Workers' compensation law is designed to protect employees from financial and health losses arising from injuries or illnesses incurred while going about their normal working duties. These laws and the insurance they require most businesses to carry are designed to ensure employees receive medical attention and compensation for injuries sustained on the job, within certain limits. While workers' compensation claims may vary from state to state, nearly every state has some version of the same basic laws. A workers' compensation lawyer will often help a client to file their initial claim. If a request for benefits is denied, then an attorney may help a client to fight for their rights to those benefits.
How does workers' compensation work?
Workers' compensation insurance is mandatory in most states, for most classes of regular hourly wage or salaried employees. Many states exempt employers that have under a specified number of employees. The employer pays for this insurance directly and is normally prohibited from requiring the employee to pay any or all the cost of the coverage. Like most other types of insurance, benefits are paid out when a valid claim is filed and the criteria under state law are met.
Workers' compensation claims
In most states, the laws are intended to streamline the process for filing workers' compensation claims. However, these claims must pass certain tests that vary depending upon the state, jurisdiction and type of work. Some of the more common tests for whether a claim is valid include:
- The presence or absence of drugs or alcohol in the employee's body at the time of the accident
- Whether the employee violated company safety policies and procedures
- Whether the injured party was a company employee at the time of the incident
- Whether the injury or illness occurred on the job
The employer's duty to provide workers' compensation insurance also extends to providing proper safety training, equipment and information where appropriate, and the employee's duty to follow and use this training are generally also considered key elements in whether a claim is accepted or denied.
What does workers' compensation cover?
Workers' compensation insurance benefits normally cover medical costs and a percentage of lost wages arising from the injury or illness, on a tax-free basis. Benefits may be limited to a specific amount of time, or they may be enhanced if the employee requires more comprehensive services such as occupational rehabilitation or training for another position due to the injury or illness preventing them from resuming their normal duties. Coverage, claim requirements and filing windows vary by state.
What doesn't workers' compensation cover?
Among other things, workers' compensation typically does not cover:
- Injuries sustained off company time or premises
- Injuries or illness arising from drug or alcohol consumption on company time or premises
- Injury or maladies sustained as a result of an employee's disregard for safety procedures and best practices
- Pain and suffering arising from the illness or injury
Also, certain classes of workers may not be covered under workers' compensation law in a given state, including:
- Maritime workers
- Independent contractors
- Business owners
Can an injured worker sue the employer?
Most states do allow a mechanism for a lawsuit against the employer by an injured employee, but the worker generally cannot claim workers' compensation benefits if legal action is taken as a direct result of the injury. However, in some cases, a workers' compensation lawyer may be engaged to assist the worker in claiming benefits that were improperly or arbitrarily denied. If workers' compensation is accepted, benefits do not cover pain and suffering, while in litigation, there is the possibility of awards for punitive and other damages beyond the immediate medical and financial losses.
When do you need an attorney?
If the employer or insurance carrier improperly denies a claim, or if benefits are not disbursed to an employee as state law directs, a workers' compensation attorney may be able to assist in obtaining the employee's rightful benefits under the appropriate state law. Workers' compensation law is a particularly complex and challenging field, but an experienced attorney can properly evaluate the particulars of a specific case.
The information on this page is meant to provide a general overview of the law. The laws in your state and/or city may deviate significantly from those described here. If you have specific questions related to your situation you should speak with a local attorney.
Additional Workers' Compensation Articles
- Workplace Injuries do not Discriminate Between Legals and Illegals
- Obesity as a Work-Related Injury Covered by Workers' Compensation
- If my employee was injured because he/she didn't follow instructions for performing the job correctly, can I deny workers compensation?
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State Workers' Compensation Articles
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