According to the Bureau of Labor Statistics, there were 5,190 fatal work injuries in 2021 and 2.6 million total injury and illness cases related to employment. Those statistics are staggering, and those injured workers are entitled to receive workers’ compensation coverage during their recovery. However, not all employers willingly pay claims, and insurers often deny coverage. Workers are always encouraged to review their rights and take steps to ensure they receive the benefits they’re entitled to.
Understanding the Definition of Workers’ Compensation
Before going further, workers must understand what workers’ compensation is and what it’s meant to accomplish. Workers’ compensation is designed to cover medical expenses, lost wages, and any rehabilitation costs related to a workplace injury. The coverage applies to workers who are injured or become ill while engaged in their work duties. If you’re injured on the job, take advantage of free consultations with a workers compensation lawyer to protect your rights.
What is the Employer’s Responsibility When an Injury Occurs?
Employers are required to assist an injured employee in obtaining appropriate medical attention as quickly as possible. Once medical care is obtained, the employer must provide all the necessary forms needed to file a claim with the workers’ compensation insurer. Once the forms are completed, the employer must submit them within a specified time frame that’s outlined in the state’s labor laws.
What Must an Employee Do Following an Injury?
Every injured employee must follow specific steps after suffering an injury. Doing so is crucial for ensuring their rights are safeguarded during the claim process. While many of the forms are formalities, consulting a workers’ compensation attorney early in the process is always a good idea.
Immediately following a workplace accident, report the incident to a supervisor. Any delay in notifying the supervisor could jeopardize the claim, as the employer or insurer may claim the injury occurred elsewhere. Even if an injury appears minor, take the time to notify the employer or manager on duty that an accident occurred.
Always seek medical attention immediately. In some circumstances, an employer may demand an injured employee fill out paperwork before getting care, but that’s not appropriate if the injury is severe or life-threatening. Remember that injuries that are not reported quickly are more likely to result in a denial of a claim, so never delay notifying an employer following an injury. There is also a statute of limitations involved, which is usually 30 days.
The employee must file the initial claim, which is commonly done using a computer. However, many workers’ compensation experts recommend obtaining legal advice before filling out the claim paperwork. Since the initial consultations are free, ask the attorney how to proceed.
Obtaining Witness Statements
In many instances, substantiating the circumstances surrounding the accident will prove crucial. That means obtaining statements from witnesses is always a good idea. Those statements should be gathered as soon as possible following an accident to ensure the witnesses accurately recall the incident. Again, the workers’ comp attorney will discuss the issue and provide any advice needed.
What Types of Injuries are Not Covered by Workers’ Compensation
While most workplace-related injuries and illnesses are covered by workers’ compensation, some issues are not. Here are a few issues that don’t qualify as being work-related.
Influenza and simple issues like headaches. That may sound logical, but some workers may feel those items are directly related to the workplace and should, therefore, qualify for compensation.
Pre-existing conditions are not covered by workers’ compensation. All pre-existing conditions are specifically excluded from coverage. A worker may argue that a condition was exacerbated by their job duties, but that argument is unlikely to sway the insurer. If you have questions about a specific condition, ask a work comp attorney for clarification.
Injuries resulting from on-the-job fights are not covered by workers’ compensation. However, injuries resulting from an assault would probably be covered. The distinction isn’t always clear, which is another reason the advice of an attorney is recommended anytime there are questions related to coverage.
Self-inflicted injuries are excluded from coverage. Again, these types of situations should be self-explanatory, but they’re not always clearly understood by employees or employers.
Injuries resulting from criminal behavior are not covered. This is another area that shouldn’t need explaining, but questions continue to arise in these types of situations.
Of course, there are many other cases where there are coverage questions. A work comp attorney will review the specific details of each one and provide advice on how to proceed.
What Costs are Covered by Workers’ Compensation?
Having everyone on the same page following an accident is always essential. There are several expenses workers’ compensation covers, and everyone involved must understand them.
First, all medical care expenses are covered. However, the insurance carrier may require injured workers to seek help from specific care providers for treatment. Rehabilitation expenses are also included in the coverage to ensure workers recover to the greatest extent possible.
Next, replacement income is a significant benefit. The coverage here is usually limited to a certain percentage of the injured employee’s income. Any costs for retraining are also included, which means that, if an injured employee cannot return to their old position, they are entitled to retraining for another position.
Finally, benefits are also provided when permanent injuries prevent an employee from working in the future. By the same token, death benefits are due to families of workers killed on the job.
Most Workers are Unable to Sue Employers When Collecting Workers’ Compensation
This issue comes up frequently, as an employee will feel an employer caused their injury. However, workers’ compensation laws restrict the ability of a worker to take such action. If an injured worker feels extenuating circumstances exist, they’re encouraged to contact an attorney to review the information.
Get Help to Resolve Problems with a Work Comp Claim
Although many workers’ compensation claims are resolved without any issues, an uncomfortable number of them result in a denial of coverage or other problems. If you’re injured while on the job, consider working with an attorney throughout the claim process to minimize the odds of issues developing.
