What To Know About Workers' Compensation

What To Know About Workers' Compensation

September 29, 2022

No matter how common or safe a job may appear, there is always a chance that you may find yourself in a situation where an accident is inevitable. If you work on oil drilling platforms, as a commercial fisherman, a construction worker, or even as an office assistant, you are frequently exposed to a variety of potentially hazardous situations.

According to a news release from the Bureau of Labor Statistics, companies in the private sector reported 2.7 million nonfatal occupational injuries in 2020. Even though there were 2.7 million fewer workplace accidents in 2020 compared to 2019, a sizable portion of Americans still experience a work-related injury each year. Because they fear their employer may retaliate if they claim for workers' compensation, they may feel mental distress in addition to physical pain.

What Is Workers’ Compensation?

Workers' compensation, also known as "workers comp," is a legally required program that offers benefits to workers who get sick or hurt on the job.

History Of Workers’ Compensation

In Ancient Sumeria, in 2050 B.C., a law was passed to recompense injured workers, marking one of the first known examples of a workers' compensation system. Other nations, including China and ancient Greece, also adopted restrictions of a similar nature.

Let's fast-forward to 1760 when the Industrial Revolution began. During the Industrial Revolution, there was a boom in the manufacturing of goods using new technology and very huge quantities. New technologies and large-scale production both have the potential to create hazardous working circumstances. During this time, employees who suffered workplace injuries depended on the legal system to obtain compensation for their losses.

Continue 150 more years forward until 1911. The first state to do so was Wisconsin, which passed the nation's first state workers' compensation statutes in 1911. In spite of the fact that 36 more states enacted workers' compensation legislation during the following nine years, Mississippi was the final state to adopt such a law for its workers, and it wasn't until 1948 that it became effective.

A Glimpse of American Workers' Compensation Law's History

  • 1908: Federal Employers Liability Act (FELA)- This legislation was designed to protect and provide for injured railroad workers.
  • 1911: Wisconsin Workers’ Compensation Act- Considered to be the first state law that adequately addresses workers' compensation.
  • 1948: Mississippi Passes Workers’ Compensation Act – Mississippi was the final state to pass a law governing workers' compensation in 1948.
  • 1990: Americans With Disabilities Act- This legislation was developed to make it obligatory for all places of business to be handicap accessible, enabling workers with impairments to do so with the required adaptations in a safe environment.

When Is Legal Representation Required For A Workers' Compensation Claim? 

Statistics can show you how often workplace mishaps and injuries are, but they can't tell you what to do if you have an injury at work. Although legal disputes involving workers' compensation are not the most complex, it is crucial to know when to get counsel and who should represent you. The following situations—which are the most critical ones for having a lawyer present—could arise.

  • Your employer rejects your claim.
  • The settlement with your company does not cover all of your damages, including missed pay.
  • Your medical condition either prevents you from returning to work or demands significant limitations on your capacity to carry out your job responsibilities.
  • You were hurt because of the deeds of a third party or obvious employee wrongdoing.

How To Submit A Workers' Compensation Claim

  1. Any accident or injury must be reported to your employer- As an employee, it is your obligation to inform your employer of any illnesses or injuries you have at work.
  2. Your company should walk you through the required documentation- Once you've informed your employer of the accident or injury, they are obligated to tell you of your rights, workers' compensation benefits, and how to get back to work.
  3. Your employer must file a claim and report the incident-Typically, the claim form and any supporting documents should be sent by the employer to the workers' compensation insurance company. Keep in mind that your doctor will also need to provide a medical report.
  4. The insurer either accepts or rejects the claim- Once your claim is lodged, the insurer will determine whether to accept it or reject it.
  5. If you can, you go back to work- Once you have recovered from an injury and are able to return to work, you must notify your employer and the insurance company in writing. Depending on the extent of the harm, the insurance company may be compelled to provide compensation for permanent impairment. With the aim of getting workers back to work and productive as quickly as possible, several firms have also chosen to implement a systematic return to work program.

How to Proceed If Your Claim Is Rejected 

Prior to filing a workers' compensation claim, you must be aware that occasionally employers or their insurance companies may look for any justification to deny it. There are several causes for claim denials, including:

  • Late submissions.
  • Disagreements on whether the accident happened at work.
  • Your injury does not meet state requirements.
  • You made a claim after quitting your job.

Consult with a workers' compensation attorney as soon as possible if one of these conditions has allegedly been violated, but you maintain that it has not happened. Workers' compensation attorneys will defend your rights and can help with any questions you may have regarding the denial of your claim.

Appealing A Workers’ Compensation Denial

As soon as you are aware of the reasons your claim was denied, you can start the appeal process. A date by which you might appeal should also be included in the letter informing you of the rejection; however, time frames vary from state to state.

To further understand the facts around the denial, make sure to speak with your employer or the company's insurance provider. In some instances, a denial can be as easy as a clerical error or misunderstanding, which can be corrected very quickly.

After consulting with your employer or their insurance provider, if you still want to appeal the workers' compensation rejection, you must contact an experienced workers' compensation attorney. You must produce any information, including any medical records, that establishes the basis for the decision in order to give your lawyer the best opportunity of successfully appealing your workers' compensation denial. You might give your lawyer more medical reports or a timesheet showing your job at the time of the accident, for example.

Employer’s Legal Obligations Under Workers’ Compensation Laws

In accordance with state workers' compensation laws, businesses are also expected to adhere to a number of additional criteria in addition to insurance, such as posting notices, reminding employees of their legal rights, and providing claim forms to injured workers.

Signs must be put up by the employer in areas where employees often gather during working hours. The following must be on the notice or poster:

  • Important information on employee rights, including the right to medical care.
  • Information about the available workers' compensation benefits.
  • Indicate if the business is self-insured, the name of the company's workers' compensation insurance provider, or the person responsible for adjusting claims.

Within 24 hours of learning about the work-related accident, employers are required to provide workers' compensation claim documents to the injured workers. Furthermore, businesses must provide written information to workers about their rights under the workers' compensation system (often in the form of a brochure).

Additional Guidelines and Laws for Compensation and Benefits

Since some occupations do not come within the typical workers' compensation, many acts have been put in place to fill in the gaps and allow these individuals to get some form of benefits.

The Merchant Marine Act of 1920

A federal legislation called the Merchant Marine Act of 1920, sometimes referred to as the Jones Act, offers much-needed protection to sailors who risk their lives to flee dangers on the high seas and in other navigable waterways.

The Jones Act's adoption constitutes a big step for these people since, unlike workers on the land, commercial marine personnel are not entitled to workers' compensation benefits. Workers who suffer injuries while working onboard a vessel may be eligible for compensation under the Jones Act due to a lack of safety or negligence on the side of their employer.

The Jones Act also applies to those working on cruise ships, cargo ships, and fishing boats, just as it does to people working on oil rigs.

Who May Submit A Jones Act Claim?

For you to be qualified to file a Jones Act claim, you must be employed as a ship's crew and have spent 30% of your professional time at sea. The Jones Act is somewhat analogous to workers' compensation since it covers the costs of medical treatment, lost wages, and accommodation during rehabilitation.

In the event of catastrophic injuries like limb loss, paralysis, or wrongful death, the Jones Act also entitles sailors to a bigger sum of money as compensation for their pain and suffering, lost future wages, and medical bills. This is the case even if the damage you sustain prevents you from working again.

The Federal Coal Mine Health and Safety Act of 1969

The United Mine Workers' campaign to persuade the U.S. Congress to adopt some kind of workers' compensation program was successful. On December 20, 1969, President Nixon signed The Federal Coal Mine Health and Safety Act of 1969, which offered compensation for workers who had black lung disease. Pneumoconiosis (CWP), silicosis, emphysema, and chronic obstructive pulmonary disease are among the lung conditions that can arise as a result of exposure to coal mine dust and are together referred to as "black lung disease."

The primary goal of the law is to provide universal, federally mandated standards for the health and safety of coal miners. Additionally, it had a very fascinating income maintenance clause that temporarily granted the federal government jurisdiction over workers' compensation.

Federal Employers Liability Act

The Federal Employers Liability Act  (FELA) allows railroad workers to sue for damages if they are injured, get ill, or die while working as a result of the carelessness of their employer. The personal representative of the deceased employee may file a claim on behalf of the surviving spouse, children, parents, or other dependent relatives of a deceased railroad employee against the railroad employer. The railroad employer will be held liable for any employee injuries that are fully or primarily the consequence of their carelessness.

The Longshore and Harbor Workers' Compensation Act (LHWCA)

The payment of benefits to employees who become disabled as a result of workplace accidents that take place on navigable waters within the United States or in close-by locations that are typically used for loading, unloading, repairing, or building vessels is governed by a federal law known as the Longshore and Harbor Workers' Compensation Act (LHWCA). The provision of medical aid and services for vocational rehabilitation are also included.

The Longshore and Harbor Workers' Compensation Act may provide coverage if the oil rig where you now work does not comply with the Jones Act's requirements (LHWCA).

Who Is Eligible For LHWCA?

The LHWCA benefits are typically preferable than those offered by many state workers' compensation laws for the injured worker. The LHWCA further enables injured employees to obtain payments for permanent partial disability, which is not permitted under other state workers' compensation laws. To help in identifying who is eligible for LHWCA payments, the LHWCA has devised two tests known as the status and situs tests.

The Statues Test

The kind of work a person performs has a big impact on the status test. An employee must do at least a portion of "maritime" work in order to be qualified for LHWCA benefits. This implies that a sizable portion of the employee's employment must include using water or maritime transportation.

The Situs Test 

The situs test is the second criterion for evaluating LHWCA coverage. The situs exam focuses on the area where the employee frequently works for the organization. The LHWCA only applies to maritime workers who conduct their operations on, on, or adjacent to navigable water. Furthermore, if a person spends at least some of their time working on piers, wharves, dry docks, terminals, or other areas often used by an employer when loading, unloading, repairing, dismantling, or building a vessel, they are likely to pass the situs test.

Frequently Asked Questions

Q: How should I respond if I am harmed at work?

A: You must inform your employer as soon as you can after suffering an injury at work. Even if you don't think you were wounded, you should still report the accident because some injuries don't manifest themselves until after the fact.

Q: Do I need a lawyer to help me with my workers' compensation claim? 

A: If your injury is severe or you expect to be out of commission for an extended length of time, you might want to consider hiring a lawyer.

Q: What if my organization lacked workers' compensation coverage? 

A: If your organization does not have workers' compensation insurance and you are injured at work, you may be entitled to sue them in civil court. Employers who lack the appropriate insurance may potentially face severe fines and legal action.

Q: What constitutes a workplace accident?

A: An accident is deemed to be work-related if it happens while you are employed by your firm or while you are working. This includes social events that your employer sponsors, such as workplace parties, even if they might not happen on company property.

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