Workers' Compensation (Workman's Comp) Claims
By Aaron Larson
March, 2005
Contents
- Overview of Workers' Compensation
- Exclusions from Coverage
- Special Federal Statutes
- Litigating Workers' Compensation Claims
Overview of Workers' Compensation
Workers' Compensation (sometimes called "Workman's Compensation" or "Workers' Comp") is a system of laws under which workers are guaranteed specified benefits in the event that they suffer work-related injuries, but in return give up their right to sue. This "no fault" system provides significant protection to injured workers, even those responsible for their own injuries, by providing compensation for such costs as lost wages, medical care, and rehabilitation. Workers' compensation laws also typically extend death benefits and a burial allowance to workers killed on the job.
It is sometimes possible for an injured worker to pursue both a workers' compensation claim and a personal injury claim. It will benefit any injured worker who believes that a personal injury claim may be available to discuss that possibility with a lawyer.
Exclusions From Coverage
Depending upon the jurisdiction, an employee may be restricted from collecting workers' compensation benefits if the injury or death giving rise to the claim resulted from the employee's own willful misconduct or intoxication. Workers' compensation laws typically provide do not shield an employer from tort liability where the employer intentionally causes injury to a worker.
Special Federal Statutes
There are some special federal laws which provide additional protection to certain classes of worker:
- The Black Lung Benefits Act - This Act provides compensation to miners who suffer from from pneumoconiosis, a condition commonly known as "black lung" disease.
- The Federal Employment Liability Act (FELA) - This Act makes railroads engaged in interstate commerce liabile to employees who suffer injury as a result of the railroad's negligence.
- The Jones Act (The Merchant Marine Act) - This Act provides seamen with the ability to seek "maintenance and cure" benefits when they are injured on U.S.-flagged vessels, as a result of their employer's negligence.
- The Longshore and Harbor Workers' Compensation Act (LHWCA) - This Act provides workers' compensation benefits to certain classes of employees of private maritime employers.
There has been discussion of a possible new compensation act which might compensate workers injured by asbestos, including those who suffer from asbestosis or mesothelioma as a result of asbestos exposure. At present, asbestos-related injury claims are often litigated through the tort system.
Litigating Workers' Compensation Claims
Most injured workers are fortunate, and recovery quickly from their injuries. A worker who suffers a minor work-related injury may have no real awareness of the workers' compensation system, beyond knowing that it paid their medical bills and perhaps provided compensation for a few days of lost wages. However, workers who suffer more serious injuries at times have trouble obtaining their benefits due to difficulties with their employers or a workers' compensation insurance carrier. When problems occur, an injured worker will typically benefit from consulting with a workers' compensation lawyer.
The progress of a workers' compensation case is typically faster and simpler than traditional personal injury litigation. The claims are handled through administrative law proceedings, and may involve more relaxed rules of evidence. Most states limit the fees a workers' compensation lawyer may charge, either by statute or by requiring that fees be approved on a case-by-case basis.
Injured workers will usually benefit from consulting with a workers' comp lawyer when they are refused benefits to which they are entitled, are told that they must return to work before they are medically able to do so, or are denied extended or permanent disability benefits despite significant disabling injury. Some employers and workers' compensation insurance carriers will attempt to send injured workers to doctors who will certify that an employee is capable of returning to work, even though the worker does not feel able. Sometimes an employer will attempt to convince an employee to return to work to a special job created to accommodate the worker's injury, with the intention of eliminating that job shortly afterward such that the employee (and the employee's workers' compensation benefits) can be terminated without obvious violation of the law. If you feel you have been sent to a bad doctor, or that your employer is scheming to find a way to terminate your employment despite your legal rights, you should consider consulting with a comp lawyer.
Recall that although you, as an injured worker, may not know the governing law, a typical employer is very aware of how the workers' compensation system works. If the employer is scheming to eliminate an injured worker's rights or benefits, a lawyer can help prevent a dubious termination or unlawful reduction or termination of benefits.
An injured worker will benefit from consulting with a lawyer who specializes in workers' compensation cases. Often, a lawyer who devotes a significant amount of time to a workers' compensation practice will be acquainted with the administrative judges and hearing officers who decide workers' compensation cases, may also know of the questionable doctors and tactics used by the employer, and may have a good working relationship with the defense attorney who will be defending against your claim. Using a qualified, experienced lawyer can help ensure that you get the benefits to which you are lawfully entitled, or if you prefer and the option is available to you, that you obtain a maximum pay-off to settle your workers' comp claim.