Workers’ compensation is insurance that covers expenses related to a work-related injury or illness. Employers purchase it to stop employees from suing their employer for work-related injuries. Workers’ compensation is needed when an employer has one or more employees in most states.
Workers’ compensation insurance companies must pay for an employee’s temporary disability payments. However, states vary on how much compensation is required.
What Benefits Are Available Under Workers’ Compensation
Workers’ compensation benefits typically include:
- Replacement income
- Medical expenses
- Long-term or lump sum pension if you are permanently unable to work
- Temporary disability pension while you are unable to work
Requirements for Workers’ Compensation
To satisfy workers’ compensation requirements:
- You must be an actual employee of your employer (i.e., not an independent contractor)
- Your injuries have to be work-related.
What Is a Workplace Injury?
A workplace injury or workplace accident is any injury that happens during employment at the regular site for work. However, not all “on the job” injuries can be compensated for through workers’ compensation. This is because workers’ compensation demands that the injury be related to the job task or the employee’s job descriptions. Therefore, the injury must also be “job-related” to be covered by workers’ compensation.
There are many circumstances where you may be able to sue outside of ordinary workers’ compensation routes. It sometimes may be required to file a non-workers compensation claim, especially where worker’s compensation isn’t available as an option for recovery.
Processing a Workers’ Compensation Claim
There are several steps you must follow to obtain workers’ compensation.
- Promptly report your injury to your employer. Some states generally require notice within 2-30 days following the injury. If an injury or illness results over time, you must report it as soon as you discover your work caused it.
- Get medical treatment and obey the physician’s instructions.
- File your claim with your employer’s insurance carrier. Your employer must supply insurance claim forms.
- Keep all copies of paperwork throughout the whole process.
What Types of Injuries Are Covered Under Workers’ Compensation?
Workers’ compensation benefits injured workers regardless of whether the injury was the employer’s or the employee’s fault. As long as your injury is work-related, it is covered under workers’ compensation.
Typical injuries covered are:
- Repetitive stress injuries
- Illnesses or diseases that are an incremental result of work conditions
- Traumatic physical injuries
- Repeated trauma injuries
- Mental injuries, when associated with physical injury
- Occupational diseases
What Types of Injuries Are NOT Covered Under Workers’ Compensation?
Workers’ compensation provides for almost every type of injury at the workplace. Nevertheless, various kinds of injuries remain uncovered:
- Self-inflicted injuries (including injuries to you when you cause a fight)
- Injuries resulting from the commission of a grave crime
- Injuries caused when your conduct violates company policy
- Injuries obtained while intoxicated or under the influence of illegal drugs
- Injuries where the employee was acting in a reckless manner
Who Is NOT Covered by Workers’ Compensation?
Several classes of workers are not entitled to workers’ compensation benefits.
The following are workers not covered by workers’ compensation:
- Business owners
- Independent contractors
- Federal employees (under the state’s scheme)
- Domestic employees in private homes
- Maritime workers
- Railroad employees
- Unpaid volunteers
Note that workers’ compensation laws can differ by state. For example, California workers’ compensation laws may differ from other areas.
What Types of Damages Can be Recovered?
These non-workers compensation claims often yield greater possibilities for an injured party to recover damages for their losses. In a typical workers’ compensation claim, disability payments are usually somewhat lacking. They may not cover all the costs and losses that have to be shouldered by the injured party.
In comparison, a successful non-workers compensation lawsuit will typically cover:
- Medical expenses, such as hospital bills, payments for medicines, rehab and therapy sessions, etc.
- Lost wages and loss of earning capacity due to the injury
- Any damage to personal property or belongings
Finally, one significant difference between workers’ compensation and a private lawsuit is the availability of punitive damages. Punitive damages aren’t available in workers’ compensation claims, but they are often a significant aspect of a civil lawsuit. A punitive damages award can help deter the employer or third party from committing the same violations again. They can often result in a significantly higher damages award for the plaintiff.
Is it Possible to Sue Without Going Through Workers Compensation Routes?
Many workers don’t seek legal action for their injuries simply because they aren’t conscious of their options. Workers may continue to suffer through losses once they understand that workers’ compensation isn’t an option. Yet, there are many options for legal remedies outside of workers’ compensation.
Some examples of non-workers compensation claims include:
- Defective Products: If you were hurt at work due to a defective product, you might be able to sue based on a product’s liability theory against the manufacturer. A typical example of this is a defective assembly machine.
- Toxic Exposure: If you were exposed to toxic substances at your workplace, you could file a toxic tort suit against the party that manufactured the substance.
- Intentional/Egregious Acts by Employer: You may file a personal injury lawsuit against your employer if their intentional or egregious conduct has caused your injury.
- Lack of Insurance: If your employer has failed to carry workers’ compensation insurance, it may be possible to sue them in a private civil lawsuit. Alternatively, you might be able to gather reimbursements through state funds.
What Is the Subsequent Injuries Benefits Trust Fund?
The Subsequent Injuries Benefits Trust Fund (SIBTF), formerly known as the Subsequent Injuries Fund, benefits individuals involved in disastrous on-the-job injuries. It delivers an additional source of compensation for employees hurt at work.
To receive the SIBTF benefits, the injured worker must have had a disability or impairment at the time of their injury. Nearly all states have a Subsequent Injuries Fund. In California especially, for benefits to be paid from the SIBT, the integrated effect of the work-related injury plus the prior impairment or disability must result in a current disability of 70% or more.
What Is the Purpose of the Subsequent Injury Benefits Trust Fund?
The fund lets employers not worry about being liable for employees’ previous disabilities or impairments. In short, the fund enables and encourages employers to hire employees who have disabilities or impairments.
How Does the Fund Pay Workers’ Compensation?
Each state supervises the payments from the SIBTF as a surcharge imposed upon employers in proportion to their payrolls. The SIBTF permits the employee to receive compensation commensurate with her overall impairment or disability for employees with severe injuries. The employer is not held responsible for more than the amount due for a recent injury. In other words, the employer is not held responsible for the employee’s previous disability.
How Do I File a Claim for My Subsequent Injury?
Each state is different with its own set of requirements. In general, the worker must fill out an application for the benefits. You can find the necessary paperwork with your state’s Division of Workers’ Compensation department.
Should I Contact an Attorney to Help Me File a Claim for Subsequent Injury?
An attorney is recommended to file a claim against the Subsequent Injuries Fund because it is a complicated area of the law. A workers’ compensation attorney can help you file a compensation claim for a subsequent injury. Also, hiring a lawyer can help ensure that a valid claim is protected.