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How Workers’ Compensation Works

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Work Injury Compensation Claim Form Concept

Accidents happen – at home, at school, and even at work. Employees are sometimes seriously injured in workplace accidents, and some develop chronic conditions or illnesses related to their work. To protect workers, a majority of states require that most employers carry a type of insurance coverage called workers’ compensation insurance. It is important to understand how workers’ compensation works if you have been injured or become sick due to work-related activities.

How Workers’ Compensation Works

Workers’ compensation coverage is designed to protect injured or ill workers if their injury/illness was legally caused by their work and occurred while they were working within the scope and course of their employment. Employers must carry insurance by law, with some specific exceptions. Employers in dangerous fields, such as construction or remodeling, are required to have insurance, and statutory employees are covered, again with certain exceptions.

If you are injured or become ill while on the job, you must notify your employer as soon as possible. You must also request that your employer provide medical attention for your injury or condition, immediately if possible but as soon as possible otherwise. You may request contact information for your employer’s workers’ compensation insurance carrier and your employer must provide you with a claim number and insurance contact information. Some employers and their insurance carriers try to deny or dispute workers’ compensation claims. The Division of Worker’s Compensation provides some services to those who have been injured on the job, however the judges at the Division are not allowed to give one-side legal advice. If your claim is disputed, you may need to contact a lawyer experienced in workers’ compensation claims to help you to recover the benefits to which you are entitled.

Benefits of Workers’ Compensation

Workers’ compensation coverage may pay for several different categories of expenses and losses. The three most basic benefits are approved medical care, temporary compensation, and compensation for permanent impairment/disability. The insurance should cover all of your related medical expenses, meaning that you will not be responsible for using your own medical insurance or paying any copays. Workers’ compensation should also cover rehabilitation costs, prescriptions, and prosthetic devices. In addition, if you are left temporarily or permanently disabled, you should be able to recover disability benefits (temporary or total, partial or permanent). These disability benefits replace a percentage of your former salary and are paid to you monthly for as long as you remain unable to return to your job.

Denials of Workers’ Compensation Claims

If you have submitted a claim for workers’ compensation and it has been denied, you may appeal the company’s decision to the workers’ compensation administrative board. An Administrative Law Judge will hear evidence in your case, and your lawyer may present evidence on your behalf in order to show that you deserve to receive benefits. At the hearing, specific rules of evidence apply, so having an experienced lawyer may be important to prepare your case properly.

Occupational diseases and conditions are often disputed by employers and insurance companies. For example, an employer may dispute a work-related case of hearing loss or certain types of cancer. Conditions related to repetitive trauma injuries, such as carpal tunnel syndrome and degeneration of the spine due to years of heavy lifting, are also commonly denied. You will need to be able to show the link between your condition and your work environment. Because this may require you to gather and interpret medical evidence that proves your illness or condition was caused by your job, you will need the help of an experienced workers’ compensation attorney as well as a medical expert.

In addition, some employers purposely misclassify workers in order to avoid paying certain types of taxes and to evade unemployment claims and workers’ compensation claims. If you think that your employer purposely misclassified you and you have been injured, an attorney can assess your case in order to determine whether or not you can seek coverage by requesting correct classification.

Filing a Civil Lawsuit and the Exclusive Remedy Doctrine

Most states have laws that make filing and pursuing a workers’ compensation claim the Exclusive Remedy that workers have against their employer. This means that if you are hurt on the job, even due to the negligence of your employer, you may be restricted from filing a civil lawsuit against your employer. However, there are some limited exceptions, and an experienced workers’ compensation lawyer may be able to help you determine if they apply. Additionally, if you are injured on the job by the negligence of a third party, you may have two legal cases and causes of action: one for workers’ compensation benefits and one for civil liability against the negligent party who caused your accident. Common examples include vehicle accidents while on the job and injuries from defective products while on the job.

What Happens If Your Employer Punishes You for Filing for Workers’ Compensation?

Employers are forbidden by statute from retaliating against workers who engage in certain protected activities, including filing for workers’ compensation benefits. If your employer institutes a negative employment action against you (a demotion, a dismissal, transfer to an undesirable shift, etc.), you may have valid grounds to file a lawsuit for wrongful termination or retaliation. Your attorney may review the circumstances in order to determine whether or not your employer likely engaged in retaliatory actions against you. If your attorney determines that you were retaliated against, he or she may then help you file a lawsuit against your employer.


If you have filed or need to file a workers’ compensation claim, we urge you to contact the Law Offices of Bryan Musgrave today for a free consultation. Our legal team can gather the evidence needed to move your case forward and recover needed benefits to safeguard your future. If your case is at a standstill, our attorneys can work on your behalf to move your case through the administrative process. Our knowledgeable and experienced team can help you pursue the compensation you deserve. To get started, please give us a call at 417-322-2222 or contact us online to schedule your free consultation.