There is nothing wrong with applying for compensation if you have been injured at work or developed a condition from your working conditions- even if the reason why is “your fault.” The workers’ compensation program exists for a reason- sometimes things just don’t go as planned. Whether your condition is due to an accident or an oversight on anyone’s part- the aid you can get could keep you from going into debt or losing your job.
If you are thinking about filing, the most important thing you can do right now is to get checked out by a doctor right away. Make it clear why you are there and that you will be filing a claim for workers’ comp. Then you need to make sure to have a record of the injury on file with your employer. If your illness or injury was due to an accident those reports should, ideally, be filed the same day. If it was due to repetitive stress or exposure, it’s important that you file a report as soon as possible after you or your doctor notices the condition.
Eligibility – Benefits
The biggest question most people have before filing is how much they could get. The truth is, 3 out of 4 valid workers compensation claims will result in the coverage of all medical expenses. Only 1 in 4 will result in an additional cash payment. However, it’s important to keep in mind that many cases are for minor injuries that do not fit the bill for maximum compensation categories.
Worker’s Compensation (Workmans’ Comp) Benefits are divided into 6 main categories:
- Medical Benefits – This is the most commonly awarded group. If your condition falls under Medical Benefits then, as the name suggests, all of your medical expenses will be covered but no more. To fit into this category, the majority of your recovery time will occur in the 3-7 day waiting period before benefits begin to accrue and there will be no lingering disability.
- Temporary Partial Disability – With this category, you are injured but can still work in a reduced capacity. While you are recovering, you may receive partial disability payments determined by the type of injury and length of recovery.
- Temporary Total Disability – To qualify for this category you would be injured or ill in a way that leaves you unable to work but with a high chance of full recovery. If you have received or been deemed eligible for a cash payment, this is usually the category your disability will fall under. Under this category, you will receive up to 2/3 of your pre-injury wage.
- Permanent Partial Disability – If you have a permanent disability but can still work you may qualify for this category. The amount of these payments vary by state but usually work in a similar way to Temporary Partial Disability payments.
- Permanent Total Disability – If, after a period of recovery, you are judged to have a permanent and total disability preventing you from working you will receive these benefits.
- Death Benefits – In the case of a death, workers’ comp benefits may help the family or eligible dependents for a time. Benefits may cover funeral costs or partial earnings depending on the program.
Eligibility – Special Conditions
Certain circumstances may make determining your eligibility a little trickier and may require more proof on your part. Though it is likely that you will still be eligible to receive benefits in these circumstances, consulting a lawyer that is experienced in workers’ compensation cases in your state may increase those chances. These circumstances and conditions include:
- Car Accidents – If injured during a work related trip or errand you may be eligible. If you were on a work or meal break, you are likely ineligible.
- Mental Health – Though often difficult to prove, workers’ comp does cover mental health.
- Preexisting Conditions – You may not be approved for a preexisting condition unless it was aggravated, inflamed, or made worse by your current job.
- Injuries on Company Time but Not At the Office – These may be covered depending on where they occurred, proof that the injury is work-related, and state-specific factors.
The Cost of Cheating
Once you have been approved, expect some deadlines and checkups. Getting you back to work as soon as possible is a top priority. “Malingering” or cheating your way into a workers’ compensation problem is harder than you might think and can result in severe penalties. Depending on your employer and state, an Insurance agent or another inspector may visit you at scheduled or random intervals to check up on your disability claims or the progress of your recovery. As long as you are still legitimately ill or disabled, this shouldn’t be a problem- it’s only meant to weed out anyone draining resources away from those that need them.
How to Know If You Are Exempt
Each state has it’s own workers’ compensation laws and program regulations. In most states, employers are compelled by statute to offer workers’ comp losing many protections.
Industries that are frequently exempt include:
- Small Businesses
- Part-Time Workers
- Domestic Service
Even if you work in one of these industries, you may still be covered depending on your state. Just know that you may be offered reduced benefits even if your employer has opted into a workers’ compensation program. In any case, documenting the injury or illness and consulting a knowledgeable lawyer to confirm your status is never a bad idea.
How Long It Takes to Receive Benefits
It can take several weeks to over a month to receive benefits. If you are planning to file a claim and your employer does offer a workers’ comp program, then your medical bills may be covered immediately from the time of the accident. They may alternatively be deferred until a final ruling has been made on your claim.
What to Do If You Are Turned Down
If you believe you have been wrongly rejected or declined workers’ comp, you can reapply or append your original application. You will often need additional evidence to support your claim or to show that a mistake was made on the original request by you or your employer. Often, a lawyer can help find any areas in your original application that were lacking or help you through the reapplication process in general.
Returning to Work
You may never be fired for applying for workers’ comp. However, you may be fired or lose your benefits for reasons unrelated to your injury. These reasons could include downsizing, failing a drug test, poor work performance, and more.
Once you can return to work, your work life should be the same as it was before. If, after filing a claim, you have reason to suspect that you are being treated unfairly for doing so it is in your best interest to get a legal consultation as well as file a complaint or bring up your concerns with your company’s HR department.
Consulting and Hiring a Workers’ Compensation Lawyer
If you have just been injured or discovered a lingering condition- facing the prospect of being unable to work with bills looming can be frightening. However, a workers’ compensation attorney can help for a very reasonable fee- one that is usually not paid until after you have been awarded benefits.
When working with a professional, you will have less stress when it comes to deadlines, coming up with sufficient proof, and making sure you follow every rule even after you have applied. Once your claim has been approved, the worker’s compensation panel will recommend the fair rate of compensation for your attorney- typically between 10-20% of the benefits awarded.
Regardless of why you are seeing workmen’s compensation, you need to contact an attorney. There are too many nuances of workmen’s compensation law to try to handle it on your own. Your focus always needs to be on recovering. The right attorney will make sure you can keep your focus where it belongs.