Workers' compensation insurance is a state-mandated benefit system designed to protect employees who are injured on the job, whether from typing on a computer keyboard in an office or from being struck by a falling beam on a construction site. Employers foot the bill for such injuries, regardless of who is at fault. This means that even if a worker was careless and is to blame for his injury, he is still eligible for workers' compensation insurance benefits. In exchange for these benefits, however, the injured worker forfeits his right to sue his employer for damages.
Most employers purchase workers' compensation insurance plans from insurance companies specifically designed to provide workers' compensation insurance benefits. In most states, these are mandatory, with the exception of a few 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 get the injured employee back on his feet and working again as quickly as possible without causing the employer unnecessary hardship or loss of business.
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)
Be aware, however, that such insurance benefits are somewhat limited and will most likely not cover all your expenses.
On-the-job Injuries: What Qualifies for Workers' Compensation Insurance Benefits
Workers' compensation is typically awarded by law when an employee is hurt in a specific incident, such as a slip and fall or other accident. Still, the system is not limited to injuries sustained in accidents. Illnesses or injuries incurred through participation in a normal, daily work environment or routine, such as repetitive stress injuries or problems from long-term exposure to toxic chemicals, may also qualify for benefits.
Mental illness or emotional problems are only occasionally covered, as these are more difficult to prove. As a result, most employees who suffer from job stress or job-related depression cannot usually rely on benefits from workers' compensation for assistance. If, however, an employee witnesses or experiences a traumatic event on the job that subsequently leads to mental or emotional problems, the employee may be eligible for workers' compensation, according to law. For example, a cashier robbed at gunpoint while on duty may be entitled to workers' compensation insurance benefits if he or she needs psychological treatment or counseling or treatment after the event occurs.
Workers' Compensation Laws and Exemptions
In certain cases, workers' compensation insurance can be denied to employees. Review the information below to learn more about workers' compensation laws and exemptions; if you have a case, speak to a workman's comp attorney as soon as possible for a claim evaluation.
On-the-job Injuries Exemptions
Some types of on-the-job injuries may not merit workers' compensation insurance benefits. These include:
- Self-inflicted injuries (such as those incurred if two employees were fighting)
- Injuries incurred while an employee was breaking the law (i.e. a delivery worker robbing a receptionist at one of his sites)
- Injuries incurred while the employee was not working
- Injuries incurred while the employee was violating company policy
In addition, some workers are excluded from receiving workers' compensation insurance benefits. These workers include:
- Farm workers
- Railroad employees
- Maritime workers
- Independent contractors
- Federal government workers
- Standard employees in nearly one-third of all U.S. states
To verify whether or not you are eligible for workers' compensation, speak to your employer AND consult one of the personal injury attorneys in your area who specializes in workers' compensation laws.
Receiving Medical Treatment: Deciding Between Your Own Doctor and the One Provided by Your Employer
Depending on your state, you may be permitted to see your own doctor if you suffer an on-the-job injury. However, you MUST submit a written statement requesting this before you are injured, or you may forfeit your right to choose your physician. In most jurisdictions, your employer will choose the doctor who will examine you.
When you visit this doctor, be sure to 1) be honest about your injury and its impact on your life, 2) be thorough when discussing your medical history. If you fail to be truthful, you may seriously affect your chances of winning the workers' compensation to which your injury entitles you.
Workers' Compensation Insurance Eligibility – Assessing Risk
To determine eligibility for workers' compensation benefits, an employee must prove that his on-the-job injury 1) occurred while working or 2) stemmed from the nature or responsibilities of the job. He must also demonstrate that the risk of injury was augmented by being at work and by performing job duties. Such risk generally falls into one of the following categories:
Risk Directly Linked to Employment
A factory worker injured after his hand was lodged in a machine would not have sustained the injury had he not been at work - his job was the only reason his hands were near the machine. This, presumably, qualifies him for workers' compensation insurance benefits.
An employee who developed adult-onset diabetes after years of smoking, neglecting to exercise, and choosing a poor diet would not be eligible for benefits, because the risks and injury were personal rather than work-related - unless the employee can prove otherwise.
These cases are the most difficult, because the contributing factors are either mixed or unclear. Examples include a lifeguard who developed heatstroke while on the job, a teacher assaulted by a parent after school, and a person injured at work during an earthquake or other natural disaster.
Once increased risk has been proven, the employee must demonstrate that the job injury took place during the course of employment - meaning not only that she was employed by the company at the time of injury, but also that the injury was connected to employment. The injury does not necessarily have to occur during normal work hours to merit workers' compensation.
Third Parties and Workers' Compensation Law
While injured employees who accept workers' compensation insurance benefits aren't permitted to sue their employers, they may still sue negligent third parties who are directly or indirectly responsible for their injuries. For example, if an employee was injured on the job when the ladder he was climbing suddenly snapped AND the employee accepted workers' compensation damages, the employee could not sue his company, but he could file a claim against the manufacturer of the ladder.
But there is a catch: if the employee were to file a personal injury lawsuit and win his case, he would be required to reimburse his employer for all costs out of his settlement. Further, the employer, too, could sue the third party to recover some of the funds it paid out to its injured worker.
Finding an Experienced Workers' Compensation Lawyer
It is in your best interest to hire a personal injury attorney who specializes in workers' compensation law if 1) you are permanently injured or 2) your claim has been denied. If either of these occurs, be sure to save all documents - including your doctor's report - and maybe even get a second opinion.
Next, enlist the help of a qualified workers' compensation lawyer in your area. A personal injury attorney can help you understand how to file an appeal and to ultimately win the workers' compensation insurance benefits to which you are rightfully entitled, as well as help you get past the red tape that often comes along with these lawsuits.
Find an attorney who specializes in workers' compensation law in your area.