WASHINGTON, May 6, 2012 – Most of us assume that if we are injured at work, our employer’s Workers’ Compensation coverage is there to make sure we are covered medically, and that our wages will be paid while we recuperate. Assume not, or at least, not always my friend.
Workers’ Compensation benefits are administered by, and paid by insurance companies. Insurance companies are not your friends. Worker’s Compensation is not an employee’s right to insurance for on-the-job injuries. It was designed specifically to reduce or eliminate personal injury lawsuits between you (the employee) and your boss, the employer.
It was designed to be fast, and to eliminate the stress and conflict about fault. Your clumsiness will not prevent you from recovering benefits.
From the design concept of the system then, Worker’s Compensation usually is a quick and uncomplicated method to obtain wages lost and to assure medical bills are paid. Instead of filing a lawsuit against your employer for a work related injury, the process begins with you filing a claim with your employer’s workers’ compensation insurer. The insurer will investigate the incident to determine if you are an employee and if you were injured on the job. Assuming these things, you will receive benefits and you will not have to file a lawsuit.
The problem, if there are any, surfaces when your injury is serious, or your absence from work is considerable. This is because insurance companies do not want to continue to pay for your medical care, or your wages, or both. Beware then of insurance selected doctors who report that you are healed, suffer no more injury, and are ready to return to work.
You have the right to a second opinion on all of these matters.
I recommend speaking to an attorney, always. If my description above is not clear, let me be blunt: you are dealing with an insurance company that has a client to serve; the employer. Does this mean as an employee all is lost if things don’t exactly go your way? Actually, in practice, it’s quite the opposite; as usually, for minor injuries and short absences from work, there are no problems. I will call these the routine cases.
What are the benefits, and are you covered?
Workers’ compensation routinely provides wage replacement benefits and payment for necessary medical treatment when you are injured at work. It covers you, but the coverage is through your employer, who is the policyholder for the workers’ compensation insurance.
Again, the insurance is there as a protection for the employer, preventing you from filing a lawsuit. Fault, again, is not an issue. It does not matter if you were negligent or that you caused your own injury. Before coverage “kicks in” for you however, it must be established that (1) the employer-employee relationship existed; and that (2) you must have been injured while working for your employer.
An employer is one who hires and pays wages, withholds taxes from the wages, and dictates the time, place, and duties to be performed. The employee collects the wages and performs the dictated duties under the direction of an employer at a specified time and place.
Independent contractors and the self-employed do not meet the employer-employee relationship test. For example, you would be classified an independent contractor or self-employed individual if you owned and operated a business where you quote a price for your services as well as a time to perform the services for your customer or client. Moreover, your customer or client would not be considered as your employer.
In a Workman’s Compensation claim, where and when your injury occurred will also be examined. If you were driving after hours and were not performing a work activity, there will be no coverage.
How do you get medical care and other benefits?
You report the injury immediately or as soon as possible, and you cooperate with the players involved.
Your employer should have an established policy and plan in place for reporting work place injuries. Typically most policies require you to report the injury immediately to your supervisor or employer. Delaying notification could create doubt as to when and where the injury occurred, so get the injury on record as soon as possible. You will be asked to recount your actions leading up to the injury. This to assure the injury was not caused by inappropriate behavior such as intoxication or drug use.
If a hospital visit is necessary, go. You can also go to your doctor. But the worker’s compensation insurer will want you to go to “their doctor.” You must do this to remain eligible for benefits. However, if you find that the medical care and attention you are receiving is either detrimental or is not moving you toward relief in a reasonable time, you can consult other doctors. In order to have these bills covered, you doctor must be willing to provide documentation detailing what he or she is doing differently than the insurance doctor, and why that medical course of care is necessary.
Always seek medical attention, and ask for help immediately from your boss or supervisor. Tell the doctor or hospital personnel how the injury occurred so it is on record.
You will be required to complete forms. You should read everything carefully before signing them, and you should submit them promptly.
Keep all scheduled doctor appointments and any other appointments scheduled on your behalf by the workers’ compensation insurance carrier. Failure to do so could cause delays or your injury claim could be denied.
Should I consult with an attorney?
I am an attorney. My answer to this question is yes, but you may not need to do so in every case. Initially contacting an attorney, in my view, is the smart thing, and will result in you obtaining information. From there, you can then make an informed decision about hiring an attorney.
There is nothing prohibiting you from consulting an attorney. Worker’s Compensation laws and the process were designed to allow you to make the claim by yourself. However, the more serious your injury, the more reason there is to talk to an attorney. After speaking to an attorney, you may learn that you do not need additional legal help.
Finally, you need to know that some injuries will qualify for claims in addition to Worker’s Compensation. An attorney may be helpful in recognizing and assisting you with potential additional claims. For instance, you might have a claim (called a third party claim) against a ladder manufacturer if it broke, causing your injury. If you are a delivery person making a delivery for your employer, and are involved in an automobile collision that was not your fault, you have a third party claim against the other driver as well as a Worker’s Compensation claim.
Worker’s Compensation is a good system. It usually does what it was designed to do (fast, uncomplicated payment system) and it does benefit employees most of the time. Be aware, however, that the greater benefit is ALWAYS to your employer and their insurer. With that understanding, go to work, enjoy your work, try to be safe, and make sure you come home each day able to say that because of you, the world is now better than it was yesterday.
Paul A. Samakow is an attorney licensed in Maryland and Virginia, and has been practicing since 1980. He represents injury victims and routinely battles insurance companies and big businesses that will not accept full responsibility for the harms and losses they cause. He can be reached at any time by calling 1-866-SAMAKOW (1-866-726-2569), via email, or through his website. He is also available to speak to your group on numerous legal topics. Paul is the featured legal analyst on the Washington Times Radio, on the Andy Parks show, on Wednesdays at 5:15 P.M., and he is a columnist on the Washington Times Communities.
His book, The 8 Critical Things Your Auto Accident Attorney Won’t Tell You, is free to Maryland and Virginia residents and can be obtained by ordering it on his website. Other readers can obtain it on Amazon.com.
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