Have you been injured on the job? You might be entitled to benefits. The concept behind workers’ compensation is easy to understand, but the laws are frustrating to navigate. At its core, worker’s compensation is an insurance policy carried by an employer. When you are injured on the job, the plan pays out benefits for a certain amount of time during the disability.
The advantage to workers’ compensation is that it doesn’t require employees to prove their employer was at fault. For example, if you fall off a ladder at work and hurt yourself, you don’t have to show that it’s the employer’s fault. There are exceptions. These exceptions include that your injuries can’t have been from your own willful misconduct (having a who can jump off the highest rung of the ladder contest) or be a result of drugs or alcohol.
In this article, we’re going to teach you some general information about workers’ compensation law. This information will help when you meet with a workers’ compensation lawyer at an initial consultation. We’re also going to explain different ways that a workers’ compensation lawyer might be able to help your situation. Finally, at the end of the article, we link to our guide which lays out the specific steps to take on how to get a lawyer.
General Information On Workers Compensation Law
Before we proceed, you need to know that the information provided on this webpage is only general information about workers’ compensation law. It is not legal advice and it is not even specific advice. Instead, it is general information to help you prepare for a consultation with a workers’ compensation lawyer. At the consultation, the lawyer can give you legal advice on your specific situation.
Workers Compensation Depends on State Law
The laws for workers’ compensation depend heavily on state law. You should speak to your lawyer who can advise you on the laws of your state. Here are some of the ways workers’ compensation laws can differ depending on the state:
- Which companies must carry workers’ compensation insurance
- Which employees are eligible for coverage
- Injuries covered and related regulations
- Length of time an employee has for filing a workers’ compensation claim
- Payout amounts and death benefits
- Exclusions (ex., willful misconduct, injuries attributable to drugs or alcohol, etc)
Categories that Affect Benefit Calculation
Benefits for a workers’ compensation claim are paid every week. The total amount of benefits paid for a claim depend not only on state law but also on the classification of the disability. Most states break up workers’ comp claims into four main groupings:
Temporary Total Disability
Temporary total disability is where an employee’s injury resulted in a disability that prevents
The insurance company will pay benefits until the employee recovers. Although, some states put a limit on how long benefits can be paid. In some states, this time limit is capped at 52 weeks, whereas in other states it is capped at 500 weeks. A workers’ compensation lawyer could help you figure this out for your state.
The amount of the weekly benefit depends on the employee’s prior salary. Usually, benefits range about 66% of their prior weekly wage, but every state puts a cap on the maximum weekly benefit. The benefit could differ, depending on their state, anywhere from $350 to $1,300 a week.
Temporary Partial Disability
Temporary partial disability is where an employee’s injury resulted in disability and they are expected to recover. The employee can perform some work while partially disabled, but the work is often at a reduced income level.
The insurance company will pay benefits until the employee recovers. Some states do limit the duration of the payments. Just like total disability, a state could limit benefits to 52 weeks or extend it out to 500 weeks.
The amount of the weekly benefit depends on the employee’s prior salary. The computation begins just like calculating temporary total disability. Once that amount is determined, the state then subtracts a percentage based on the reduced income they are receiving at their new position or job. The remaining amount is the weekly benefit paid by the state.
Permanent Total Disability
Permanent total disability is for employees with injuries so serious that they are not expected to recover for the rest of their life. It is a total disability because, according to state law, the employee is not able to work.
In most states, the insurance company will pay benefits for the rest of the employee’s life. The total weekly benefits are roughly 66% of their previous weekly salary. This amount is capped at a certain amount depending on the state. As already stated, the amount could be capped as low as $350 or as high as $1,200 depending on the state of residence.
Permanent Partial Disability
Permanent partial disability is for employees with injuries so severe that they are not expected to recover for the rest of their life. Unlike a total disability, the employee can still hold a job, but often at a reduced income level.
Benefits for a permanent partial disability do not last for life, as they would for permanent total disability. In general, the weekly amount of benefits is fixed, but the duration varies depending on state laws and a disability rating percentage calculated by the employee’s doctor. The rating refers to how disabled they are according to the rules in their state. For example, if the employee loses a toe, you might be given a disability rating of 5%. The insurance company would multiply this rating by the number of weeks that the state provides disability benefits for a lost toe (ex., 100 weeks). The resulting amount would be the number of weekly benefit payouts (ex., 5% of 100 weeks is five weeks of benefits).
Additional Workers Compensation Benefits
In addition to weekly disability benefits, a state often makes available the following additional benefits:
Medical & Hospital Benefits
In addition to weekly benefits, many states also provide disabled individuals with medical benefits for the duration of their disability. These benefits vary by state but can include medical treatment, hospital and nursing services, medicine, assistance devices, and artificial or prosthetic limbs and devices.
In many states, when a worker dies, a surviving spouse and their children are entitled to death benefits. These benefits are usually in the amount that the deceased spouse would have received as a disability benefit, but many states cap the total payout to some amount, such as $50,000 or more.
Workers Compensation Stops Lawsuits
A little-known fact to employees is that if their employer carries workers’ compensation insurance, they generally cannot sue their employer. This is called the grand bargain. When a worker is injured they don’t have to prove their employer was at fault and they get benefits. These benefits are often reduced from what they could have been awarded at trial had their employer not had workers’ compensation. In exchange, the employer is not at the mercy of the court for certain injuries.
There are a few exceptions to the rule and an employee that is injured on the job could still sue someone:
Exception 1 – Injury by Someone Other Than An Employer
An employee might be able to sue someone other than their employer if the other person was responsible for the injury. Other examples include injuries due to defective equipment manufactured by someone other than the employer, injuries due to chemicals interacted with at work produced by someone other than the employer, etc.
Exception 2 – Intentional Injury by Employer
In most states, an employee can sue an employer who deliberately or intentionally caused the injury. An intentional injury is a standard beyond negligence. In some instances, this might be where the employer knew of the potential for injury but hid the danger. The issue could also arise when a superior physically assaults an employee. These types of situations fall under something called “tort” law which a workers’ compensation lawyer can explain.
Exception 3 – Employer Doesn’t Have Workers Compensation
In every state, employers that have a certain number of employees below a threshold don’t have to purchase workers’ compensation insurance. The threshold varies by state law and you should talk to your workers’ compensation lawyer for specifics on your state.
Be aware that most states will let allow injured workers’ to sue employers who don’t have workers’ compensation insurance. This might sound great, right? It depends. Keep in mind that winning at trial requires proving that it was the employer’s fault, which is not a requirement with workers’ compensation.
Each state may have additional exceptions that allow suing an employer, but this will depend on the laws of the state. You need to talk about these things with your workers’ compensation lawyer. There are many attorneys who offer free consultations and can lay out your options in regards to your specific situation.
How a Workers Compensation Attorney Can Help
You would be surprised by the many ways a workers’ compensation lawyer can help. They can help fight denial letters, determine payout amounts, assist in filing a claim and gathering evidence.
Fight a Denial Letter
In situations where an employee loses a finger, an arm or leg or something that is easy to quantify, calculating benefits are easy. The benefits are determined based on state payout charts and the disability rating from a doctor. In these situations, insurance companies will often not deny the claim, unless there are other circumstances in the mix.
There are other instances, however, which are easier for an insurance company to wiggle away from liability. In these harder to determine situations, insurance companies look through the employee’s medical history for any hint of preexisting conditions. If they see the employee went to the doctor for a coughing episode years ago, they will argue that was an indication the employee already had lung cancer.
At this point, the employee needs to hire a workers’ compensation lawyer. They can fight back against this disingenuous treatment by the employer and insurance company.
Help Determine Payout Benefit Amounts
There are some disabilities that make computing benefits more difficult. A workers’ compensation attorney can help navigate the state laws and make sure the insurance company is offering a fair amount according to state law. In every situation, an insurance company wants to limit their payments as much as possible. Sometimes, this ends up hurting employees with real and serious injuries. In these cases, hiring a lawyer can make the difference between not receiving any benefit, and receiving what the employee is entitled according to the law.
Assist Filing Your Claim
Workers’ compensation claims carry with them many deadlines. In most states, an employee only has 120 days to report an injury to an employer. If the employee fails to report the injury within this period, they might not receive any workers’ compensation benefits. The claims process also has many other state-mandated deadlines which must be met. A worker’ compensation attorney will know about these deadlines and can help in filing your claim.
An attorney can also help ensure the insurance company is not acting in bad faith. It has happened before than an insurance company would drag their feet and request an unreasonable amount of paperwork to verify a claim. The insurance company hopes that the employee will give up on the claim and, well, go away. This is wrong!
Gather Medical Records and Associated Documentation
What happens after an employee is injured? In most situations, the employer created an incident report of the injury. A supervisor might have filed a report with their supervisor or human resources. Hospitals will have records of the visit and treatments. Doctors, physicians, nurses, anyone that the employee had contact with regarding your injury may have records. These are all valuable records which a lawyer can gather and use to establish the nature and severity of the disability.
Many employees find gathering records and meeting deadlines difficult, especially when they are busy dealing with their disability. The last thing an employee who is laid up in a hospital bed wants to worry about is finding records and completing paperwork. These are all things that a lawyer with experience in workers’ compensation law can do for the employee!
Represent and Negotiate on Your Behalf
One of the main function of an attorney is to best represent the employee’s interests in the face of opposition. A workers’ compensation attorney will go with the employee to any depositions, meetings with opposing attorneys. They will also attend meetings with the employer and the insurance company. A lawyer can negotiate in the employee’s place and they have their back. There is no need to do it all alone with a lawyer. Let the lawyer do the heavy lifting and focus on recovering from the injury.
How To Get A Workers Compensation Lawyer
If you’ve come this far, then you should have enough general information about workers’ compensation law to assist a lawyer in advising you about your specific situation. Also, you should have a general idea about how a workers’ compensation lawyer can help your situation.
But before you start searching for a local workers’ compensation lawyer, there is one more step you should take. We highly recommend reading our guide about how to get a lawyer. In the guide, you will learn many things about how to get a lawyer. Here is an example of what you will learn:
- How to find a lawyer experienced with workers’ compensation law.
- How to research the lawyer’s background.
- Questions to ask before an initial consultation.
- Questions to ask during an initial consultation.
- Observations to record about the lawyer
- How to decide whether to hire the lawyer.
Once you read this guide, you should be prepared to hire a lawyer to help with your worker’s compensation needs.