Workers Compensation Legal Information
 

OVERVIEW

Workers’ compensation lawyers help workers get medical treatment and financial compensation for injuries they sustained at work. They serve as advocates for workers who have trouble with the often-complex workers’ compensation administration systems. Under some circumstances, they may also file lawsuits against employers who fail to provide workers’ compensation.

In the United States, workers’ compensation exists to help workers survive financially and get treatment for injuries they sustain at work. Each state administers its own workers’ compensation system. Employers either buy their own workers’ compensation insurance or join an insurance program maintained by their states. If an employee is hurt at work, this insurance pays for related medical treatment, as well as payments that help the worker make ends meet during recovery. It doesn’t matter who was at fault for the injury. In return, the worker who collects these payments usually can’t sue his or her employer over the injury.

Unfortunately, the workers’ compensation system is complicated, bureaucratic and controversial. Workers who were injured may have trouble getting payments as quickly as they’re needed. They may also need advice on their rights in order to file for their compensation correctly, or to avoid being penalized. And if employers or insurance companies intentionally try to keep workers from collecting all that they’re owed, workers may need to sue. Workers’ compensation lawyers help employees handle all of these problems and others related to workers’ compensation.
 

 

“WHEN AM I ENTITLED TO WORKERS’ COMPENSATION PAYMENTS?”

As long as your employer falls under your state’s workers’ compensation law, you’re entitled to workers’ compensation when you’re injured while working. However, because workers’ compensation can be controversial, these things are frequently very specifically defined. For example, an on-the-job injury doesn’t just mean one that takes place in the workplace. You are likely also entitled to compensation for an injury that took place when you were performing work-related duties outside the workplace, like driving a delivery truck or attending a conference. And if you were using drugs or alcohol, committing a crime or picking a fight, you are probably not covered even if you were at work.

When we think of workplace injuries, we most often think of sudden accidents, like falling off a ladder. But accidents aren’t the only cause of injury covered by workers’ compensation insurance. You can also collect for injuries caused by repetitive stress that builds up over time into an injury that takes you out of work. This can include a “fresh” injury as well as an old injury that was aggravated by your job. And if you’re regularly exposed at work to a substance that builds up over time and makes you sick, workers’ compensation should cover it.

 

“WHAT BENEFITS CAN I COLLECT UNDER WORKERS COMPENSATION?”

Generally, you can collect:

  • Replacement wages during your recovery. These are usually less than your usual wages -- half to two-thirds -- but they’re not taxed.
  • Medical treatment for the injury.
  • In cases of permanent disability, regular long-term compensation or a large lump sum.
  • In cases of a death, funeral costs as well as wage replacement to any dependants.
  • Sometimes, rehabilitation for injured body parts.

The rules governing when and how you collect these wages are state-specific and often very complicated. If you’re making an expensive claim, it’s best to start as soon as possible.

 

“CAN I CHOOSE WHICH DOCTOR I SEE?”

Yes and no. In most cases, you can choose to pre-designate a doctor to see for a workplace injury before you are injured. But if you didn’t do that, you will probably have to go to the doctor chosen by your employer, at least at first. It pays to be a little skeptical with this doctor. After all, he or she is paid by the insurance company, which has a financial interest in denying or minimizing your claim.

In most states, you have a right to a second opinion if you didn’t like the first doctor; after a waiting period; or if your injury is very serious. If you will be treated for several months, you may also be able to transfer your case to a doctor you choose after a certain amount of time.

 

“WHAT IF MY CLAIM IS DENIED?”

If the insurer denies your claim, it believes that you are not entitled to workers’ compensation benefits for your injury. You have the right to appeal this denial through a state agency or with the help of a workers’ compensation lawyer.

You may be able to represent yourself, but experts don’t recommend it because appealing a denied claim is a complicated and bureaucratic process. It’s important to know deadlines and procedures in order to make sure your claim is filed correctly. You should also try to get started early, because it can take a long time to resolve the claim. You will probably have to write letters to the state and to the insurer and provide lots of supplemental medical information. In some cases, you may have to go to meetings or informal hearings.

If you simply haven’t heard from the insurer and it’s been more than 90 days, your claim was probably accepted. Insurers are not permitted to deny treatment by delaying decisions.

 

“CAN MY EMPLOYER PENALIZE ME FOR COLLECTING WORKERS COMPENSATION?”

Legally, it cannot. This is called “retaliation,” and it takes many forms: Threats of firing, firing, demotion, reduction in hours, reduction in pay, passing over for promotion, sudden changes to less desirable jobs. These and other forms of retaliation are illegal, but they happen anyway.

In almost every state, you have the right to sue your employer for retaliating against you for filing a workers’ compensation claim. Depending on the circumstances, you may also be able to sue for violations of a few key federal worker protection laws, such as the Family and Medical Leave Act or the Americans With Disabilities Act.

 

“DOES COLLECTING WORKERS’ COMPENSATION STOP ME FROM SUING OVER MY INJURIES?”

For the most part, you can’t sue if you’re collecting workers’ compensation. The workers’ compensation system was designed to keep disputes about workplace injuries out of the courts. The worker gets compensation regardless of whose fault the injury was, and in return, the employer avoids a lengthy and expensive court battle.

However, you may still sue your employer if it retaliates against you for pursuing workers’ compensation. You may also be able to sue a third party, such as the maker of a defective piece of equipment, while collecting workers’ compensation. And if your employer fails to maintain any workers’ compensation insurance at all, of course, you have every right to sue.

 

PAYMENT

Workers’ compensation lawyers are generally paid on contingency; that is, they are paid at the end of the case, with a percentage of the money you recover. Unlike most contingency lawyers, they won’t usually negotiate the percentage with you before taking the case, because the percentage is set by law in many states. If you lose, the workers’ compensation lawyer gets nothing. This fee arrangement allows the workers’ compensation lawyer to represent people without a lot of extra money -- or people who are having financial trouble because they’re too injured to work.

Your workers’ compensation lawyer may also ask you to pay administrative costs and fees. You can ask about these costs and other parts of your case at your initial consultation -- a meeting that helps you get to know a lawyer you’re considering hiring. Most workers’ compensation lawyers offer free consultations.