PERSONAL INJURY IN GENERAL
It's only natural that when we suffer bodily injury, no matter how severe, we want to blame someone and possibly even be compensated if someone else was at fault... but how far will the law allow us to go? It depends on the type and nature of the injury. To make it easier, I'll break it down by topics. This one is devoted to Work Injuries.
WORKERS' COMPENSATION
You've all heard those words before. What exactly is workers' compensation? In a sense, it is what it says. Workers who get compensated for their injuries. How exactly does the system work? Well, every state and territory in the United States has a system of workers' compensation set up to compensate the injured worker. This system was set up around the beginning of the 20th century as a "great handshake" compromise between the employers and employees. The idea was to compensate the workers without the worker having to establish liability or fault (as in auto accidents). However, as will be discussed below, there are certain limitations as to the types and amounts of compensation available under the workers' compensation system. Again, as I said in my Auto Accident posting, I will try to generalize this so as to not speak about a specific state or jurisdiction.
Compensable Work Injuries
When are you entitled to workers' compensation? When you suffer an on-the-job accidental injury. Generally, the most common injuries are the ones that you can trace to a specific point in time or incident. Common examples are slips and falls, lifting something heavy and injuring a body part, etc. As long as the injury happens in the course of your employment, it will be considered compensable (i.e. you will be entitled to various benefits to be described below). Of course, there are exceptions to this rule which vary from state to state (for example, if you are driving on your way to work from your house and you have a car accident on the way in, you will likely not be entitled to make a claim for benefits).
In addition to an accidental injury at a given point in time, sometimes you can sustain an injury or condition at work over a period of time and not even realize it until years later. This is known as an occupational disease. These come in many varieties- an example would be a worker who develops carpal tunnel syndrome in his/her hands from a period of repetitive movement like typing; another example would be an illness or condition that results from continuous exposure to environmental toxins like mold or asbestos if you work in such an environment (ship yard for example).
Benefits Available
As stated previously, the benefits available vary from state to state, but this section will give a basic overview of the general benefits you may be entitled to if you sustain a compensable injury.
1. MEDICAL TREATMENT: If you suffer an on the job injury or occupational disease, you are entitled to have all medical treatment provided by your employer (or your employer's workers' compensation insurance carrier to be more specific). The key determination is that the medical treatment is reasonable, necessary, and causally related to the original work injury. This is usually an easy determination (for example, if you injure your back, it is reasonable to get physical therapy or chiropractic treatment, and maybe even surgery). In some cases however, it is necessary for a doctor to actually render an opinion that the treatment is reasonable, necessary, and causally related to the original injury. Medical treatment includes such things as doctor's visits, physical therapy, chiropractic care, MRI's, x-rays, CT Scans, surgery, prescription medications, and injections, just to name a few.
One important thing to keep note: NEVER ATTEMPT TO HAVE THESE EXPENSES PAID BY YOUR HEALTH INSURANCE. These are the responsibility of the employers' workers' compensation insurance carrier. If you do put them through your health insurance, your health insurance may pay them, but may ask to be reimbursed later if you get a significant monetary award as a result of your injury (i.e., the health insurance carrier may put a lien on your future award).
2. TEMPORARY WAGES- While you are in active medical treatment for your injury(ies), you are entitled to be compensated if you miss time from work due to your medical treatment, or if your doctor requires you to be off of work for a period of time. This is sometimes referred to as "Temporary Total Disability." Basically, when you are temporarily totally disabled from working due to your injuries, you are entitled to be paid a portion of your wages. In some circumstances, you may be able to work, but not full-time, or not at full-duty. If you are forced to work part-time or earn less wages while you are receiving medical treatment, then you are can receive a portion of your wage loss differential (i.e. the difference between your full wages before the injury, and the partial wages after the injury). The idea is to make sure you don't lose your wages just because you were injured and can't work. Also, important to note, you are entitled to past time missed from work if you don't file a claim right away.
3. VOCATIONAL REHABILITIATION- After you have reached the point of maximum medical improvement (or when you have improved as much as possible after medical treatment and you are as good as you will get), you may be injured to the point that you cannot return to your pre-injury employment or anything comparable. Under those circumstances, you may be entitled to job re-training and/or job placement by a professional vocational counselor. The idea is to help you find employment if you have permanent restrictions as a result of your work injuries. During the period of time you receive such vocational assistance, you will usually be entitled to temporary total disability benefits (since you won't be working, but rather looking for work).
4. PERMANENT DISABILITY- In almost all, if not all jurisdictions, this will be the last benefit you are entitled to receive. You may sustain a permanent injury or disability as a result your initial injury. Most people sustain a permanent partial disability to a specific body part or the body as a whole (expressed in a percentage) and some even sustain a permanent total disability (100%). Permanent disability does not necessarily mean that a person cannot work at all (except for permanent total disability). Based on the amount of permanent disability you sustain, you will be entitled to permanent disability benefits (or payments similar to those received as temporary total disability benefits). Sometimes you receive them on a regular weekly basis, and sometimes you receive them in a lump sum.
CLAIMS PROCESS
So how does the whole process work? Well, it all begins with notifying the employer. Many jurisdictions require that you notify the employer of your injury within a certain time period of the injury occurrence. After you have done so, the next step will be to file a claim with your state's workers' compensation commission- many can be filed via the commission's website for your state, and an attorney can normally help you with this process. The claim will then be sent to the employer, who will in turn send the claim to its insurance company.
In some circumstances, the employer/insurer will accept the claim and provide benefits as allowed and as the employee is entitled to receive. In other circumstances, if the employer/insurer does not accept (or contests) the claim, the workers' compensation commission will help sort out disputes and hold informal hearings to determine when benefits are allowable by law. This usually involves testimony under oath from the claimant (worker) and presentation of documentation as evidence, particularly medical records and reports. Although these hearings seem like formal trials, they are informal and are decided by Commissioners who are normally appointed by the Governor of your state.
After a decision is rendered, either the employee or employer/insurer may appeal to the appropriate court or other agency within the state if they believe the Commissioner made an error in his/her decision. Like any other personal injury matter, many workers' compensation claims settle out of court or the workers' compensation commission. However, settlement is not always the best avenue to pursue because the worker is entitled to certain continuing benefits after any permanent disability benefits are allowed, including lifetime necessary medical treatment related to the injuries sustained by the worker, and the possibility of reopening the claim within a certain time period if the worker's injury or condition worsens.
The most common misconception of injured workers is that they are "suing" their employer for the injury. This is not so! You are simply making a claim for benefits you are entitled to by law. Even if you file a claim with the workers' compensation commission, you are not filing a lawsuit in the same sense as a car accident matter. Along those lines, you should not feel intimidated or awkward for making your claim. Your employer cannot treat you disparately or retaliate against you for filing a workers' compensation claim, and the employer cannot terminate you either.
FINDING THE RIGHT ATTORNEY
I, like most of my constituents, work very hard for my clients to ensure that they are taken care of and treated fairly. All attorneys on behalf of injured workers are paid on a contingent fee basis, which is set by law. Again, this means that you will pay nothing unless you recover money by way of a settlement or award, and your attorney will be entitled to a fee as a percentage of the total amount recovered. Expenses will also be deducted, but will generally not be collected unless any amount of money is recovered, and this is also set by law. Your attorney will specifically discuss this with you when you sign the legal services agreement prior to beginning work on your claim.
Workers' compensation cases can be quite time consuming and stressful, which is why your attorney and his team are here to help to move things along as quickly as possible. The most important thing to remember for any workers' compensation matter is that YOU are in control. Yes, YOU steer the ship. Your attorney is your counselor and advisor and will guide you through every step of the process. But you will make all final decisions- whether to settle, for how much to settle, whether to appeal a decision of the workers' compensation commission, etc. While nobody wants to be get injured on the job, you should definitely get what you rightfully deserve to make you whole again, and we're all here to help.
WHAT TO DO IF YOU SUFFER A WORK INJURY
1. Notify your employer promptly. Even if you're out of work due to the injury, call in or have someone call in on your behalf- your employer will probably have a designated representative or human resources person to record and document such work injuries.
2. Seek immediate medical treatment, even if you think nothing is wrong with you. A doctor can best determine what if any injuries you have or may sustain, what course of treatment will be necessary, and whether it will be necessary for you to miss time from work. When you see the doctor, make sure you notify him/her that this is a workers' compensation injury so you will be billed accordingly.
3. Keep track of your new injuries or aggravation of pre-existing injuries that you believe were caused by the work incident.
4. Keep a regular journal or diary. If the injury occurred to a loved one who is not capable of doing so, keep a journal or diary for them. Include daily notes of problems experienced, limitations in daily and/or work activities, medical treatment sought or received, medical expenses paid by health insurance or out-of-pocket, time missed from work, and any other relevant information.
5. Consult with an attorney immediately! You may not be fully aware of your rights, and don't forget, you have a time limit (statute of limitations) in which you can file such a claim, or you will be forever barred from doing so.
6. NEVER SPEAK to anyone about this claim without first consulting an attorney. If you have an attorney, it is unlawful and unethical for anyone to try to speak to you about your claim, including the insurance company.
7. Remain calm and patient, and know that your attorney will work hard to determine if you have a valid claim, and to make sure you get what you deserve if you do.
Regardless of content, the information contained in this blog is intended for educational purposes only and shall not operate to bind the writer or any associated or referenced business, law firm, or other entity to any order or other contract unless pursuant to explicit written agreement or government initiative expressly permitting the use of such blog for such purpose. The reader hereby expressly agrees to save and hold harmless from liability the writer or any associated or referenced business, law firm, or other entity for the information provided in this blog, and further acknowledges that the information contained in this blog does not constitute legal advice or counsel, and shall merely be construed as informational, and not binding advice. The reader further acknowledges and agrees that this information does not serve to create a lawyer-client or other legal relationship between the reader and the writer or any associated or referenced business, law firm, or other entity.
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