When someone is injured at work, the workplace may be responsible for their injuries. What this means is that the business's workers' compensation insurance will cover medical bills, lost wages, and other costs related to the injury instead of the injured person having to pay out of pocket.
However, it is common for workers' compensation claims to be denied. It is important for the injured person to make sure they qualify for workers' compensation when filing a claim for compensation.
How Workers' Compensation Works
Workers' compensation is intended to help cover the cost of recovery for injuries or illnesses that occur in the workplace or as a result of work-related activities.
If someone is injured at work or becomes sick because of their job, workers' compensation should cover medical bills and related expenses like lost wages while they recover.
However, it's not always easy for employees to get the compensation they need from their workers' compensation claim. Instead, they may need to work with a lawyer for worker's comp to get the right help and make sure they can get the full amount of compensation they're entitled to for their injuries.
When someone is injured or ill because of their workplace, the first step should be to seek medical attention. They will want to let the employer know that they have been injured as a result of something that occurred at the workplace or within the scope of their job.
After receiving the emergency medical attention, the employee can then file a claim for workers' compensation. It is important to do this carefully and provide all required documentation, like medical bills, to have a higher chance of being approved and receiving compensation for the injuries.
If a person is not provided information on how to file a claim or is unsure what steps to take, calling a lawyer is recommended.
An Employee of the Business
In order for someone to be able to claim workers' compensation benefits, they do need to be classified as an employee. Independent contractors and freelancers are not eligible for workers' compensation.
However, if someone is classified as an independent contractor, they may want to look into their classification to see if it's correct. Even though they are labeled as an independent contractor, they may meet the requirements to be considered an employee. If the workplace sets their hours, for example, they may be an employee and be incorrectly classified.
This would mean they could qualify for workers' compensation. It is a good idea for anyone who is not classified as an employee to look into the differences to see if their label is incorrect.
The Business Carries Workers' Compensation Insurance
Most businesses are required by law to have workers' compensation insurance. However, there are some exemptions to the laws that can be applicable. Since the laws can vary from state to state, it is important to check the state's requirements to see if it is required.
In general, any business with more than four employees, whether they're full-time, part-time, or seasonal, will need to have workers' compensation. There are additional requirements for construction or agriculture jobs, and there may be other requirements if there are any employees who live out of state.
If the employer is supposed to have workers' compensation and does not, they may be subject to penalties.
However, it is important to note that there are exemptions where a business that otherwise would need to have workers' compensation is no longer required to have it. If a workplace does not have workers' compensation or an alternative option, it is a good idea to speak with a lawyer about the options to gain compensation for any injuries or illnesses.
Injury or Illness is Work-Related
The employee will need to be able to show that their injury or illness was related to their work. If someone is injured due to an accident in the workplace, this could be easy to show.
However, if the person becomes sick or ends up with an injury such as a repetitive motion injury, this can be a little more challenging to prove. It is important to have as much evidence as possible about how the injury or illness occurred. In some cases, medical experts may be needed to show that an injury or illness could have been related to the person's job. This typically happens if the person is denied and appeals their case.
The medical expert will testify at the appeals process that the injury or illness was work-related.
Injury Was Reported Before the Deadline
It is incredibly important to ensure that the injury was reported to the workplace by the deadline. The amount of time that someone has to report an injury or illness to their workplace can vary by state, with some states having a reporting period of as little as 72 hours.
A claim does not need to be filed within this period, but the workplace does need to be notified of the injury. It is a good idea to make sure the notification is in writing to ensure there is a paper trail in case the business or insurance company tries to say that the injury or illness was not reported in time.
Medical Treatment Was Obtained
When a worker is injured or ill because of their workplace, they will want to seek medical attention right away. If they wait too long, the workplace may try to claim that the injury or illness occurred outside of work and, therefore, the person isn't qualified for workers' compensation.
If the injured person doesn't seek medical attention, the workplace may deny the claim as unfounded, and the worker may not be able to receive as much compensation for it, even if their claim is approved.
Workers should make sure they keep track of all medical documents related to their injury or illness.
Copies of bills will be needed to show how much compensation they should receive for their medical treatment. If the worker is permanently injured as a result of an accident at work, they may also need the documentation to show that the injuries are permanent and they no longer have the ability to work as a result. This can help them get compensation for potential loss of future earnings.
What Disqualifies Someone for Workers' Compensation
Even if a person is otherwise qualified to receive workers' compensation, there are some exceptions that will mean they do not get compensated for their injuries or illnesses. Some of the most common reasons a person will be disqualified include the following.
Under the Influence - A drug test can be done at the hospital after a person is injured at work. This is typically required to show that the person was not under the influence of drugs or alcohol at the time of the incident. If a person fails the drug test or refuses to take it, the claim can be denied.
Self-Inflicted - A person who causes the injury on purpose to get out of work and get compensation for their injury may not be able to file a claim or may have it denied.
Due to Reckless Behavior - If the person caused the injury to themselves because they were acting inappropriately, did not follow workplace rules, or failed to use proper personal protective equipment (PPE) that was required and available, they can be denied a claim.
Off-Duty at the Time - If a person was not clocked in to work when they were injured may not be able to file a workers' compensation claim. This can vary, though, and they may be able to prove that they were supposed to be clocked in, so it is a good idea to speak with a lawyer if the employee is denied for this reason.
How to Get Help With Determining Qualification
There are complex rules and regulations surrounding qualifications for receiving workers' compensation, and they do vary from state to state.
A person may be initially denied compensation even though they believe they do qualify under their state laws. In these cases, they may want to speak with a lawyer about their situation. The lawyer is familiar with state laws, exemptions, and more, and can review the case carefully. If the person is qualified but was denied, the lawyer can help them file an appeal to request compensation again.
This process can be highly complex and take a significant amount of time, so it is recommended for employees who are injured or ill at work to seek legal assistance if they are initially denied compensation.
If you've been injured at work, you may be owed workers' compensation to help cover medical bills, lost wages, and other related expenses. However, it is important to make sure that you qualify for compensation.
Use the information here to determine if you're qualified. If you aren't sure if you should receive workers' compensation for your injuries or if you've been denied, it is a good idea to schedule a consultation to speak with a lawyer and get more information about your specific situation.