Workers' Compensation - Overview

"Workers' compensation" refers to a system of laws outlining specific benefits to which injured employees are entitled, and the procedures for obtaining such benefits. Every state has its own workers' compensation laws, which are contained in statutes, and vary somewhat from state to state. In addition, there are special workers' compensation laws for employees of the federal government, and still others for workers in specific types of industries such as railroad employees.

Under the law in most states, every business must have some form of workers' compensation insurance to cover injured employees. Filing a workers' compensation claim is similar to filing an insurance claim; it isn't a lawsuit against an employer, but rather a request for benefits.

The Purpose and Effect of Workers' Compensation Laws

Workers' compensation laws are designed to ensure that employees who are injured on the job receive fixed monetary awards, without having to litigate their claims against their employers. In this way, workers' compensation is an important safety net for employees when they are injured on the job or as a result of their job. 

Most workers' compensation laws also provide employers and co-workers with a certain level of protection, by limiting the amount employees can recover from their employers, and prohibiting, in most cases, injured employees from suing their co-workers. In essence, workers' compensation is a no-fault system, where an injured worker's own negligence, or the negligence of his or her employer or co-workers, is not put at issue; rather, the injured employee is simply covered for his or her work-related injuries.

Thus, workers' compensation is an injured worker's "exclusive remedy" with respect to a work-related injury, unless he or she can point to a third party who contributed to his or her injuries. For example, because workers are often injured by products or machinery they use at work, they may, and often do, seek compensation from the manufacturers of such products.

Employers are generally not directly involved in the third-party claims of their employees, and such claims take place in civil actions, rather than in the workers' compensation system. In most cases, however, an employer can recoup its workers' compensation payments and obligations from the recovery an injured worker obtains from a lawsuit against a third party. In some states, the workers' compensation insurer and employer may enter into the lawsuit commenced by the employee and seek to protect their rights to recover the sums. In other states, the employer is given a lien against the employee's recovery. In those states, the employer and insurer must wait until the employee has made a recovery, at which point they assert the lien and the employee must then pay back monies which duplicate workers' compensation benefits previously received or receivable.

The Scope of Workers' Compensation Coverage

Workers' compensation coverage varies by state, and by occupation. For example, some states exempt certain categories of workers, such as agricultural employees, domestic employees and independent contractors, from their workers' compensation systems. Other states require coverage only if an employer employs a minimum number of employees. To determine whether you are entitled to workers' compensation benefits, you should contact an experienced workers' compensation attorney in your area.

Also, keep in mind that if you are not covered by workers' compensation, you may be able to bring a civil claim against your employer or a third party.

Workers' Compensation Benefit Claims vs. Civil Lawsuits

Workers' compensation is usually considered a substitute for a lawsuit against your employer. In exchange for not suing your employer in court, you are entitled to workers' compensation benefits, regardless of who was at fault for your injuries. Prior to the creation of the workers' compensation system, employees had no choice but to go to court to recover compensation for their work-related injuries. Now, most employees are automatically entitled to workers' compensation, but at the same time, the employer is automatically protected from most employee lawsuits.

Keep in mind, however, that even if you file a workers' compensation claim, you still may be able to bring a lawsuit if your injury was caused by someone other than your employer, or by a defective product you used on the job, such as a piece of equipment that malfunctioned.

Types of Injuries Covered by Workers' Compensation

For a work-related injury, you may be eligible for compensation for any of the injuries listed below:

  • Preexisting conditions that the workplace accelerates or aggravates. Examples may include a back injury, even though you don't notice the pain from the injury until later.
     
  • Injuries caused during breaks, lunch hours, and work-sponsored activities (such as a company picnic), and at-work injuries caused by company facilities, such as a chair in the company lunchroom.
     
  • Diseases such as lung cancer, if contracted by exposure to toxins at work as a result of normal working conditions.
     
  • Injuries resulting from mental and physical strain brought on by increased work duties or work-related stress. In some states, this includes employees who develop a disabling mental condition because of the demands of the job and a supervisor's constant harassment.

There are some injuries, however, that may not be covered by workers' compensation. State courts are divided on whether an employee can recover for an injury sustained during horseplay at work. Many states will not award benefits to a person who is injured while intoxicated or who deliberately inflicts injury on himself. Furthermore, an employee who is injured while traveling to or from work is not generally entitled to benefits unless the employer has agreed to provide the worker with the means of transportation, pay the employee's cost of commuting, or if travel is required while performing his/her duties.

If a worker leaves the employer's premises to do a personal errand and is injured, he or she might not be entitled to workers' compensation benefits. However, if an employee is injured while returning from company-sponsored education classes, or goes to the restroom, visits the cafeteria, has a coffee break, or steps out of a nonsmoking office to smoke a cigarette, and is injured, workers' compensation boards and courts typically recognize that employers benefit from these "nonbusiness" employee conveniences, and often award compensation.

What To Do If You Think You Have a Claim

Here are the first steps you should take if you are injured on the job:

Report the injury to your employer
If possible, report the injury in writing and keep a copy of the report for personal records.

Complete a claim form
No matter how your employer learns of the incident, it must offer you a claim form immediately. Until this claim form is completed, the employer has no obligation to provide you benefits. Make sure the claim form is filled out completely and specifically. Keep a copy of your completed claim form. Once your employer receives your claim form, it is then the employer's responsibility to immediately notify its workers' compensation insurance company and arrange medical assistance for you.

File the claim as soon as possible
If you are seeking to claim workers' compensation benefits, you should do so quickly. Any delay on your part could lead to potential snags or delays in receiving benefits. Immediately reporting injuries and filing a claim as soon as you decide to seek compensation increases the likelihood that benefits will begin quickly.

If a dispute should arise regarding the claim, you can seek help from the workers' compensation commissioner's office in your state, but you may also want to contact an experienced workers' compensation attorney. If you are unhappy with the decision in a hearing that was held to determine some aspect of your workers' compensation claim, procedures exist for you to appeal the unfavorable result. In some states, your first appeal must be made to a workers' compensation court of appeals. Once the workers' compensation appeals has made its ruling, or if no such appeals court exists, an appeal to your state's court can usually be commenced if you are still unsatisfied with the results of your workers' compensation case.

Getting Help With a Workers' Compensation Claim

The workers' compensation system of laws is designed to provide a straightforward method for employees to receive compensation for work-related injuries. However, workers' compensation laws vary from state to state, and have quite specific procedural requirements. If you have been injured at work, contacting a lawyer who specializes in workers' compensation or personal injury law is the best way to ensure that your rights will be protected. A lawyer can protect your rights in many ways. For example, if someone other than your employer or co-worker was partly at fault for your injury, you may be able to file a liability insurance claim against that person or business.

Additionally, if your accident is not covered by workers' compensation (for example, if you are an independent contractor or because the company does not have workers' compensation insurance), you may be entitled to bring legal action against someone for whom you were working, just as you could file a claim against any other person who caused you personal injury. In such a case, you may be able to recover compensation that you couldn't recover in a workers' compensation claim, including attorney fees, compensation for pain and suffering, and punitive damages (damages to punish the party who injured you).