Each year, many people are either injured while working or develop medical diseases or conditions due to workplace exposures, but getting workers’ compensation can be a complex process if you’ve never navigated it before. In order to protect workers, state law requires that employers provide workers’ compensation insurance coverage. Through this program, injured employees may receive benefits to compensate them for matters such as medical expenses, ongoing treatment costs and lost income. In order for an employee to qualify for workers’ compensation, they must have been injured while at work or while they were performing the duties of their job. Also note that if a worker is compensated through this insurance, the employee is not eligible to file a lawsuit against their employer. This guide will step you through qualifications for workers’ comp, what is covered under this insurance, and how to file.
Am I an employee for workers’ comp purposes?
Workers’ compensation covers employees, including those who are seasonal or temporary. The program does not cover independent contractors. If you are a temporary worker, whether or not you are covered through workers’ compensation depends on whether you are treated as a contractor or as an employee. Sales personnel may also be treated as either employees or independent contractors. In general, if your employer withholds taxes from your paychecks, they are treating you as an employee. If you believe you are being unfairly treated as an independent contractor so that your employer can avoid providing you with workers’ compensation coverage, you may want to consult workers’ comp attorneys to help you sift through the legalities.
What about injuries that are partially the employees’ fault?
Employees who hurt themselves while fighting or intoxicated have often been rejected to receive such compensation. If the injuries are a result of an employee’s misconduct, this will disqualify employees from eligibility to file for workers’ compensation. Examples of these are self-inflicted pain, injuries resulting from a brawl, or the result of using non-prescription or illegal drugs.
Illnesses and injuries that are covered by workers’ compensation:
Repetitive Motion injuries
Repetitive motion injuries are the most common workplace injuries due to the nature of manual labor and the need to perform the same motions consistently. They also go by different names, such as Repetitive Stress Injuries (RSIs), Cumulative Trauma disorders (CTDs), and Repeated Motion Injuries (RMIs).
The most common is called Carpal Tunnel Syndrome, which affects the wrists, hands and forearms as a result of repetitive motions such as typing. This is generally an issue for office workers. Not only are the hands susceptible to such injury, but the rest of the body as well. A person who stocks shelves is another potential candidate for a repetitive motion injury, as they could suffer chronic back pain due to years of heavy lifting. When certain parts of the body do a certain motion repetitively, it increases the likelihood of such an injury over time.
Naturally, a lawsuit cannot be filed against the employer. This is due to workers’ compensation laws that effectively remedy injured employees. If the Repetitive Motion Injuries workers sustain is, in fact, related to the physical activity demanded by the job, workers may have the following benefits: weekly compensation benefits, permanent impairment benefits, payment of medical treatment, and vocational rehabilitation.
An occupational illness is when a disease has resulted from work or working conditions. It is also when a worker’s medical condition has developed due to exposures in the workplace and there is a relation between the exposure and the disease. For example, a firefighter who has been exposed to asbestos can have a condition known as mesothelioma. Hearing loss can also develop caused by workplace noise exposure. Other conditions like allergies may be due to exposure to allergens in the workplace. Asthma may occur as a result of hazardous substances. And tennis elbow may be caused by repetitive movements of the arm or heavy weight lifting, and using the arms way above the shoulder length.
But, in order for occupational illnesses or disease to be compensated, it should be recognized as an industrial injury. One is if the disease and the exposure that has caused it are included on the occupational disease list. Second, is that if the disease cannot be found on the said list, it can still be possibly recognized. That is if the Occupational Diseases Committee, in their recommendation, state that it is likely, beyond reasonable doubt, that the disease was caused by environmental hazards and other factors in the workplace.
Emotional or Mental Stress Injuries
Emotional or mental stress-related injuries are now recognized by the courts to be covered by workers’ compensation insurance. Job-related stress has now been acknowledged as one of the major causes of injuries, which can lead to multiple conditions such as heart disease and cancers. Mental or emotional stress-related injuries are more difficult to prove and laws about what qualifies as “stress” differ by state. It is difficult to prove mental or emotional stress as a result of a job rather than as a result of personal stress, which could explain why these are some of the less common workers’ comp requests.
According to the American Institute for Preventative Medicine, stress is the root cause of nearly 2/3 of all doctor’s office visits. However, only about half of all states currently support emotional or stress-related workers’ comp laws. An employee must be able to prove that the stress has reached a level of disability in order for workers’ comp to be awarded. These stress-related mental injuries can result from sudden one-time events. For example, firefighters may experience a particularly traumatic fire, which could result in workers’ compensation benefits.
Is an examination done by the company’s doctor necessary?
The answer to this depends on the company you work for. Usually, it does require a thorough examination to be done by a doctor, once the employer’s insurance carrier deems it so. At the appointment, be sure you take notes to document everything that occurred during the medical evaluation. Try to jot down the names of the doctors that evaluated you, the diagnostic tests you took, and all other procedures and major occurrences. Remember, this is an evaluation done to prove your claim that your injury is, in fact, work-related. Some doctors would likely be sympathetic to the workers, but some are not.
It is also helpful if an experienced attorney is present during the required medical evaluation. Some attorneys may even help you look for the right doctor on the insurance list and provide insight into the best doctors for workers’ compensation documentation.
When is it appropriate to sue?
If an employer does not carry workers’ compensation, it’s possible to sue for access to workers’ compensation. They may be sued for negligence on their part as employers and fault for the injuries workers sustained.
Workers’ compensation is designed to help provide for workers who are injured or who become ill due to their jobs. Even if the employee is at fault, they are still eligible for benefits if the injury or illness is related to their work. In some cases, an employer or their insurance carrier may try to dispute or deny a claim for workers’ compensation benefits. Injured or ill workers may want to consult with a workers’ compensation attorney for help. An attorney may be able to assist their clients with properly submitting their claims. They may also help to gather the necessary documentation to support their benefits application. With workers’ compensation benefits, you may receive the compensation for your medical and treatment expenses as well as a monthly amount to replace your former income if you are left disabled.
Paul Gilbert is a professional blogger, enthusiast who loves to write on several niche including Insurance, Personal Injury, workers compensation attorney & Social Security Disability. He is also a part-time consultant providing best solutions & support to injured workers for claiming workplace injury benefits under Workers’ Compensation.
The information contained in this article is general in nature and you should consider whether the information is appropriate to your specific needs. Legal and other matters referred to in this article are based on our interpretation of laws existing at the time and should not be relied on in place of professional advice. We are not responsible for the content of any site owned by a third party that may be linked to this article. SafetyCulture disclaims all liability (except for any liability which by law cannot be excluded) for any error, inaccuracy, or omission from the information contained in this article, any site linked to this article, and any loss or damage suffered by any person directly or indirectly through relying on this information.
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