Do I Have a Workers' Comp Case?
Heavy lifting, hazardous chemicals or an unexpected fall can cause a job site injury. Whatever the cause, getting hurt at work is a hardship.
If you're unable to work or have medical bills due to an incident at your job, you may qualify for workers' compensation.
Workers' compensation — often called workers' comp — is a government-mandated program that helps people who are injured while performing their job. The program provides coverage for lost wages and medical expenses.
The program is somewhat similar to disability insurance. However, employees don't pay the premiums, and unlike taxes and health insurance, workers' comp isn't taken out of pay as a deduction. Instead, the employer must carry workers' compensation insurance according to state requirements. Employers who fail to meet these requirements may face legal penalties.
Individual states mostly manage workers' comp programs, so benefits and rules vary by state. A successful workers' comp claim usually requires that:
- You're an employee. Independent contractors usually can't get workers' comp.
- You have a work-related injury or illness. Your injury must be due to work. The injury can be due to a single accident or a long-term activity, such as injuries from heavy lifting or exposure to chemicals.
- Your employer must carry workers' compensation. Many states require employers with even one employee to carry workers' comp, but other states only impose the requirement for businesses with more employees. Some states exempt homeowners with part-time domestic employees.
- You must meet legal requirements for filing a claim. You'll need to meet state filing deadlines and other conditions.
You can check with your state's department of labor or a local workers' compensation lawyer to learn about requirements in your state.
Speaking with a workers' compensation lawyer is usually a good idea. Workers' comp claims are sometimes complicated and can have long-term legal and financial consequences.
Once you accept a workers' comp settlement, you lose your right to sue for additional funds later. For example, if your employer's negligence led to the injury, you won't be able to file a lawsuit after you accept a workers' comp claim. Workers' comp claims can be further complicated if you have preexisting medical conditions.
Lawyers usually take workers' comp cases on a contingency basis, which means they take a percentage of awarded benefits, rather than requiring upfront payments. Contingency payment plans make it easier for people to hire a lawyer and mean you won't owe anything if the lawyer doesn't get money for you.
There are a few situations where you might not need a lawyer for your workers' comp claim. Hiring a lawyer may not be worthwhile if your injury is minor and you don't need to miss much work. Additionally, if your employer admits the injury is work-related, you may be able to get by without a lawyer. However, workers' comp settlements are final, and unexpected future complications can be problematic. You'll also still need to meet filing deadlines and documentation requirements. A workers' compensation attorney can help you understand your rights and ensure you get adequate compensation.
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Employers deny claims for several reasons. The insurer may deny your claim if the injury was caused by horseplay, alcohol consumption or because you failed to follow company rules.
Injuries that happen while you aren't at work aren't covered, including those that occur during a regular commute. Sometimes insurers question whether an injury is due to a preexisting condition. For example, an insurer may believe your back pain is due to an old injury or incident outside of work. The severity of injuries is sometimes called into question as well.
If you feel your employer has wrongfully denied your claim or offered an unfair settlement, you can appeal their decision. The appeal usually involves an administrative hearing similar to a trial. Legal paperwork and administrative procedures can be complex, so it's best to get legal advice if your claim is denied. In some cases, you may have the option of filing a personal injury claim or another lawsuit against your employer in court.
Some states allow workers' compensation claims to be made by employees who have experienced sexual harassment. In these states, workers who experience harassment may be compensated for therapy, doctor's visits and lost wages due to missed work. However, not every state requires workers' compensation coverage for sexual harassment. Check your state's requirements or speak to an attorney before filing one of these claims.
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