Even when on-the-job safety is highly prioritized, injuries can happen. If you’re not sure how exactly to proceed from there, this information can help.
You’ve been injured on the job. Now what? Do you hire an attorney? Do you notify somebody? Is your injury compensable, and if so, what benefits are you entitled to? If you don’t know these answers, the following eight questions will help you understand your rights.
1. What is Workers’ Compensation?
Generally, workers' compensation laws mandate compensation if you suffer a job-related injury or illness. To furnish compensation, your employer, with some exceptions, is legally obligated to purchase insurance from a workers' compensation insurer.
2. Which Workers’ Compensation Laws Apply?
Federal employees receive workers’ compensation benefits under the Federal Employees Compensation Act. Non-federal employees are covered by state workers’ compensation laws, which differ from state to state. Contact your state's workers' compensation office for up-to-date information on your state’s laws.
3. Is My Employer Exempt from Workers’ Compensation Coverage?
Many states require workers’ compensation coverage from all employers. However, limited exemptions might exist based on industry type, entity type, business size and/or employment type. Your employer might be exempt if:
- you’re a sole proprietor or a partner in a business;
- your employer runs a small business (e.g., less than five employees);
- you’re employed as an independent contractor, freelancer or consultant; or
- you’re a domestic, religious or farm worker.
4. Did I Suffer a Compensable Injury?
You risk your rights if you can’t recognize an injury. You need to think beyond broken bones and lacerations. You may be entitled to compensation if you’ve suffered a:
- Specific injury: Your injury results from a specific work-related event or incident that occurs suddenly at a specific time and place (also known as a traumatic injury);
- Cumulative injury: Your injury results from repetitive work-related activities over time (also known as occupational, continuous trauma or repetitive trauma injuries);
- Aggravated injury: Your on-the-job injury aggravates a pre-existing injury or condition. The rationale behind this is the "but for" rule: But for your job activities, your pre-existing condition would not have been made worse;
- Illness: Your job creates a risk for contracting a disease or illness (e.g., black lung disease for coal miners or mesothelioma caused by asbestos exposure);
- Mental/physical injury: Your physical injury is caused by a psychological or psychiatric condition (e.g., excessive work-related stress causes a heart attack);
- Physical/mental injury: Your physical injury results in a mental injury (e.g., a work-related injury necessitates psychological counseling); or
- Mental/mental injury: Your depression or anxiety is caused by work-related stress. These are very difficult to prove and are often denied.
5. Is My Injury Covered?
To receive workers’ compensation benefits, your injury or illness must be work-related. This means it must occur in the course of employment. Obvious work-related injuries are those that occur while performing work for your employer. Not-so-obvious work-related injuries may occur during business travel, work-related errands or mandated business/social functions.
If your injury is work-related, fault or negligence – yours, your employer’s, a co-worker’s, or a customer’s – generally will not prevent compensation. Thus, workers’ compensation is known as a “no-fault system.” If you trip over your own feet and injure yourself, you’re still guaranteed benefits. However, you could forfeit your benefits if your injury is:
- crime-related; or
- traceable to a violation of company policy.
6. What Benefits Am I Entitled To?
If injured, you’re entitled to see the doctor of your choice (sometimes with limitations) if you live in an “employee-choice” state. In other states, an employer or its insurance carrier has the right to choose your doctor.
You’re also entitled to certain payments under workers’ compensation law. Workers’ compensation will generally pay for:
- medical expenses, including medical bills, prescriptions and transportation costs;
- indemnity (lost income) benefits, including temporary/permanent disability benefits and total/partial disability benefits (“disability” is sometimes referred to as “incapacity”);
- rehabilitation or retraining;
- death/survivor benefits, including burial expenses and lost family income.
One thing you’re not entitled to is compensation for pain and suffering. As a trade-off for the no-fault system, you lose the right to sue your employer, eliminating negligence claims and related damages. However, if your employer’s recklessness or intentional act causes your injury, you may be able sue your employer for damages, including punitive damages, pain and suffering, and mental anguish. There is also the possibility of filing a 3rd party injury claim.
7. What Steps Must I Take to Recover Compensation?
After suffering a work-related injury, you must notify your employer within the specified time limit, anywhere from 30 to 90 days after the accident happened or after you became aware of your work-related injury. Failing to provide timely notice can forfeit your benefits. Also, be aware of any internal deadlines set by your employer. Missing these deadlines won’t forfeit your benefits but could result in reprimand or suspension.
You must also request and complete a workers' compensation claim form and do so before the statute of limitations expires. Once the statute of limitations expires, your claim and any recovery will be barred forever. Note that the limitations period may be shorter (e.g., one year) or longer (e.g., four years) depending on your state. Also, the limitations period may be affected by your claim type or a delay in your injury’s symptoms/manifestation.
One thing you must never do is file a false workers’ compensation claim or exaggerate your injuries. If you do, you’re committing fraud and could suffer criminal punishment.
8. Should I Hire an Attorney?
Hiring an experienced attorney is often necessary to protect your workers’ compensation rights. An attorney can also help you win a larger workers' compensation award. While it’s always a good idea to hire an attorney, it’s critical that you hire one if:
- your claim is disputed;
- your benefits are delayed;
- the insurance company denies necessary benefits;
- your employer's settlement offer undervalues lost wages and/or medical bills;
- your employer retaliates by firing, demoting or disciplining you; or
- another employer refuses to hire you because of a past claim.
Contact Scott Kessler for more information on the workers’ compensation laws in your state.