The Workers’ Compensation laws provide an often complex array of questions
You get up to go to work every day, and you always arrive on time. You work hard, and you don’t complain. When you are injured on the job, you would expect that your company would be more than happy to pay the bill. Businesses in the United States are expected to carry Workers Compensation. If an employee is injured on the job, that insurance is supposed to pay their bills.
Unfortunately, that is not quite how it works out in many cases, despite the fact that most employers have a legal obligation to protect employees through workers’ compensation insurance. And also despite the fact that workers’ compensation is intended to provide injured workers with immediate assistance.
Unfortunately, there are some unscrupulous employers and insurance companies who will try to get out of paying a legitimate work injury claim despite the emotional, physical and financial hard done by worksite accidents.
And workplace accidents are incredibly common. Every year, close to 3 million American workers suffer non-fatal injuries on the job¹ and more than 5,000 workers die from work-related injuries, according to the US Bureau of Labor Statistics.
Your Basic Worker’s Compensation Rights
If you are injured on the job, you should tell your supervisor and go to the doctor right away. Your employer should provide you with paperwork to fill out, file a claim for you, and notify the worker’s compensation office.
Injured workers need to know when and how to file a valid workers’ comp claim – an obviously important first step – but the next one can be more difficult: having the insurance company approve the claim and begin their payment or payments.
The scope and nature of the actual injury will affect the view taken by the insurance company, whatever you may think as the injured party.
So what amounts to a ‘workplace injury’? The legal definition says –
“Any injury or illness is considered work-related if an event or exposure in the work environment caused or contributed to the condition, or significantly aggravated a preexisting condition.” OSHA, U.S. Dept of Labor
The nature of the actual workplace injury will vary greatly. Some will be sudden and often dramatic accidents – burns, vehicular, crushing, slips and falls – while others will be work-related such as lung disease, carpal tunnel syndrome and the like.
Remember that not every injury will qualify for workers compensation. For instance, an employee who is injured while off-site on a break without carrying out work duties will not qualify. But if you are injured on the road, for instance, while on work duties then you do qualify for workers compensation.
Circumstances and the ‘context’ of the injury or illness matter.
How Long Will A Workplace Accident Take To Process?
Most times you can expect the workers’ compensation insurance company to respond to your claim promptly. As most are straight forward they should proceed without issue.
It is obviously important to seek urgent medical advice after the accident with full details on how you were hurt with all affected body parts in order that you have on record the details of the injury for which compensation is sought.
It’s also a lot easier to prove a workplace injury when you act promptly. If someone else witnessed your injury you should ensure you get their details for any future case and you obviously need to report the details of the injury to the workplace.
Different States Have Different Rules
Different states have different laws when it comes to workers’ compensation. Every state will allow you to file a workers compensation claim when you have been injured on the job. You should be able to see a doctor, and you should be able to return to your job as soon as that doctor says it’s okay.
If you are permanently disabled due to a work injury, you should be able to get disability compensation. If a worker’s compensation claim is denied, you will be able to appeal the decision.
The department that oversees workers’ compensation claims and the process for filing those claims depends upon the state. In the State of Florida, the Division of Workers’ Compensation is controlled by the Department of Financial Services.
A worker can get compensated for their work-related injury no matter who was at fault. A company can purchase insurance from a private provider or from the state.
In the Sunshine State, the doctor that worker’s compensation sent you to has the final say when it comes to your diagnosis; you may not get a second opinion.
If you are temporarily disabled in the state of Florida, you will not be able to collect benefits for the first seven days that you are unable to work unless you end up being disabled for at least 21 days.
Who Will Pay for a Workplace Accident?
The insurer will pay the medical and income replacement, but if your employer is not insured you can take legal action to seek full compensation for the damages that have occurred.
Mostly, employers are difficult to sue because of the array of workers’ compensation laws that protect them, but there are exceptions where an injured or badly treated worker can sue for compensation.
If you suffer a workplace accident or have been wrongfully fired you may well have state or federal access to a lawsuit against your employer.
Most employers are immune to employee lawsuits due to a complicated web of workers’ compensation statutes protecting them.
An attorney is obviously key to success in this area, particularly if there is a question of determining the difference between employer liability insurance and workers’ compensation insurance. Many employers will have Workers’ Compensation, but will also have Employer Liability insurance and Employer Practices Liability insurance, which are different ‘beasts’.
Remember too that your injury may have been the result of some third party, in which case Workers’ compensation will pay, but you may also pursue a claim against the third party, for instance via auto insurance liability coverage.
Appealing a Decision
According to the website https://realjustice.com/, almost every state allows you the opportunity to appeal a denial from the worker’s compensation office.
In the state of Florida, an employee must make an effort to resolve the dispute before filing a formal appeal. They can call the Florida Employee Assistance and Ombudsman Office to speak directly with the insurance adjuster.
If they are not able to work anything out, they will file a petition for benefits. A person has a 2-year statute of limitations to file. The worker’s compensation office will have 14 days to either agree to pay a claim or file an answer. If they do not agree to pay, the case will go to mediation, and if mediation doesn’t work, it will go to court.
Finding an Attorney
Finding legal representation may be challenging as the fees they can charge are limited. There are some attorneys who will still be willing to represent you in such a case. The one you should select should have years of experience in dealing with workers’ compensation in your location.
Keep in mind that workers’ comp adjusters are trained to deal with these matters and will look at whatever is available to limit or even terminate whatever claim you may have.
Adjusters will always find it a great deal harder to take advantage of an injured worker in a vulnerable position if they are represented by an attorney, so don’t ignore the benefits of having an experience lawyer represent your interests in pursuing a claim.
Injured by a Third Party
There are some situations in which you may be injured on the job, but the fault may belong to a third party who was working in your office building or at the worksite where the accident happened. In this case, you may not be able to file a workers’ compensation claim. You would want to sue the company that caused the accident.
An on-the-job injury can be devastating. If you take the right steps and hire the right attorney, you may get the money you need to begin the healing process.