WORKERS' COMPENSATION INSURANCE
Workers' compensation insurance is a state-mandated benefit system designed to protect employees injured on the job. We can assist those involved in any work-related injury, whether it results from typing on a computer keyboard in an office or from a falling beam on a construction site. The employers are required to pay the bill for such injuries, regardless of who is at fault. Consequently, even if the carelessness of a worker caused an accident, s/he remains eligible for workers' compensation insurance benefits. In exchange for these benefits, however, the injured worker forfeits his/her right to sue his/her employer .
Most employers purchase workers' compensation insurance plans from insurance companies specifically designed to provide benefits for their employees. Most states mandate these plans, with the exception of a small number of jurisdictions that allow larger companies to insure themselves. Smaller companies, however, such as those with just a handful of employees, need not purchase such plans.
The goal of workers' compensation insurance is to facilitate the process of allowing the injured employee to return to work as fast as possible without inflicting unnecessary hardship or loss of business on the employer.
Third Parties and Workers' Compensation Law
While injured employees who accept workers' compensation insurance benefits are not permitted to sue their employers, they are entitled to sue negligent third parties who are responsible for their injuries, directly or indirectly. For example, if an employee faces an injury on the job when climbing a ladder that suddenly snaps AND s/he accepts workers' compensation damages, s/he cannot sue her/his company. Yet, s/he can file a claim against the manufacturer of the ladder. However, if the employee files a personal injury lawsuit and wins her/his case, s/he is required to reimburse her/his employer for all costs out of her/his settlement . Further, the employer has the right to sue the third party in order to recover some of the funds that the third party paid the injured worker.
On-The-Job Injuries: What Qualifies For Workers' Compensation Insurance Benefits?
Typically, when an employee gets hurt in a specific incident, such as a fall, s/he is granted workers' compensation by law. Still, the system is not limited to injuries suffered in accidents; illnesses or injuries caused by participation in traditional, daily work environments or routines, such as repetitive stress injuries from long-term exposure to toxic chemicals, may also qualify one for benefits.
Workers' compensation only occasionally covers mental or emotional illnesses, since these cases are more difficult to prove. As a result, most employees who suffer from job stress or job-related depression cannot rely on benefits from workers' compensation. However, an employee may be eligible for workers' compensation by law if s/he witnesses or experiences a traumatic event on the job that leads to mental or emotional problems. For example, a cashier who is robbed at gunpoint may be entitled to workers' compensation insurance benefits if s/he needs psychological treatment, counseling, or personal injury treatment after the event.
Assessing Risk When Determining Workers' Compensation Insurance Eligibility
To determine eligibility, an employee must prove that her/his on-the-job injury occurred while s/he was working or resulted from the nature or responsibilities of the job. S/he also must demonstrate that the nature of the job and/or the work environment augmented the risk of injury. Such risk generally falls into one of the following categories:
Risk Directly Linked To Employment
A factory worker who lodges his hand in a machine would not have suffered the injury had he not been at work. This, presumably, qualifies him for workers' compensation insurance benefits.
An employee who develops adult-onset diabetes after years of smoking, neglecting to exercise, and choosing a poor diet would not be eligible for benefits; the risks and injury are personal, not work-related, unless proven otherwise with substantial evidence.
These cases prove the most difficult because the contributing factors are either mixed or unclear . Examples include a lifeguard who develops heatstroke while on the job, a teacher assaulted by a parent after school, or a person injured at work during an earthquake or other natural disaster.
Once increased risk has been proven, the employee must demonstrate that the injury took place during the course of employment. However, the injury does not necessarily have to occur during normal work hours to merit workers' compensation.
Workers' Compensation Laws and Exemptions
Some types of on-the-job injuries may not merit workers' compensation insurance benefits. These include:
* Self-inflicted injuries (such as those incurred in a fight between two employees)
* Injuries incurred while an employee is breaking the law (i.e. a delivery worker robbing a receptionist at one of his sites)
* Injuries incurred while the employee is not working
* Injuries incurred while the employee is violating company policy
In addition, some workers are excluded from receiving workers' compensation insurance benefits. These workers include:
- Shop owners
- Farm workers
- Railroad employees
- Maritime workers
- Independent contractors
- Federal government workers
- Standard employees in nearly one-third of all U.S. states
To determine whether or not you are eligible for workers' compensation, we advise you to speak to your employer and then consult with one of our personal injury attorney's who specializes in workers' compensation laws.
Workers' Compensation Insurance Benefits
If you have been injured on the job, you may be eligible to receive compensation to cover the following:
* Medical costs
* Up to two-thirds of your pre-injury salary, tax-free
* Expenses, should you not be able to resume your pre-injury job duties
* Vocational rehabilitation (job training, placement assistance)
Need Medical Treatment? Choosing Between Your Own Doctor And The One Provided By Your Employer?
Depending on your state, you may be permitted to see your own doctor due to an on-the-job injury. However, you MUST submit a written statement requesting this right prior to the injury, or it is likely that you will forfeit your right to choose your physician. In most jurisdictions, the employer chooses the doctor who examines the employee.
When you visit this doctor, honestly describe your injury and its impact on your life, and thoroughly discuss your medical history . Otherwise, you may negatively affect your chance to receive the workers' compensation to which your injury entitles you.
Iannella & Mummolo Workers' Compensation Attorney
It is in your best interest to hire a personal injury attorney who specializes in workers' compensation law if you are permanently injured or your claim has been denied. In either case, be sure to save all documents, including your doctor's report, and perhaps even seek a second opinion. Please feel free to call us toll free at 1-800-369-5300 or take our Free Online Evaluation