If you are injured on the job, you may be entitled to Worker’s Compensation. It’s that simple. You don’t have to prove that someone was negligent, or that the accident was preventable, or that it was someone’s fault. Generally, you will need to show 3 things:
- There was an accident
- It was “on the job”
- You were injured as a result
Although it might seem self-explanatory, there are a few issues to consider. As far as accidents are concerned, about all that isn’t covered is an intentional act on the part of the injured person. Also, we don’t generally think of occupational illnesses as being caused by “accidents”, they can be covered also.
Carpal tunnel syndrome caused by repetitive-stress conditions such as working an optical scanner is a common example, but a heart attack can, under the right circumstances, may be covered as well, even though factors outside of the job may have contributed to the condition.
Whether an event is in the course of employment can be contested. Factors that can be looked at include the location of the accident, the job duties of the individual, what the person was doing at the time of the accident and whether the person was “on the clock”.
As to the injuries, one must show that there was an injury and that it was caused by the accident. For example, orthopedic injuries are very often accompanied by chronic conditions. You might have bulging discs in your back and never know it. Then you strain your back, get an MRI and find that you have a bulging disc.
Your employer may not be liable for the disc, but may have to pay for the treatment if the back strain on the job exacerbated that condition to the point where it became painful, thus requiring treatment.
You will need to fill out the paperwork related to your claim and your doctor will need to certify that the treatment is medically necessary and that it is due to the injury received on the job. If the employer and its insurance company do what they are supposed to do, you likely wouldn’t need the assistance of a lawyer.
If you have a valid, covered claim, your medical expenses should be covered as well as two-thirds of your loss of pay. Also, the pay is calculated on the average weekly wage of the 52 weeks before the accident. This can be tricky if you had brief spikes of overtime, seasonal layoffs, or commissioned income.
If you are receiving worker’s comp pay, one problem you could encounter is learning that your loss of pay benefits have been cut off. No hearing, no warning, not even a phone call. Someone in the insurance company decided that you were well enough to return to work, so they terminated your benefits.
Now you have to fight to get them back. You need to know what information was used to make the determination and come up with counter-information. Then there will be a hearing before the Worker’s Compensation Board to determine who is right. Many people in this situation turn to a lawyer to represent them.
Because you received worker’s compensation, you can’t sure your employer and you cannot recover for pain and suffering. This is the trade-off. You don’t have to prove that the employer was negligent, so you are covered even if the employer was not at fault. But, even if you can prove that your employer was at fault, violated safety rules, failed to address repeated accidents or known hazards, you don’t get a dollar more.
However, in some situations, you may be able to recover from a “third party.” For example, you slip and fall because the janitorial company applied the wrong kind of wax. You are covered by worker’s comp but you may be able to sue the janitorial company. The comp carrier will get reimbursed for any money they spent on your, but you can recover for that one-third of income you lost, plus pain and suffering.
If your job requires you to travel and you are injured in a car, you should also be covered by no-fault insurance. You can’t recover twice for one loss, but you can reduce your losses: Worker’s comp covers two-thirds of your loss of income, but no-fault covers 80% so worker’s comp would pay you the first two-thirds, then you can recover the additional 13.33% from no-fault.
Finally, if you have a permanent injury, you may be able to get a “schedule award” which is based on a formula depending on the extent of your disability and your rate of pay, offset by payments you have already received. But, you may want to get some advice as to whether the schedule award is your best option.
Depending on your situation, you may be better off getting disability payments and having your medical expenses taken care of.
The bottom line is: any time you are injured on the job, report it. You may not realize at first how injured you are. You may be entitled to coverage if you need medical attention or are unable to work due to your injuries.
This is your right as an employee and your employer’s legal obligation. But in order to protect your rights, make sure to report accidents and injuries, make sure the correct paperwork is filled out and timely submitted , and that your doctor is supplying the information that the insurance company needs to fulfill its responsibilities.
This article was written by guest blogger, Andrew T. Velonis.