What Is Workers’ Compensation?

Most people have heard about workers’ compensation but know little about its particulars. As an attorney who has dedicated over thirty years to this area of practice—with a front-row seat to nearly all aspects of this law—I often joke that if you know little about workers' compensation, you have lived a blessed life. Unfortunately, for those injured on the job, it’s no longer a laughing matter, nor is it a matter of choice. Once an employee is injured on the job, workers’ compensation becomes a difficult reality—with a whole new set of rules and events, coming at the worst of times. If you are reading this, chances are you are now encountering the workers’ compensation system and need real information to ensure that you and your family are not lost in the shuffle, or worse. The goal of this post is to provide foundational information so you can make educated decisions towards protecting your future against the opposing forces of workers’ compensation.

Each state has its own workers’ compensation law; yes, there are fifty, and none are identical. At its most basic level, workers’ compensation is the exclusive (only) remedy an employee may have against his or her employer for injuries at work. Meaning, if you are injured at work, you probably will not be able to sue your employer for full damages (pain and suffering, loss of enjoyment of life, or loss of abilities to enjoy life)—even if the employer is negligent! Instead, you are limited to recovery only through a workers’ compensation claim, which is governed by statutory limitations, diminished monetary benefits, and a whole different set of rules. Whether or not this seems fair, this is the law and it has been—in each state—since the early 1900s. Try as we might, it’s not unconstitutional. It’s the law.

Perhaps the biggest differences in the law’s treatment of workers’ compensation claims and personal injury cases (for example, an auto accident or a slip and fall occurring outside of work) are the court process and the benefits available. A personal injury claim is heard in a proper court, with a jury making the findings of fact and determining the amount of damages to be awarded. Workers’ compensation cases are heard by administrative judges (usually appointed by the Governor in your state) in a specialized tribunal. Every aspect of workers’ compensation is controlled by statutes, and there is no real place for fairness or equity as the terms are ordinarily understood. Workers’ compensation judges have very limited powers under the law, and they cannot, like a jury might, award you a verdict and end the case. As a result, workers’ compensation cases can go on for a long time, with a hearing here and there to resolve any past disputes, but resolution and finality are elusive—until you and the insurance company decide to settle on mutually agreeable terms. It’s a long and difficult journey—especially if you do not know what to expect and the rules of the road. But there is hope; workers’ compensation benefits, although diminished, are still substantial and designed to provide sustenance during the period of medical recovery. Also, because workers’ compensation benefits are payable regardless of fault, it’s often more favorable and expedient than a personal injury case (for example, if the injury is nobody’s fault). Were there one rule trumping all others for success in the workers’ compensation system, I would have to say it must be: “be true to yourself, and be honest to all others, very honest.” The insurance industry preys on injured workers who, perhaps as a sincere cry for help, embellish or hide the truth. Most states have disqualification provisions in the workers’ compensation law, imposing death-knell penalties (denial of all benefits) for any false utterance made by the injured worker. Have faith, though: usually, the truth prevails and falsehoods (no matter how small) do not; you want to be the one wielding the sword of truth. Thus, although workers’ compensation claims do not offer the full benefits of a personal injury case, if it is your only remedy (for most injured at work, it is) there is every reason to make sure you collect all that you are entitled to under the law.

If Workers’ Compensation Isn’t a Personal Injury Claim… How Do I Recover Compensation?

Unlike a motor vehicle accident, where you’re paid by the at-fault party’s insurance provider, workers’ compensation claims concern your employer's insurance. There’s no claim for negligence, nor is there a jury trial. Instead:

• You must first notify your employer of any workplace injury; do so immediately because lack of notice is a valid defense under most states’ laws. If you suspect any level of trouble with your employer, send an email, letter, or text (this can become valuable evidence).
   
• The employer should file a claim with its insurance company; if it has not, again write or text your employer for workers’ compensation medical treatment and benefits.
   
• The claim is investigated by the insurance company to determine that the accident occurred and the employee was injured. Most insurance companies are looking for reasons to deny, so if there is evidence to be had, gather it and keep it handy.
   
• If your claim is accepted (not denied) the employer and its insurance company will authorize medical care. Although most doctors who take workers’ compensation have opinions more favorable to the insurance industry, be polite and honest in all regards; again, the truth usually prevails.
   
• If the insurance company delays or denies any disability or medical benefits that you believe are due, you are then required to file a claim. Although you can file a claim on your own (pro se) most pro se litigants are not successful in taking on well-funded insurance companies, and there are procedural pitfalls that abound.
   
• Once you file a claim for a benefit that has not been provided and that you claim is due, the process of discovery takes place. Usually, there will be a mediation where you will have an opportunity to resolve the issues—if both sides agree.
   
• If mediation or settlement is unsuccessful, the parties then attend a hearing with the workers’ compensation judge (again, no jury) who will decide the case based on the admissible evidence presented.

…And What Can I Recover?

Your claim will only yield compensation for medical costs and your lost wages, limited by the statute in your state. Other personal injury damages, as featured in TV commercials and online, aren’t usually eligible for recovery.

• Medical costs include your initial doctor’s visit, and necessary follow-up and ongoing treatment costs caused by and related to your workplace injury.
   
• The other component is disability benefits, which cover your lost wages, if any. This lasts until you reach MMI, and your employer or their insurance provider may request your return to your position in full or limited capacity. If your employer offers you a light-duty job, take it and do everything you can to show full participation. Usually, the job is offered as a defense because many injured workers refuse based on pain or other reasons. Working, or making a good faith effort to do so, is the only real way around this defense.

Your Guide to Workers’ Compensation Claims

Delays, denials, and diminished compensation can all throw a wrench into the process. It’s not uncommon for insurance providers to send injured workers to hand-picked medical providers or attempt to delay your claim. This behavior is unacceptable and is the primary reason people turn to an attorney in workers’ compensation. If you find yourself in such a situation, it is likely time to turn to an attorney, and there is little time to waste.

America's Largest Personal Injury Firm can help support your workers’ compensation claim from beginning to end, regardless of the hurdles on the road ahead. Complete our free, no-risk case evaluation to get started.