Workers’ Compensation Claims FAQs

Workers’ compensation programs provide support to individuals who are injured or become ill as a result of a work related event, activity or exposure. For workplace injuries and illnesses, employees typically must be compensated through the workers’ compensation program rather than through a lawsuit. Most employers are required to keep workers’ compensation insurance policies, but just because they exist does not always mean that an injured employee will find it easy to have their claim accepted. There are many factors that can impact an individual’s ability to get workers’ compensation.

Are all employees covered by workers’ compensation policies?

No, not everyone is covered by workers’ compensation insurance policies. Not every company or place of business must keep workers’ compensation insurance. The rules are determined by the states, so they vary, but sometimes very small employers with only a handful of employees might be exempt from the need to maintain a workers’ compensation policy. Additionally, employees of certain types or in certain industries might not be covered by the state workers’ compensation laws. However, most places of employment will have to comply, and most employees must be covered.

Does workers’ compensation cover any injury that is work related?

No, but most injuries that are work related qualify. Workers’ compensation is often referred to as a “no fault” system because there is no need to show that an employer did anything wrong in order to be able to collect benefits from the program. This is the trade-off employees get in exchange for the fact that they cannot usually sue for work related injuries in a court of law. This benefits employees because even if the employee’s own lack of care or caution caused the injury to occur, workers’ compensation should be available to that employee. There are exceptions however, for scenarios where the employee is guilty of serious wrongdoing. If an employee arrives at work severely inebriated and his or her intoxication leads to an injury at the place of work, the employee might not be covered. Additionally, if the employee is engaged in a criminal act at his or her place of work, and suffers an injury during the course of that act, then he or she will likely be denied coverage. If the employee starts a fist fight with a co-worker and is injured, again, this would probably not qualify, nor would an employee qualify when he or she egregiously violated a safety policy that the company instituted and enforced.

The laws of the governing state, and specific facts of a case might present questions about whether the employee is eligible for workers’ compensation benefits.

Does workers’ compensation only cover injuries at the worksite?

No, while state laws vary on this as well, the injury does not have to occur at the place of work. An employee injured while running out to pick up lunch for a company meeting would likely qualify, and if the company hosted an event somewhere off of the company’s property, an injury that occurred there would probably qualify as well. The important thing is that the employee was injured doing something that was a part of their job, and that the injury occurred as a result of that work related activity.

What types of injuries are covered?

Many types of injuries are covered. While it is common to think about injuries cause by one accidental event in the workplace, many claims involve injuries that result from a repeated activity, and these injuries tend to develop over time, rather than arise from one event. The classic example of this is carpel tunnel syndrome. Other workers’ compensation claims arise out of illnesses, such as mesothelioma. Mental health issues can be covered too if they result from a workplace event or atmosphere.

With many slow building injuries, physical illnesses, and mental illnesses, the problem many employees face is proving the causal relationship between the illness or injury and their place of work. In some cases, the impact of exposure to a substance, or a repeated activity will have well documented links to specific diseases and injuries, but in many cases, the employee will have to show that the link exists.

Do I need an attorney to file a claim?

No, you usually will not have to have an attorney to file your claim. Instead, you can likely file the claim yourself, by notifying your place of work, and depending on the state, filing a formal claim with the state. However, consulting an attorney can help you develop a strategy for your case and increase your chances of success. If your claim is denied, you should reach out to an attorney to discuss appealing your claim.

Contact Stern Law, PLLC for A Free Consultation

At Stern Law, PLLC, we have compassionate and caring attorneys ready to work with you in order to find the best way strategy for seeking compensation for your job related injuries. Contact Stern Law, PLLC today at (844) 808-7529 for a free consultation with an experienced attorney.

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