injury that happened on the job, you have the ability to appeal this decision. This probably won’t come as a shock to you but employers are looking out for themselves first. Your wants and needs are a distant second.
When an employee files a worker’s compensation claim, this will frequently cause the rates that the business pays for their insurance to go up. Paying a higher premium for insurance will affect the bottom line of any business. Therefore, if they think they’ve found a way to avoid a worker’s compensation claim, they’re going to take it.
But, just because your employer denies your worker’s compensation claim, you don’t have to simply accept their decision. You can appeal.
What Are Some Of The Reasons An Employer Might Use To Deny A Workers Comp Claim?
Failing to report your injury on time and/or failing to follow the procedures of your employer and filling out all necessary paperwork could cause your claim to be denied .
Your employer may also claim that your injury is not work-related.
Your injury doesn’t meet the guidelines of the state for an injury.
You attempted to file a claim for worker’s compensation after leaving your job.
If your worker’s compensation claim is denied for any reason you’ll receive a letter in the mail explaining why your claim was denied. Make sure that you keep this letter. You should also read through it to see if there was some kind of error on your employer’s part leading to your claim being denied.
You could try to discuss the matter with the adjuster for the insurance company, but in most cases, this won’t do a lot of good. Remember, insurance companies don’t want to give you money if they don’t have to.
So, the likelihood that they will admit a mistake and approve your claim is pretty low. Still, it never hurts to ask.
A Workers Comp Lawyer Is Your Best Option When You’ve Been Denied Workers Comp
If your worker’s comp claim was denied and you don’t have any luck getting the adjuster to approve it yourself, the next thing you’ll need to do is appeal your claim. How do you do that?
If you want the best chance at winning your appeal, you do it with an experienced workers comp lawyer. The legal process for filing an appeal is complicated, and unless you’re a lawyer you’re going to struggle to keep up with the process.
An added bonus of hiring a lawyer is that it lets your employer and the insurance company know that you aren’t going to allow them to deny you benefits. Realizing that you aren’t going to just go away, this often prompts insurance companies to offer a settlement rather than risk going to trial. Especially, when they could end up paying out much more in compensation to you.
Workers Compensation Return To Work Restrictions Explained
If you’re returning to work following an injury, it’s very important that you follow workers’ compensation return to work restrictions carefully. If your doctor feels that you can return to work safely while following certain restrictions, then failing to do so could end up causing your claim to be denied, or you may even lose your job.
Your employer will be provided with a copy of your work restrictions, which they’re legally required to abide by. If your employer feels that you cannot perform any functions of your job under the restrictions that your doctor places you under, then you won’t work and will instead get a worker’s compensation benefit check.
Make Sure That You Follow The Workers Compensation Return To Work Restrictions That You Receive
Your employer should receive a list of your work restrictions, but it’s still a good idea to have a copy with you when you return to work. Make sure that you follow the instructions. Failing to do so could result in you making your injury worse which is the last thing you want.
If your employer is insisting that you do something that violates your doctor’s restrictions, you should refuse to do so and contact a worker’s compensation lawyer immediately. This is very unlikely to happen since employers know that violating doctor’s restrictions could get them into a lot of trouble.
One thing you should make it a point to do is keep an open line of communication with your employer. If something that you’re doing is causing you pain, let them know. Then, follow up with your doctor.
Doctors aren’t perfect and it’s possible that one could send you back to work with restrictions that are inadequate to protect you from further injury. Remember, your health is what is most important here, so don’t take any chances. If you’re in pain then speak up.
You should also do whatever you can to avoid an adversarial relationship with your employer. You may be unhappy that you have an injury. On the other hand, your employer may be unhappy that they’re dealing with a worker’s compensation claim that will probably make their worker’s compensation insurance rates go up.
No matter how you feel, try to get along with your employer. When this process is complete, the ultimate goal is for you to be healthy. And, of course, for you to return to work. So, damaging your relationship during the worker’s compensation process could affect you adversely down the road.
Whenever You Have Questions Or Concerns About Your Workers Compensation Case, A Lawyer Can Help
Are you confused about the whole worker’s compensation process? Do you feel like your employer is trying to take advantage of you? Are your return to work restrictions inadequate to protect you? If you answered yes to any of these questions, you should remember that there is help available to you.
That help is an experienced workers compensation lawyer. An experienced lawyer can answer your questions, and most importantly, they can ensure that your rights are protected.