Workers’ Compensation Attorneys
In most states, workers’ compensation insurance can cover workers who suffer injuries and workplace-related illnesses. Workers’ comp pays medical bills related to injuries and illnesses received on the job, and it pays a portion of the affected workers’ salary.
If you were hurt or made ill on the job, it’s smart to contact an experienced workers’ compensation attorney. While workers’ comp can help you and your family recover from a workplace injury, it is, frankly, not an easy system to navigate. Each state has a different system of obtaining benefits and a separate appeal system if benefits are denied. The seasoned attorneys at Jacoby & Meyers, LLP, can help you negotiate and maximize your compensation. Reach out to us today for a free case evaluation.
What Is Workers’ Compensation?
Workplaces throughout the United States can be dangerous places. In fact, according to Safety + Health, 4,414 workers were fatally injured in workplaces in the last year for which statistics are available, and nearly 86,000 workers are injured every week nationwide. An arm of the U.S. Department of Labor, the Occupational Safety and Health Administration, is tasked with seeing that workplaces and employers follow safety requirements.
Workplace injuries on the job and workplace-related illnesses can happen anywhere and anytime. Construction workers may tumble from high buildings because they lack proper safety harnesses. Maintenance workers can be electrocuted or caught in moving machinery. Office workers can develop repetitive stress injuries. Workers whose jobs require driving automobiles or other vehicles can get into accidents. Furthermore, workplace sites can have toxic mold or even asbestos.
Workers’ compensation (often abbreviated as workers’ comp) is a form of insurance, paid by employers. When workers are injured on the job or become ill specifically due to workplace tasks or conditions, the workers can file a claim for workers’ comp benefits. The advantage to both employers and workers is that the workers’ comp system does not require either side to show fault. In other words, employees don’t have to show that the employer was at fault, and employers don’t have to show that employees were at fault.
Most employers throughout the country are required to pay for workers’ comp insurance; they can be severely penalized in most states if they don’t.
However, while workers’ comp is available in most states, it is a very complicated system. Each state is entitled to set its own specific rules, regulations, laws, benefit amounts, coverage stipulations, and more. There is no national, one-size-fits-all workers’ comp system. The process is set by individual states.
Moreover, there are situations where you may work in one state and live in another, and, of course, it’s equally possible to live in one state, live in another, and be injured on work-related business in yet a third state. In some cases, you may have your choice of which state to file a workers’ comp claim in if this scenario applies to you, but this, too, may depend on the state and its specific requirements.
“I had an amazing experience with Jacoby & Meyers, LLP. I would highly recommend them for anyone needing a law firm.” -Paul T.
As a result, if you have been injured on the job or suffer from a work-related illness, you should make sure you understand the procedures and requirements in your state. It is essential to know the facts and the proper filing jurisdiction, or your workers’ comp may result in denial.
Consulting an attorney with local offices but national reach, like Jacoby and Meyers, LLP, can help you understand the specifics of your state’s workers’ comp system.
What Does Workers’ Comp Cover?
Because workers’ comp is set up individually by each state, you will need to consult the state’s workers’ comp authority and/or an attorney to determine the coverage for your state. That said, some general observations apply to most workers’ comp coverage.
First of all, most workers’ comp systems are designed to cover all medical bills that arise from job-related injury or illness. This includes doctor’s bills, hospitalizations, urgent care treatment, prescription medication, physical therapy, and more. Many systems will also compensate the injured person for transportation to and from medical treatment. Some states may also require that insurers pay benefits for mental illness treatment, either directly related to the job or as a result of illness or injuries suffered on the job.
Additionally, most workers’ comp systems will pay a portion of the injured person’s average wages as wage replacement. About two-thirds of the average weekly wages is a common amount, but states vary. Most have caps on the maximum weekly wage replacement benefit that workers’ comp must pay.
If a worker has died as a result of job-related injuries or illnesses, some workers’ comp systems will pay survivor’s benefits. What individuals are eligible to file as survivors varies by state; the surviving spouse and children are usually eligible, and some states allow other family members and dependents, such as parents and siblings. Finally, payment of funeral or burial expenses via workers’ comp benefits is done in some jurisdictions, but the amount varies by state.
What if the Injury or Illness Has Curtailed or Ended Your Ability to Work?
Some workers’ comp systems will also pay benefits to workers who are either injured too severely to ever return to work or injured severely enough that they cannot return to their previous occupation, although they may be able to work.
In many states, a doctor must evaluate an injured worker’s condition after medical treatment. If the worker has attained maximum medical improvement (that is, is highly unlikely that the person will get better, even with continued treatment), the doctor must then usually assign a percentage of disability, ranging from 0 percent to 100 percent.
Workers’ comp systems vary when permanent full or permanent partial disability is assigned. Some continue to pay benefits for full disability; others will pay benefits over a certain period of time. For partial disability, some workers’ comp systems continue to pay benefits, while others factor in the amount of disability and multiply it by the percentage of disability. It’s very important to know the rules and amounts for your specific state.
Some states pay weekly benefits or lump sums to workers who have lost substantial body parts or the use of them. Others pay weekly benefits or lump sums to workers whose injuries have scarred or disfigured them, as such injuries have the potential to reduce their earnings capacity. Some will require or pay for vocational retraining if a worker can no longer work in a former capacity as a result of their injury or illness.
How Does a Worker Obtain Workers’ Compensation Benefits?
Workers must understand that each state has a specific set of procedures to obtain workers’ comp benefits. Failure to follow these procedures can either delay workers’ comp benefits or result in claim denial.
People seeking workers’ comp benefits also need to stay on top of all deadlines. Almost all states require that claimants complete all of the steps needed to receive workers’ comp benefits within specific time frames. Failure to do so may result in losing benefits.
Below we discuss steps that generally apply:
See a Doctor
A person injured at work needs to see a doctor. If you are ill as a result of your workplace, see a doctor when you first become aware of symptoms. Some workers’ comp authorities require that employees choose all healthcare providers from a list authorized by the employer or insurance carrier, while others let employees choose. It is very important to know the requirements in your state.
In most cases, your doctor or healthcare provider will need to file a specific form for your injury or illness to fall under workers’ comp. Let your doctor know that this is a workplace-related incident. Keep all paperwork and recommendations (as well as bills) related to your treatment.
Notify Your Employer, Its Insurance Carrier, or Both
In most cases, an injured worker needs to notify his or her employer, its insurance carrier, or both, of the worker’s injury or illness. Some workers’ comp authorities mandate that this notification is in writing. You need to check if this is the case. You also need to ascertain what information is required, and all of the important deadlines. You should do all of this as soon as possible.
File Your Claim
In some states, the notification to the employer or insurance carrier alerts them of your intent to file a specific workers’ comp claim. In other states, though, the worker must file a claim. Claims are often filed using a specific form, but in some states, a letter or online filing is acceptable. Your workers’ comp lawyer can prepare this claim for you, or help you fill it out.
Review of Your Claim
After you file your claim, the workers’ comp insurer will investigate it, based both on your notification and the doctor’s filing of a relevant form. After a certain period of time (which also varies by state), the insurer should notify you of approval or denial (or dispute) over your claim. If the carrier approves your claim, you should start to receive benefit checks from your state’s workers’ comp authority.
Appeal a Denial
If the workers’ comp policy disputes or denies you claim, you generally have appeal rights. The appeal process may involve a judge who works for the state’s workers’ comp authority or a panel. You may have to testify, present evidence, and introduce expert testimony. Some states have an appeal procedure that allows you to appeal to the state appellate court; others do not. Your state workers’ comp authority and an attorney will both have specific information about state requirements to appeal.
Why Does Workers’ Comp Deny Claims?
Claims are denied for a variety of reasons. The insurance company may dispute that your injury or illness is work-related. It may agree that the injury or illness occurred at work, but cite your specific behavior at work rather than the overall workplace conditions (such as alleging failure to wear available safety equipment).
Some denials occur if you left the job, quit, or were terminated. (Some states have rules concerning whether employees who quit can file workers’ comp claims.) Other denials may occur because you failed to file your claim within the legal deadline. Finally, some states may rule out specific conditions, such as psychological stress, from qualifying for workers’ comp benefits.
What Injuries and Illnesses Does Workers’ Comp Cover?
Almost every type of injury and illness imaginable can occur in the workplace and on work-related travel. The following can occur as a result of injuries or illness:
- Soft tissue injuries
- Back injuries
- Knee injuries
- Neck injuries
- Torn ligaments and tendons
- Fractured bones
- Traumatic brain injuries (TBIs)
- Spinal cord injuries
- Loss of limb(s)
- Loss of vision
- Loss of hearing
- Internal injuries
- Repetitive stress injuries
- Carpal tunnel syndrome
- Illnesses from exposure to toxic chemicals
- Illnesses from exposure to toxic mold
- Mental illness
- Post-traumatic stress disorder (PTSD)
- Black lung disease
- Chronic obstructive pulmonary disease (COPD)
Does Workers’ Compensation Cover Pain and Suffering?
While no one would deny that injuries and illnesses stemming from work conditions are painful and cause suffering, workers’ comp was never designed to pay for pain and suffering. In fact, pain and suffering is a term usually associated with civil litigation and personal injury lawsuits. Workers’ comp was in part designed to avoid lawsuits, by establishing a system of no-fault for occupational injuries and illnesses.
Knowing that, can you bring a personal injury claim to compensate you for pain and suffering in addition to workers’ comp? Here, too, states vary. It is unlikely that a state will allow you to bring a personal injury suit against your employer if you are receiving workers’ comp. However, in some instances, you may bring a suit in a work-related injury. If you are working on a construction site, for example, and a contractor, a building’s owner, or another firm has created unsafe conditions that end up specifically causing your injury, you may sue them, because they are not your employer. In situations like this, consult a workers’ comp attorney.
Contact Our Workers’ Compensation Attorneys
Jacoby and Meyers, LLP, is a nationwide firm with local offices designed to serve your city and neighborhood. We have successfully practiced for more than four decades. We also have a sister firm with 50 years of experience in winning Social Security disability and workers’ compensation claims for injured workers. Find out more about how they can help us help you at https://www.foalaw.com/.
For a complimentary evaluation of your case, you can chat with a live representative, call us today at (877) 565-2993, or you can email us through our contact page. We look forward to helping you.