Most adults spend a third of their waking hours or more in labor and work-related activities. The opportunity for mishaps and accidents during such pursuits abound.
For example, the U.S. Bureau of Labor Statistics reported 129,000 nonfatal workplace injuries and illnesses in New York State in 2020. Over 90,000 of those cases resulted in days away from work, restrictions or a job transfer. Since a workplace injury can upend a person’s livelihood, considerations for compensation are valid.
Rights of Injured Workers
Workers’ compensation is not a recent innovation. The practice dates back thousands of years. However, current circumstances add complex factors to restoring injured workers.
Basic benefits for workers’ comp include:
- Income replacement for disability
- Payment for medical recovery expenses
- Dependent support for an employee’s death
To qualify for such benefits, the employee must prove that the job was the reason for the injury or illness.
Why Employees Often Cannot Sue Employers
With this form of insurance in place, employees usually cannot sue an employer for a workplace accident. The reason for this is due to the doctrine of exclusive remedy.
The idea simply means that a person can only receive a remedy or restoration from a single source. This doctrine attempts to prevent a person from getting double compensation for a single incident.
State laws establish workers’ compensation arrangements. Thus, employees forfeit the right to pursue any personal injury lawsuit against their employers. The courts recognize that under certain circumstances, an employee received compensation through this insurance coverage and, therefore, must shoulder any additional financial burden themselves.
Reasons for Denial of Claims
If an employer suspects potential fraud in workers’ compensation claims, they have a legal obligation to investigate. The employer will deny the claim if the evidence satisfies the insurer that the case is fraudulent.
Other reasons can lead to denied claims, such as:
- Disputes over whether the injury resulted from work
- Missing or incorrect paperwork
- Missed deadlines
- Lack of witnesses
- Disputes over employment status
Whether the insurer approves or denies an initial claim, filing an appeal is always an option in workers’ compensation cases.
Barring apparent legal exceptions, the optimal way to seek restoration following an on-the-job injury is to work through the workers’ comp arrangement. The complexity of the proceedings leads many individuals to seek counsel to ensure they understand their options.
When Filing a Suit Against an Employer May Be Possible
In some cases, the conduct of an employer is egregious. Such actions may permit an employee to bring a lawsuit against the company.
One such circumstance is if the employer does not carry sufficient workers’ comp coverage. Without this insurance protection, the issue of exclusive remedy is moot, and an employee may attempt to recover damages through court action. Some employers do not have a requirement to carry such coverage and, as such, are open to legal action for on-the-job injuries.
Employees can also file a suit against employers who cause them intentional harm. The plaintiff bears the burden to prove that such an injury was intentional, which is often challenging and requires a strong case.
With the rise of freelance work, workers should remember that independent contractors are not employees and do not have workers’ comp protections. Freelancers can file a suit or enter arbitration with the companies through which they contract.
Statutes of Limitations and Timing
Each state has different regulations regarding workers’ compensation laws and may vary widely regarding the type of benefits and when an injured worker may receive them. Insurers have their own stipulations on investigating and processing claims.
For example, the government-run New York State Insurance Fund has a seven-day statutory waiting period before a person can receive any benefits. However, payments must start within 18 days of a disability appearing. Insurers will generally not pay out claims if the lost time is less than a week.
The institution bases payments on payroll records from 52 weeks before the date of the accident. However, the case manager can set a temporary rate while the employer completes the necessary paperwork. The case manager then adjusts the rate afterward.
The Workers’ Compensation Board sets a maximum weekly benefit amount. The department determines the number using the average weekly wage in New York State and adjusts the figure each year. A worker receives the benefit rate that was in effect on the date of the injury and not what rate the WCB recently approved.
For instance, the weekly maximum for July 1, 2022, through June 30, 2023, is $1,125.46. Suppose an accident injured a worker in June of 2022. In that case, the worker could only receive the previous maximum rate of $1,063.05, even if payments began in July 2022.
Harassment and Coercion Concerns
Sometimes an employer encourages an employee not to file a claim. The reasons may vary. For instance, some companies may fear that their rates will rise. Other times, an employer is not complying with workers’ comp statutes and worries about the authorities discovering the negligence.
Some employers may even try to offer an incentive to dissuade a worker from filing a claim. An employee has a right to act and pursue compensation for claims through workers’ comp. Employers cannot harass or threaten reprisals for a worker deciding to file. Such intimidation raises other legal issues and potential penalties.
If a third party bears any responsibility for a work-related injury, the employee may sue that entity. This action may be necessary since workers’ comp might not provide all the remuneration a person needs to recover fully.
For example, a person might suffer a motor vehicle accident while on the job due to another driver’s negligence. Because of being on the job, the person can file a claim for workers’ comp. The individual may also file suit against the careless driver.
If a dangerous piece of equipment injures a person on the job due to malfunction or a defect, a person may have a liability claim against the manufacturer. These cases are more frequent in high-risk industries, such as manufacturing, construction and health services.
A person may suffer an accident from unsafe conditions at a worksite. Such circumstances can raise a premises liability claim. A delivery person or onsite workers can experience slips and falls that permit such litigation.
What To Do After a Workplace Accident
Reporting an accident and receiving exhaustive medical examinations is vital since damage from some injuries can show up weeks or months after an event. Workers must give notice of a work-related accident or illness within 30 days to be eligible for compensation. From that point, the individual has two years to file a claim for other complications, injuries or aftereffects of the incident.
After an accident, a person should document everything possible about the incident. Voice recordings, digital notes, photos and video recordings can ensure that an individual can accurately and consistently recount all details.
A complete medical evaluation is a requirement for proving the extent of injuries. For workers’ comp cases, the insurer often has a list of approved doctors. However, a person may decide to get a second opinion to fight a claim denial.
Helpful Assistance After a Workplace Accident
Injuries on the job can immensely affect a person’s physical ability, emotional state and earning potential. Such damage usually requires compensation.
Discover your options with a free case review from the team at Cellino Law. With decades of experience, the team can help you examine your options for getting on the road to full recovery.