What Is Workers' Compensation Law?

Workers' compensation is an insurance program required by the state that provides compensation to employees who suffer job-related injuries and illnesses. Workers' Compensation Law is generally designed to assure the quick and efficient delivery of disability and medical benefits to an injured worker and to facilitate the worker's return to gainful reemployment at a reasonable cost to the employer. The law is designed to ensure the prompt delivery of benefits to the injured worker.

Workers' Compensation: The Basics

Employers in any industry (besides construction) with four or more employees-either full-time or part-time-must have workers' compensation coverage.

In the construction industry, if the employer has one or more employees (including himself or herself), the employer must obtain workers' compensation coverage. If the employer is a state or local government, it is required to carry workers' compensation coverage. If the employer is a farmer and employs more than five regular workers and/or 12 or other workers for seasonal agricultural labor of 30 days or more, the employer must carry workers' compensation coverage.

Work-Related Injury
At the center of a workers' comp claim is a work-related injury or illness. This occurred when the employee was at work or conducting business for the employer. While the majority of work-related injuries and illnesses occur at the workplace, there are also some that happen in company-owned vehicles or in locations off-site.
Provided the employee was engaged in activities connected to his or her job, it will be designated as "work-related."

Common Workers Compensation Injuries
Claims for workers' comp can be for many types of injuries. Here are some of the most common ones.

Overexertion can occur when an employee sustains an injury from lifting, pulling, pushing, or throwing an object. The employee lifts a weight and pulls a muscle, stretches a ligament, or ruptures a tendon. While one might think that this happens exclusively in factory or construction work, any task is susceptible to overexertion where physical labor or effort is required.
 
As one would expect, many slip, trip, and fall claims stem from employees slipping on wet floors at their workplace. Likewise, falls are common in every type of work environment. Employees can sustain serious injuries when they fall off of a ladder or down a flight of stairs. A bodily reaction injury happens when an employee trips or slips, tries to keep from falling, but yet is injured. This can be a muscle pull or sprained ankle.

Injuries occur at work when an employee is struck by an object. A book or a toolbox falls off of a shelf and hits an employee. Similarly, claims arise from injuries that are caused by an employee striking an object. This happens when an employee falls into a hazard or is physically forced into a stationary object.  

Mishaps on the roadways is another common cause of work injuries. This is particularly true for truck drivers, where one of the primary causes of injury is having an accident while driving for business. It is also common for those who travel for business, as well as those in law enforcement. Machinery accidents usually involve large, heavy machinery that has caused an injury to an employee's hand or foot in a factory or at a construction site.  

Repetitive motion injuries are also common, and are caused when employees do the same physical motions over and over, such as making the same movements on an assembly line. Tendonitis, carpal tunnel, and bursitis are some of the injuries sustained when employees make claims involving repetitive motions.

Finally, workplace violence is a common injury. Unfortunately, in addition to work-related accidents, intentional acts occur in offices, manufacturing plants, and other work locations which can result in injuries to many employees.

The Workers' Comp Claim Process

Report the Injury and Make a Claim
When an employee is injured or falls ill on the job, he or she should immediately report this to their supervisor. The employee must do so within 30 days from the date the accident occurs or within 30 days of the date when the physician determines that the employee is suffering from a work-related injury.

The employee's workers' comp claim may be denied if he or she does not report their injury or illness within 30 days. The
employer should have the workers' compensation insurance information posted in the workplace. If they do, the employee should contact the insurance carrier and report the claim. If this information is not available, the employee can contact the state government office for assistance.

Insurance
The employer must report the employee's injury to the insurance company by law within seven days of when the employee reported the illness or injury to the employer.

After the injury is reported to the insurance company, many companies will ask an insurance claim adjuster call the employee within 24 hours to discuss his or her rights and obligations. Within three-to five business days after the accident is reported to the insurance company, the employee will receive information on his or her rights and obligations, as well as a Notification Letter explaining the services provided by the state Employee Assistance Office.

These may be included in a packet with some or all of the following:
·A copy of the accident report;
·A fraud statement, to be read, signed and returned by the employee (failure to return this may temporarily stop benefits;
·A release of medical records for the employee to sign and return; and
·Reimbursement forms for medical mileage for when the employee seeks medical treatment, to be sent to the claims adjuster for reimbursement.

Medical Care
Treatment and care for the employee's injury or illness is provided by a physician authorized by the employer or its insurance company. After an examination, the physician will make a diagnosis and tell the employee if he or she can return to work.

After Seeing the Doctor
The employee should let his or her employer and the insurance company know about the medical diagnosis and the decision as to returning to work or next steps in treatment. (The HIPAA Privacy Rule does not apply in workers' compensation.)

Typically an employee is not paid for the first seven days of disability; but he or she loses time because their disability extends to over 21 days, those first seven days may be paid by the insurance company.

Worker's Compensation Benefits

If the employee is unable to work for more than seven days, he or she will receive compensation to partially replace what they were unable to earn after their accident. However, the employee's weekly benefit is never permitted to exceed the maximum compensation rate for the year in which his or her accident or illness occurred.

Total Disability
If the physician determines that the employee cannot work at all, he or she should receive compensation equaling about 66 2/3% of their regular wages at the time of the injury or illness. The benefit is paid starting with the 8th day the employee loses time from work.

Temporary Partial Disability
If the employee is able to return to work, but cannot earn the same wages as were earned at the time of the illness or injury, he or she will receive compensation equaling 80% of the difference between 80% of what the employee earned before their injury and what they are able to earn after the injury. The employee is eligible to receive up to a total of 104 weeks of temporary total disability and/or temporary partial disability.

Impairment Benefits
When the physician determines that the employee is at Maximum Medical Improvement, this means that the employee's condition is as good as it is expected to get. When and if this happens, the physician should evaluate the employee for possible permanent work restrictions, as well as a permanent impairment rating. If the employee receives a permanent impairment rating, he or she will receive compensation based on that rating.

Reemployment Services
These services are intended to assist injured employees return to the workforce when their work-related injury or illness keeps them from returning to their previous line of work. Reemployment services vocational counseling, job-seeking skills training, job analysis, job placement, and education to help an injured employee return to work.

The employer's workers' compensation carrier may provide these services. In the alternative, an injured employee can find these services from the state government office.

Employee Workers' Compensation Penalties

There are criminal violations filing a false claim for work-related injuries or for exaggerating the extent of the injuries.

An injured employee must attest that he or she understands that any attempt to defraud the process will be punished. Failure to sign the document will result in benefits or payments being suspended.

Statute of Limitations

The employee has two years from the date of his or her injury or illness to file a workers' compensation claim, but it should really be reported within 30 days. If the employee does not report the injury or illness within that time, that failure may be used as a defense against their claim, despite the two-year statute of limitations for filing.  In addition, the employee's eligibility for benefits may also be eliminated one year from the date he or she last received a wage replacement check or approved medical treatment.

Denial of Benefits

If an employer and the insurance company deny an employee's claim for workers' compensation benefits, the employee may attempt to discuss the denial with the insurance company. If the answer is still no, the employee can file a Petition for Benefits with the Office of the Judges of Compensation Claims.

At this point (if not before), the employee may engage an attorney for legal advice and representation.

The Burden of Proof

The burden of proof is on the injured employee to show by a preponderance of the evidence that he or she has a legitimate claim. Further, court decisions say that an employee can succeed if he or she presents, "by competent, substantial evidence, a state of facts from which it may be found, consonant with logic and reason, that an injury was sustained during the course of and arising out of the employee's employment." Employees who present logical and sensible evidence should be successful, despite the employer or insurance company's more compelling defense.

An injured should strongly consider the assistance of an experienced workers' compensation attorney when challenging the denial of a claim. A workers' compensation attorney will understand the state's employment laws and claims process and represent the employee's interests against the employer's attorneys and the claims adjusters.

Hiring an Attorney for your Worker's Compensation Claim

When meeting with a potential attorney, the employee should be able to get a good feel for the practitioner's level of confidence, professionalism, and demeanor. A good attorney will listen to his or her client and patiently answer all of their questions. They key for the employee is finding an attorney whom they can trust, knows workers compensation law, and who inspires strong confidence.

Questions to ask an Attorney
As an employee considers an attorney, there are several questions to ask so that he or she has a good idea of the experience, background, and skills on their potential advocate.

Attorney Experience and Qualifications
·What is the attorney's success rate with similar cases?
·How does the attorney keep current with the workers compensation laws?
·Does he or she specialize in workers compensation law, or do they practice other areas?
·Will the attorney be working on the case personally or will assistants do the majority of the work?
·Does the attorney represent employers and insurance companies in workers' comp cases or only injured workers?
·Is the attorney certified in workers' comp by the State Bar?

The Employee's Case
·Ask the attorney how he or she would approach the case?
·What are the options in the employee's case?
·What are the strengths and weakness of the employee's case?

Legal Fees and Charges
·Explain the attorney's fees.
·Is the employee charged for litigation-related expenses?
·Will there be charges and fees even if the case is unsuccessful?
·How are consultative medical examinations with specialists arranged?

Other Claims

Workers' compensation will provide compensation and benefits to an injured employee. However, temporary disability and permanent disability payments are typically very low, and there are no damages available for pain and suffering. There is also no option to request punitive damages to punish an employer for poor safety measures or dangerous working conditions. As a result, an injured employee may want to bring a lawsuit outside of the workers' compensation system.

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