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Workers Compensation

If you're hurt on the job, you may be eligible for compensation.



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State laws require most, but not all, employers to provide workers' compensation coverage for their employees. For example, some states exclude coverage for household workers and farm laborers, and a number of states exempt companies with only one or two employees from the requirement to provide workers' compensation coverage.

Workers compensation is essentially a system of no-fault insurance. Under workers compensation, an employee who is injured on the job is compensated for that injury without having to prove that his employer was negligent. In return, the employer gets the assurance of knowing that it won't be hit with a big lawsuit when a worker is injured. To cover the cost of workers compensation coverage, the employer passes that cost along to its customers in the form of higher prices.

Under most workers compensation laws, an employee is entitled to benefits when injured in the course of employment (while the employee is on the job) and when the injury arises out of the employment (something foreseeable given the nature of the job).

For example, suppose you are employed as a warehouse worker, whose job is to move pallets of grocery items from the loading dock to specified places in the warehouse with a forklift. If you are injured while working your regular shift when a pallet tips over and crashes down on your head, you've been injured in the course of your employment, and your injury arose out of the course of your employment.

Unfortunately, situations that can lead to a workers compensation claim aren't always so clear. Suppose that instead of being injured while on the job, you injure yourself in the company parking lot as you return from lunch. Depending on the state in which you live, a workers compensation claim based on this scenario could either be denied or accepted.

Or suppose you are at work, driving your forklift, when another employee who dislikes you decides to intentionally crash his forklift into yours. Whether or not you'll receive workers compensation may depend on whether the dislike was due to some work-related issue, such as a dispute over a promotion, or whether it was based on a more personal matter, such as his belief that you've been having an affair with his wife.

The modern trend in workers compensation cases is to interpret workers compensation laws in the light most favorable to the employee. As a result, injuries which only a few years ago were deemed ineligible for workers compensation are now more likely to be declared compensable. However, most jurisdictions still disqualify workers when their injuries are the result of their own misconduct, such as when they intentionally disobey their employers' safety rules. And a number of states reject claims by workers who were intoxicated or under the influence of drugs at the time the injury occurred.

If you are injured on the job, or suffer an injury which you believe is work related, you should notify your supervisor about it immediately. If you fail to notify your employer within the time limits set out by state law, you may have even a legitimate claim denied. And in some states the law requires notice within a few days, or as soon as possible, so it's best to act quickly.

Your employer will be required to submit a notice of your claim to the state industrial safety department, and you will need to file a workers compensation claim with the state workers compensation board. While the time limit for notifying the board often isn't as stringent as that for notifying your employer, the sooner you file the sooner you can begin to receive benefits.

Your claim will be examined, and if it's found to be valid, you may be compensated for the cost of medical treatment, as well as amounts paid for items such as crutches and prescription medication. You will also be entitled to receive disability benefits which are designed to reimburse you for earnings lost due to your injury.

Because the premiums employers pay for workers compensation insurance depends to a great extent on the number of claims filed by employees, an employer may contest your claim. It can require you to submit to a medical examination by a physician of its choice, but you also have the right to an exam by a doctor of your own choosing. A hearing will be held by a workers compensation referee to determine whether or not your claim is valid. Either you or your employer has the right to appeal from an unfavorable decision.

Workers compensation appeals can be tricky, and you may want to get some professional legal help if your initial claim is denied. In a few states, the state itself provides legal assistance to a worker whose claim has been denied. In most states, however, you'll either need to contact the local legal aid office, or hire a private attorney to assist you. Many workers compensation lawyers will take your case on a contingent fee basis, and those fees are usually limited by state law.

Because workers compensation laws are supposed to provide adequately for injured workers while limiting an employer's liability for work?related injuries, most states do not allow an employee to file a lawsuit against their employer if workers compensation is available. In a few states, however, the law will allow a worker to bring a lawsuit if the injury is a result of the employer concealing dangerous working conditions or deliberately violating legally established safety guidelines.

In some states, workers have the choice of accepting workers compensation coverage, or "opting out" of the system. A worker who opts out and is then injured in the workplace has to file a lawsuit to recover for injuries, lost wages, and medical expenses. Of course, a worker can't wait until he suffers an injury before opting out, but must decide early on in his employment about whether or not to participate in the workers compensation system.

Unlike unemployment benefits, which are considered taxable income by the Internal Revenue Service, workers compensation benefits are not taxable. Workers compensation benefits are not limited by other kinds of private insurance which may cover you, such as a long?term disability policy. But federal Social Security disability benefits are reduced during the period you are eligible for workers' compensation.

Copyright 1999 ProSe Associates Inc. All rights reserved.

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