Workers' Compensation: FAQs
This information comes from our friends at Nolo Press. For more information or to order this book, visit Nolo's site at http://www.nolo.com.If you are injured on the job--or suffer a work-related illness or disease that prevents you from working--you are eligible to receive benefits from your state workers' compensation program. You are also entitled to free medical care. If your disability is classified as permanent or results in death, additional benefits are available to you and your family.
Who pays workers' compensation benefits?
In most states, employers purchase insurance for their employees from a workers' compensation insurance company--also called an "insurance carrier." In some states, larger employers who are clearly solvent are allowed to self-insure (act as their own insurance company). When a worker is injured, his or her claim is filed with the insurance company--or self-insuring employer--who pays medical and disability benefits according to a state-approved formula.Are all on-the-job injuries covered by workers' compensation?
Most are. The workers' compensation system is designed to provide benefits to injured workers no matter whether an injury is caused by the employer's or employee's negligence. But there are some limits. Generally, injuries caused as a result of an employee being intoxicated or using illegal drugs are not covered by workers' compensation. Coverage may also be denied in situations involving:- self-inflicted injuries (including those caused by a person who starts a fight)
- injuries suffered while a worker was committing a serious crime
- injuries suffered while an employee was not on the job, and
- injuries suffered when an employee's conduct violated company policy.
How do I claim workers' compensation benefits?
First, promptly report the work-related injury or sickness to your employer. Most states require that this be done within two to 20 days following an injury. If an injury occurs over time (for example, a breathing problem or carpel tunnel syndrome), you must report your condition soon after you discover it.Next, get the medical treatment you need and follow the doctor's instructions exactly. This may include an "off work order" or a "limited duties work order." Finally, file a claim with your workers' compensation carrier. Necessary forms must be provided by your employer. Ask someone in the personnel or benefits department.
Can I be treated by my own doctor and, if not, can I trust a doctor provided by my employer?
In some states, you have a right to see your own doctor if you make this request in writing before the injury occurs. More typically, however, injured workers are referred to a doctor or health plan recruited and paid for by their employer.Your doctor's report will have a big impact upon how you are treated. While it's crucial that you tell the doctor the truth about both your injury and your medical history (your benefits may be denied based on fraud if you don't), be sure to clearly identify all possible job-related medical problems and sources of pain. In short, this is no time to downplay or gloss over the presence of a pain.
Keep in mind that a doctor paid for by your employer's insurance company is not your friend. The desire to get future business may motivate a doctor to minimize the seriousness of your injury or to identify it as a pre-existing condition. For example, if you injure your back and the doctor asks you if you have ever had back problems before, it would be unwise to treat the doctor to a 20-year history of every time you suffered a minor pain or ache. Just say "no" unless you really have suffered a significant previous injury or chronic condition.
If I am initially treated by an insurance company doctor, do I have a right to see my own doctor at some point?
State workers' compensation systems establish technical and often tricky rules in this area. Often, you have the right to ask for another doctor at the insurance company's expense if you clearly state you don't like the one the insurance company provides, although there is sometimes a waiting period before you can get a second doctor. Also, if your injury is serious, you usually have the right to a second opinion. And in some states, after you are treated by an insurance company's doctor for a certain period (90 days is typical), you may have the automatic right to transfer your treatment to your own doctor or health plan with the cost being paid for by the workers' comp insurance company.To understand your rights, get a copy of your state's rules or, if necessary, research your state workers' compensation laws and regulations in the law library.
How do I find a good workers' compensation lawyer--and how much will it cost?
You usually don't need a lawyer unless all or part of your workers' compensation claim is denied. If this occurs you'll probably want to do some research to familiarize yourself with your rights and duties. For example, many claims are denied based on a doctor's report claiming that you are not injured. If you dispute this, you may have a right to obtain a second doctor's opinion paid for by the worker's comp insurer.After you know the lay of the land, consider hiring an experienced workers' compensation lawyer to help you navigate the appeals process. The best way to find a good lawyer is often through word of mouth--talk with other injured workers or check with a local union or other workers' organization.
In most states, fees for legal representation in workers' compensation cases are limited to between 10%-15% of any eventual award. Because these fees are relatively modest, workers' compensation lawyers customarily take on many clients and, as a result, do not have time to provide much individual attention. Most of your contacts with your attorney's office will be with paralegals and other support personnel. This is not a bad thing in itself, if the office is well run by support staff. Be sure the office is able to stay on top of paperwork and filing deadlines, and that a knowledgeable person is available to answer your questions clearly and promptly.
If I receive workers' compensation, can I also sue my employer in court?
Generally, no. The workers' compensation system was established as part of a legal trade-off. In exchange for giving up the right to sue an employer in court, you get workers' compensation benefits no matter who was at fault. Before the workers' comp system was passed, if you went to court, you stood to recover a large amount of money, but only if you could prove the injury was caused by your employer.Today, you may be able to sue in court if your injury was caused by someone other than your employer (a visitor or outside contractor, for example) or if it was caused by a defective product (such as a flaw in the construction of the equipment you were working with).
