ALL ABOUT WORKERS’ COMPENSATION COVERAGE
March 30, 2020
No one expects to be hurt on the job. When a worker is injured on the job, that worker’s medical costs and a portion of lost income may be covered by the Workers’ Compensation Act. Three important first steps that workers should take to protect this coverage are the following:
Notify your employer as soon as possible.
Get names of witnesses.
Seek medical treatment. A worker is entitled to medical treatment provided by doctors on a posted list. These doctors are preapproved by the workers’ compensation insurance company.
Employers and their insurance companies have their own lawyers on retainer who represent their interests. A worker should consult and retain an experienced workers’ compensation lawyer to protect his or her interests. Claimant attorneys represent injured workers under contingency-fee contracts that are approved by the State Board of Workers’ Compensation. If there is no recovery, then there is no fee due. The contingency fee is limited to 25 percent of any recovery.
By law, employers must have three or more employees to be covered by the Act. Some employers will have purchased coverage even with fewer than three, but some employers with over three employees fail to purchase coverage. A worker should find out if his employer is covered. Also, if a worker is working as an independent contractor, then he may not be covered under any workers’ compensation policy.
Workers’ compensation is a form of insurance providing partial income benefits and medical benefits to workers injured in the course of employment. In exchange for this no-fault coverage, the worker loses his right to sue the employer for negligence. As part of this tradeoff, the worker can recover a portion of his lost income (66 percent of pre-injury income up to a maximum of $500 a week) and limited medical coverage as approved by the insurance company or by the Workers’ Compensation Board.
The injured worker does not have to prove that the employer was at fault in causing an injury, but the injured worker also does not have any right to recover pain and suffering damages. That is part of the trade-off for no-fault coverage. Also, if the employer’s insurance company accepts the claim, then it also has a right to control treatment. The insurance company can also decide when to cut off benefits.
If the employer’s insurance company denies coverage, then the worker can file a request for a hearing with the Board of Workers’ Compensation. An administrative law judge will hear the evidence to determine the facts of injury, the degree of disability, and the degree of coverage. If a third party—someone other than the employer—causes a worker’s injury, the worker’s recovery from this third party is not limited by the Act.
In a third-party claim, the worker can file a traditional lawsuit for recovery of his or her full losses, including full lost income and pain and suffering damages. It is important to know your rights as an employee. If you have been injured on the job, you should retain an experienced personal injury lawyer.