When employees are harmed or injured while performing their duties at work, the damages that result from it are covered by the Workers’ Compensation Law. This is a system of laws designed for the purpose of paying for the expenses of employees who need to cover medical costs due to the illness or injury that was brought about by a job-related accident.
What are the benefits of the workers’ compensation law?
Through the workers’ compensation laws, employees hurt during job accidents can recover their lost wages and medical expenses. If the injury leads to a disability rehabilitation and retraining is also covered by the workers compensation laws.
The system of rules was established and administered by the state wherein employers are mandated to contribute to the workers’ compensation system to cover the workers’ salaries and benefits while injured. Federal government employees also enjoy the same benefits.
In the past, employees used to file a personal injury litigation wherein the employee files a lawsuit to prove that the employer was responsible. The resulting delays increased the possibility of losing the court case leave almost nothing for the employee.
The workers’ compensation laws have replaced the traditional personal injury litigation so that both employee and employers have a procedure to follow in case accidents at work occur. There is no need for employers to worry about employees filing lawsuit for personal injury that could lead to a large damage award. Employers need not worry about these as their contributions for the employee is enough to cover the costs in case an employee gets hurt or killed during the job.
The workers’ compensation as an insurance program
Essentially, the workers’ compensation system is an insurance program that the government mandates on the employers as a workers’ insurance program.
Since the workers’ compensation system places certainty and security on the part of employers and employees, there are certain drawbacks that set the price for both of them. Workers used to file a lawsuit and if they win the case, they get a large amount of money for damages.
With the workers compensation law, injured employees do not need to sue their employer or co-workers for negligence. They can more easily recover their compensation for the damages incurred but compared to the process of litigation, they receive much less pay with the workers’ compensation claim.
How is it funded?
Employers need to pay the premiums regardless of whether any accident has happened in the workplace or not. It is a mandatory contribution for their employees. Mandatory for both employer and employee but each state has its own exceptions to the rules. Typically, companies pay premiums of less than 2% of the average expenses of the business.
Sometimes, workers may bypass workers compensation and file a lawsuit for damages when the employer or co-worker has been proven to intentionally harm the worker. When employees incur illness due to their exposure to toxic substances or get injured by defective products, they are also free to file suit against other parties such as landowners, drivers, and subcontractors.
Workers Comp Legal Procedures
When job-related accidents happen and the employee needs to file a workers’ compensation claim, the employer may dispute the validity of the claim. Employers have an incentive to dispute some claims they feel are improperly filed because multiple compensation claims directly affect the rates they pay into the workers’ compensation system.
When there are numerous valid claims, their contribution to the system will increase as it shows that the workplace is risky for the employees and since it is insurance the premium depends on the number of valid claims that they need to pay.
The employers insurance companies will investigate the claim well to ensure that the accident did occur as reported and did result in the injuries or illness as claimed. This system is in place to ensure that fraud is avoided.
When a claim is disputed
After a disputed claim, the state workers’ compensation board will investigate the claim and decide on it. The employee goes to a physician for evaluation on behalf of the state and their diagnosis affects the decision of the state workers’ compensation board. In this case, employees need to know that the results of the consultation may be used by the employer to argue its dispute, e.g., it is not work related or the injury is not as severe as claimed.
Appealing a claim
Upon reaching a decision and the state board rules the claim isn’t covered, the appeal process can be initiated. Depending on the state, the hearing will first be conducted by officials within the workers’ compensation department and in some states this may mean that the administrative law judge will conduct the hearing. Further appeals will be brought to a review panel and if all the administrative remedies are exhausted then the employee can file an appeal in the state court.
As mentioned earlier, employers on average pay premiums of less than 2% of the average expenses they have for their business. However, contested cases can become highly contentious to employers if they feel that their employees are seeking benefits they do not deserve. Eventually, situations like this can become an employer's ‘matter of principle’ and the injured workers may feel taken advantage of by their company.
Defending a claim and filing an appeal
Employees need to retain an attorney to protect their workers’ compensation rights. They need to keep legal counsel and hire an attorney that specializes in workers’ compensation laws and claims. Contested cases are definitely a challenge to undertake and workers’ compensation lawyers have the knowledge and experience to protect employees’ rights and defend them from their employers’ disputes of their valid claims.
workers’ comp lawyers generally work on contingency. They are accustomed to handling employers who don’t value their employees. They are also used to dealing with emotionally-charged court proceedings. An experienced attorney knows how to present the contested case in such a way that the employee maximizes the amount of money and benefits that he deserve to receive. Should you feel any hesitation or doubt before even filing a worker’s compensation claim, it would be beneficial to get legal advice from a lawyer and have them examine your claim.