Individuals who suffer injuries or illnesses while they are on the job – and during the scope of their employment – may be eligible to file a claim for workers’ compensation benefits. However, problems sometimes arise during these claims, especially when insurance companies undervalue them in an attempt to avoid paying benefits.
A skilled workers’ compensation lawyer in your area can aggressively advocate for your interests, deal with the insurance company directly, and pursue the full compensation and benefits you deserve to recover from your injuries.
Types of Occurrences that Frequently Lead to Workers’ Comp Claims
Workplace injuries can vary widely, but several types of occurrences are particularly common and often lead to workers’ compensation claims, including all of the following:
- Slips, Trips, and Falls – One of the most frequent causes of workplace injuries involves slips, trips, and falls. These accidents can happen due to wet or uneven floors, cluttered walkways, or poor lighting. For instance, an employee may slip on a wet surface in a kitchen or trip over a power cord in an office. These incidents can result in sprains, fractures, or even more severe injuries, making them a leading cause of workers’ compensation claims.
- Repetitive Strain Injuries – Repetitive strain injuries occur from performing the same motion repeatedly over time. Jobs that involve repetitive tasks, such as typing or assembly line work, can lead to conditions like carpal tunnel syndrome or tendinitis. These injuries develop gradually and can become severe, causing long-term pain and affecting an employee’s ability to work.
- Falls from Heights – Workers who perform tasks at elevated heights, such as construction workers or maintenance staff, are at risk of falls. Whether they’re working on scaffolding or ladders, a fall from a height can lead to serious injuries, including broken bones or spinal injuries.
- Being Struck with Objects – Injuries from being struck with falling or moving objects are also common. This can include items like tools, machinery parts, or other equipment. For example, a construction worker may be hit with a falling hammer or a warehouse employee may be struck with a moving pallet. These accidents can cause various injuries, from bruises to concussions or fractures.
- Machinery Accidents – Workers operating or working near machinery are at risk of getting caught in – or struck with – machines. Safety guards and proper training are essential to reduce these risks. Machinery accidents can result in severe injuries, including amputations or crush injuries.
- Motor Vehicle Accidents – Employees who drive or operate vehicles as part of their job, such as delivery drivers or truckers, may be involved in accidents on the road. These accidents can lead to injuries ranging from minor to severe and often result in workers’ compensation claims.
- Exposure to Harmful Substances – Workers exposed to harmful substances, such as chemicals or asbestos, may develop health issues over time. Conditions like respiratory problems or skin diseases can arise from such exposure, leading to compensation claims.
Eligibility to File a Claim for Workers’ Comp Benefits
Determining if you’re eligible to file a workers’ compensation claim involves several key factors. Workers’ compensation is a program designed to provide benefits to employees who suffered an injury or become ill due to their job. Here’s a general overview of the eligibility requirements:
- Employment Status – To qualify for workers’ compensation benefits, you must be an employee of the company where the injury or illness occurred. Independent contractors and freelancers usually do not qualify for workers’ comp benefits. If you’re unsure about your status, check with your employer or review your employment contract.
- Work-Related Injury or Illness – Your injury or illness must be directly related to your job. This means the injury should have occurred while performing work duties or as a result of work activities. For example, if you hurt your back lifting heavy boxes at work, it will likely be covered. However, injuries that occur while you’re off the clock or not performing work tasks generally do not qualify.
- Timeliness of the Claim – You must report the injury or illness to your employer within a specific time frame, which varies by state. Prompt reporting is crucial because failing to notify your employer soon after the incident can jeopardize your claim. Most states require notification within 30 days of the injury or when you first become aware of the work-related nature of your illness.
- Medical Documentation – You need to provide medical evidence that supports your claim. This typically includes medical records and reports from your healthcare provider detailing your injury or illness and its connection to your work. Accurate and thorough documentation helps to validate your claim and ensures that you receive the appropriate benefits.
- State Laws – Workers’ compensation laws can vary by state, so it’s important to understand the specific requirements in your location. Each state has its own rules regarding eligibility, coverage, and the claims process. Familiarizing yourself with these laws – and speaking with an experienced workers’ comp lawyer in your area – can help you navigate the system more effectively.
- Employer’s Insurance – Your employer must also have workers’ compensation insurance coverage. Most employers are required by law to carry this insurance, but there are exceptions for certain types of businesses or small employers. If your employer does not have insurance, you may still have options for compensation through state programs or legal action.
Recoverable Benefits in a Workers’ Comp Claim
When you file a workers’ compensation claim, you may be eligible for several types of benefits designed to help you recover from a work-related injury or illness. Here are the most common types of recoverable benefits:
- Medical Benefits – These benefits cover the costs of medical treatment related to your injury or illness. This includes doctor visits, hospital stays, surgeries, prescription medications, and physical therapy. Medical benefits aim to ensure that you receive the necessary care to recover and return to work. This coverage usually extends to treatments that your healthcare provider deems reasonable and necessary.
- Temporary Disability Benefits – If your injury or illness prevents you from working temporarily, you may receive temporary disability benefits. These benefits provide compensation for a portion of your lost wages while you are unable to work. The amount is usually a percentage of your average weekly earnings, often around 66 percent to 75 percent, depending on the state. Temporary disability benefits are meant to help you manage expenses while you’re recovering.
- Permanent Disability Benefits – If your injury or illness results in a permanent impairment that affects your ability to work, you may qualify for permanent disability benefits. These benefits are designed to compensate you for the long-term effect on your earning capacity. Permanent disability benefits can be categorized into partial and total disabilities. Partial disability benefits are for those who can still work but are limited in their job duties, while total disability benefits are for those who are unable to work at all due to their condition.
- Vocational Rehabilitation Benefits – If your injury or illness prevents you from returning to your previous job, vocational rehabilitation benefits can help you find new employment. These benefits may cover costs for job training, education, and other services designed to help you acquire new skills or transition to a different career. The goal is to assist you in returning to the workforce in a capacity that accommodates your physical limitations.
- Death Benefits – In the unfortunate event that a worker dies due to a work-related injury or illness, death benefits may be available to the worker’s dependents. These benefits typically include compensation for funeral expenses and financial support for surviving family members who were dependent on the deceased worker’s income.
Each state has specific rules and regulations regarding workers’ compensation benefits, so the exact nature and amount of benefits can vary.
Problems that Can Arise in a Workers’ Comp Claim and "Tricks" that Insurance Companies Frequently Use
Workers’ compensation claims can sometimes be challenging due to various problems and tactics that insurance companies may use. Here are some common issues and “tricks” to watch out for:
- Claim Denials – One significant problem is having your claim denied. Insurance companies may deny a claim if they believe the injury is not work-related or if there are discrepancies in the information provided. For example, if you fail to report the injury promptly or if your medical records do not clearly connect the injury to your job, the insurer may reject your claim.
- Delayed Payments – Sometimes, insurance companies delay payments, which can cause financial strain while you’re recovering. Delays can occur if there are disputes over the severity of your injury or if the insurer needs more information. This can be frustrating and stressful – especially if you rely on these benefits to cover medical expenses and lost wages.
- Disputing Medical Evaluations – Insurance companies may dispute your medical evaluations to minimize the amount they have to pay. They may hire their own doctors to provide second opinions, often arguing that your injury is less severe than claimed or that you can return to work sooner than your doctor suggests. This tactic can undermine your claim and lead to reduced benefits.
- Settlement Pressure – Insurers may also pressure you to accept a quick settlement offer, which can be lower than what you are entitled to recover. They often use this tactic to close claims cheaply. It’s crucial to understand the full extent of your injuries and potential future costs before agreeing to a settlement. Accepting an offer prematurely can limit your ability to seek additional compensation if your condition worsens.
- Surveillance and Investigations – Insurance companies may use surveillance or private investigators to monitor your activities. They may do this to gather evidence that suggests you’re not as injured as claimed or that you’re engaging in activities that contradict your reported limitations. Being aware of this possibility can help you remain cautious about your activities during the claims process.
- Faulty Communication – Insurers can use complex language or miscommunicate information to confuse you about your rights and the claims process. They may not fully explain the benefits you’re entitled to receive – or the steps you need to take to secure them. It’s important to carefully review all documents and seek help from an experienced workers’ compensation attorney.
An experienced workers’ comp lawyer in your area can fight the insurance company on your behalf and pursue the full benefits you deserve.
How a Lawyer Can Help with Your Workers’ Comp Claim
An experienced workers’ compensation attorney can be a valuable ally in handling a workers’ comp claim. Here’s how they can help you by dealing with the insurance company and advocating on your behalf:
- Understanding the Legal Process – State workers’ compensation laws can be complicated and may vary by state. An experienced attorney is well-versed in these laws and understands the specific rules and procedures involved in filing and managing a claim. They can guide you through the legal process, ensuring that you meet all deadlines and requirements.
- Dealing with Insurance Companies – Insurance companies often have teams of adjusters and attorneys working to protect their interests, sometimes at the expense of fair compensation for you. A skilled attorney can handle all communications with the insurance company, negotiating on your behalf to secure a fair settlement. They know the tactics insurers use to minimize payouts and can counter these strategies effectively.
- Gathering Evidence – Building a strong case requires gathering and presenting evidence that supports your workers’ comp claim. An attorney can collect medical records, employment records, and other documentation that proves your injury is work-related and affects your ability to work. They may also arrange for expert opinions or testimony to strengthen your case.
- Handling Disputes – If your claim is denied or disputed, an experienced attorney can work to resolve these issues. They can address reasons for the denial or delay, such as disputes over the severity of your injury or its connection to your job. They will work to resolve these disputes and ensure that your claim proceeds smoothly.
- Navigating Settlements – Insurance companies may offer a settlement to close your claim quickly and cheaply. An attorney can evaluate settlement offers to ensure they are fair and adequate for your needs. They will negotiate with the insurance company to secure a settlement that fully compensates you for your medical expenses, lost wages, and any long-term effects of your injury or illness.
- Providing Legal Advice – Throughout the claims process, you may have questions or concerns about your rights and options. An attorney provides legal advice tailored to your situation, helping you make informed decisions. They can explain complex legal terms, clarify the benefits you’re entitled to recover, and offer guidance on how to proceed.
Talk with an Experienced Workers’ Comp Lawyer in Your Area Today
If you recently sustained an injury or illness while on the job, an experienced personal injury attorney can handle every step of the process for you. Your lawyer can communicate with the insurance company on your behalf, help you resolve disputes, and pursue the maximum amount of compensation available to you in your case.