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Despite workplace safety laws, accidents happen on the job all too often. These generally trigger a right to medical, wage, and other benefits. The Workers’ Compensation Law Center at Justia describes the rules governing these programs.
A cold January night in 1860 saw one of the most devastating industrial accidents in American history. The five-story Pemberton Mill in Lawrence, Massachusetts suddenly crumbled into a 50-foot tower of rubble that buried hundreds of workers inside. The collapse and an ensuing fire claimed up to 145 lives and caused numerous other injuries. Remarkably, the mill had been built just seven years before. An investigation suggested that the architect, Charles Bigelow, had caused the disaster by using malformed cast-iron pillars to support the mill. Bigelow pointed the finger at the owners of the mill for buying and approving the building materials. (In retrospect, they also may have erred in placing too much heavy equipment on an upper floor.)
Nobody went to prison for their role in the disaster, and the owners rebuilt the mill. Less than a decade later, though, Massachusetts became the first state to form a bureau of labor statistics, which investigated workplace conditions. In 1877, the Massachusetts legislature passed the nation’s first factory safety bill, setting an example that other industrial states followed.
Even with legal protections in place for workers, accidents remain an inescapable risk in many industries. Each state has established a workers’ compensation program that provides coverage for injuries or illnesses on the job, regardless of fault. This means that an injured employee can get compensation for their medical treatment, a certain percentage of their lost wages, and potentially other expenses without suing their employer and proving its liability. The Workers’ Compensation Law Center in the Justia Legal Guides describes what makes a worker eligible for these benefits, the procedures that they need to follow, and other key issues that victims of job-related harm should know when asserting their rights.
The Work-Related Requirement
To get workers’ compensation benefits, a worker must be an employee rather than an independent contractor, and they must not work in a profession that is exempt under state law. (Certain agricultural and domestic workers may be exempt, for example.) However, the most frequently contested eligibility requirement is that the employee’s injuries must have occurred on the job. This is not always as clear as it sounds. For example, the “going and coming rule” generally prevents an injured employee from getting benefits if they were commuting to or from work when an accident happened. An accident outside the workplace during a lunch break also probably will not be covered, although an accident at an employer-sponsored event outside the workplace may be covered.
Workers with certain types of injuries may face greater challenges in establishing their eligibility for benefits. These include repetitive stress injuries that develop gradually over time, rather than resulting from a single, obvious event. In addition, work-related illnesses may require detailed documentation linking the condition to the job duties or workplace. Workers with psychological conditions like PTSD may find that special limits or requirements apply.
Procedures in Workers’ Compensation Claims
In addition to the substantive eligibility requirements, a worker must clear certain procedural hurdles to ensure their access to benefits. One of these involves reporting the injury to the employer. A worker often has about 30 days to report an injury, although different states have different rules, and some types of injuries or illnesses may trigger distinctive rules. While oral notice may meet the reporting requirement in some states, a worker still may want to provide notice in writing if possible.
Once they have reported the injury, a worker will need to file a claim with the employer or its insurer. Sometimes the employer will handle this process, but other times the employee must do it on their own. The deadline for filing a claim tends to be longer than the deadline for reporting the injury. The time window might last for a year or more. The insurer or employer then must decide whether to approve or deny the claim. If it denies the claim, an injured employee can appeal that decision. This usually starts with an administrative process, but an appeal may eventually reach state court.
Some workers’ compensation claims result in settlements, which may involve a lump sum payment. This can be a relatively smooth and simple way to wrap up the process, but a full settlement may not make sense if the scope of the worker’s injuries and need for future medical treatment is not fully clear. An injured employee should think carefully before agreeing to a settlement that covers future medical costs.
The Role of a Doctor
The doctor treating the employee may greatly influence the benefits that they receive. The role of the doctor includes diagnosing an injury or illness, devising a course of treatment, and tracking any changes in the worker’s condition. They may need to provide reports and testimony as the claim proceeds. An employee should be honest in any consultation with a healthcare provider, describing their symptoms thoroughly. If they do not understand a question that a doctor asks or do not know the answer, they should say so because an inaccurate statement could jeopardize their access to benefits.
Some states, such as Florida, allow the employer to choose the doctor who will treat the employee, at least in the beginning. In other states, an employee may have more flexibility in choosing a doctor. However, if their employer has designated a provider network, they may need to choose a doctor within that network. Rules for changing a doctor also vary by state and must be carefully followed to avoid a gap in coverage.
Final Thoughts
If a worker has suffered a serious injury, they may want to consult a workers’ compensation attorney about their right to benefits. Although the no-fault nature of workers’ compensation is meant to make the process easier and more efficient, employers and insurers still often fight claims when possible. Working with a lawyer can help overcome these obstacles. An attorney also may advise a worker on whether they may have additional claims, such as a third-party lawsuit against someone other than their employer or a coworker, or perhaps a claim for federal Social Security Disability Insurance benefits. In the meantime, the Workers’ Compensation Law Center provides an overview of the substantive and procedural rules in this area. Like the other Justia Legal Guides, it aims to make the law transparent and accessible to all.
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