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Workers' Compensation

Workers' Compensation

Depending on a person's employment classification, they can sue their employer or receive worker's compensation for an injury incurred while on the job. In a personal injury lawsuit, the foundation of the case is usually negligence. A lawsuit based on negligence involves determining how the defendant was at fault and possible compensation for the defendant's fault. If an employee does not pursue a personal injury lawsuit, they may be able to receive payments under worker's compensation.

Worker's compensation is a state-mandated insurance program providing compensation to employees who sustain on-the-job injuries. The monthly payments are sent regardless of fault. However, employees receiving the compensation cannot sue their employers for additional financial damages.

You can apply for workers' compensation if you are injured in the course of your performing your job, whether you work for a private employer or for the government. This system allows employees injured on the job to get compensation for medical bills, lost wages, and disability payments, for example, that were suffered as a result of the injury.

The legal theory of strict liability governs workers' compensation. What this means is that the employer in the case of this type of injury is liable regardless of their part in the matter. In other words, negligence or fault of the employer does not have to be proven in order for the employee to recover in the form of workers' compensation benefits.

The laws regarding workers' compensation do vary from state to state. It is important to check the laws of the state in which you were working when you were injured. It is also important to realize that there are statutes of limitation, or time limits, regarding how long you have to file this type of claim after being injured.

How Are Employees Compensated?

Employees are given benefits to:

  • Replace income
  • Pay medical expenses
  • Cover physical rehabilitation

Employees are typically given compensation either over long-term installments or in one lump sum payment.

Requirements of Receiving Worker's Compensation

In order to qualify for worker's compensation, an employee must have:

  • An employee-employer relationship
  • Work-related injuries

Types of Injuries Covered under Workers' Compensation

Workers' compensation is designed to provide benefits to injured workers regardless of whether the injury was the employer's or the employee's fault. As long as your injury is work-related, it is covered under workers' compensation. Typical injuries covered are:

  • Repetitive stress injuries
  • Illnesses or diseases that are a gradual result of work conditions
  • Traumatic physical injuries
  • Repeated trauma injuries
  • Mental injuries – when associated with physical injury
  • Occupational diseases

Types of Injuries That Are NOT Covered under Workers' Compensation

Workers' compensation provides for almost every type of injury that may occur at the workplace. However, several types of injuries remain uncovered:

  • Self- inflicted injuries (including injuries to you when you cause a fight)
  • Injuries resulting from the commission of a serious crime
  • Injuries caused when your conduct violates company policy
  • Injuries received while intoxicated or under the influence of illegal drugs
  • Injuries where the employee was acting in a reckless manner

Who Is NOT Covered by Workers' Compensation?

Several classes of workers are not entitled to workers' compensation benefits. The following are employees not covered by workers' compensation:

  • Business owners
  • Independent contractors
  • Federal employees (under the state's scheme)
  • Domestic employees in private homes
  • Farm workers
  • Maritime workers
  • Railroad employees
  • Unpaid volunteers

Filing for Worker's Compensation

The first step of receiving compensation involves quickly reporting the injury to the employer. The employer always provide the compensation forms. Then, an employee must:

  • Seek medical attention for the injury and follow any doctor's instructions
  • File the worker's compensation claim with the employer's insurance company

Does Worker's Compensation Cover Off-Site Injuries?

In general, workers will be eligible for worker's compensation for injuries that occur away from the job site if the injury is work-related. It can be challenging to determine whether an injury is work-related, so courts typically look to see if the employment caused the injury. Off-site injuries covered by workers' compensation include:

  • While traveling, if the employee is a traveling salesperson with no fixed job site, or the employer provides the employee's transportation through a company car or by reimbursing the employee for travel expenses;
  • During a company-sponsored event, such as a Christmas party, as long as it is company-sponsored and not just employees getting together on their own;
  • During a company-sponsored recreational activity, such as a company fitness program to increase employee health or a team-building event for the office;
  • During a recreational activity to entertain potential clients.

Are Injuries Sustained While on Lunch Breaks Covered?

Generally, worker's compensation does not cover injuries during lunch breaks. However, there are several exceptions to this rule. Courts consider whether the employer benefited from the employee's actions. Examples include:

  • Purchasing a sandwich for a boss so that they can continue working at his desk might be considered an errand for the employer and covered. Nevertheless, if the employee runs personal errands during their break and offers to pick up food for coworkers, that is probably not covered.
  • A company cafeteria would provide a benefit to the employer because employees wouldn't have to travel off-premises for lunch and could return to work more quickly. Injuries occurring in the lunch room would also be covered.

Does It Matter When and Where the Accident Happened?

Most employees are not covered when they commute to work. As a result, their workday does not begin until they arrive at their workplace or any other employer-controlled location.

Commuting may be covered if the employee is performing work duties while driving. An employee might be talking to a client or their boss while driving. It may be considered work-related.

As a rule, employees whose jobs require travel are covered while engaged in work-related travel.

Lastly, some workers may be injured at work-sponsored off-site events. In this case, workers' compensation may apply. They might also be able to bring a personal injury claim against the entity that owns the site or organized the event. 

 Getting Fired for Filing a Worker's Compensation Claim

The majority of states follow an at-will employment relationship. This means that an employer can terminate an employee at any time without or with cause. An exception to this rule is that an employer cannot terminate an employee for simply filing for worker's compensation. If an employer does do this, an employee can sue for retaliatory discharge.

Proving Retaliatory Discharge by My Former Employer

If an employer terminates an employee after a worker's compensation claim is filed, the employee must show:

  1. They were eligible for worker's compensation
  2. They filed or started filing a compensation claim
  3. Their employer threatened to terminate, actually terminated, or acted against them
  4. The termination was initiated because the employee started to or actually filed a compensation claim

Recovering Workers Compensation Benefits After I'm Fired

Workers' compensation is a state-mandated insurance program which provides compensation to employees who experience job-related injuries. An employee who is injured while on the job is guaranteed benefits, regardless of who was at fault for the injury. In return for workers' compensation benefits, employees generally forfeit their right to sue their employer in court for damages for their injuries. In this way, the rules governing workers' compensation are very different when compared to other personal injury issues.

Some of the most common examples of what workers' compensation benefits cover include, but may not be limited to:

  • Replacement income;
  • Medical expenses;
  • Rehabilitation;
  • Long-term or lump sum pension, if you are left permanently unable to work; and/or
  • Temporary disability pension while you are unable to work.

In order to satisfy workers' compensation requirements, you must be an actual employee of your employer. What this means is that you cannot be considered an independent contractor. Additionally, your injuries have to be work related.

When thinking of a workers compensation claim, it is generally assumed that the employee is still working for their employer. Although this is often the case, some injuries do not materialize until after an employee has been terminated from their job. As such, there are specific circumstances in which an injured employee can still recover workers compensation benefits after termination.

When Can I Recover Workers Compensation Benefits After I'm Fired?

There are several steps you must follow in order to receive workers' compensation, which may vary by industry as well as state. Generally speaking, you must do the following:

    • Promptly report your injury to your employer. It is important to note that some states require notice within 2-30 days following the injury. If your injury or illness develops over time, you must report it as soon as you determine that it was in fact caused by your work;
    • Receive medical treatment and adhere to the doctor's instructions. It is important to note that if you do not follow the doctor's instructions, and further aggravate your injury, your workers compensation claim payout may be reduced or denied;
    • File your claim with your employer's insurance carrier using the insurance claim forms that your employer must provide to you. Typically, you may contact human resources for assistance with obtaining and filling out the necessary forms; and
    • Save all copies of paperwork throughout the entirety of the process.

When a worker is attempting to recover their workers compensation benefits once they have been fired, it can sometimes be considerably difficult for many different reasons. In order to recover your workers compensation benefits once you have been terminated, you must prove the following elements:

  1. You suffered an actual physical injury or disability, whether temporary or permanent;
  2. The injury occurred in the course and scope of your employment; and
  3. The injury would not have occurred, if you had not been at that job.

If an injured worker is successful in showing that they should recover workers compensation benefits after they have been fired, they can generally recover the following:

  • Cost of medical and disability expenses;
  • Attorney's fees and court costs;
  • Vocational rehabilitation expenses; and
  • Interest on any amount not forthcoming.

The employer may also face various penalties, such as being required to restructure their safety plan.

Legal Issues Associated with Recovering Workers Compensation Benefits

There are many legal issues associated with workers compensation settlements. One such issue involves what is and is not covered by workers compensation. Workers' compensation is intended to provide benefits to injured workers, regardless of whether the injury was the fault of the employer or the employee. As long as the injury is work-related, it is generally covered under workers' compensation. 

Some examples of the most common injuries covered by workers compensation include:

  • Repetitive stress injuries;
  • Illnesses or diseases that gradually result due to substandard work conditions;
  • Traumatic physical injuries;
  • Repeated trauma injuries;
  • Mental injuries when they are associated with physical injury; and
  • Occupational diseases.

However, there are several types of injuries which remain uncovered by worker's compensation:

  • Self-inflicted injuries, which includes injuries sustained when you cause a fight;
  • Injuries resulting from the commission of a serious crime or illegal action;
  • Injuries caused when your conduct violates company policy;
  • Injuries experienced while intoxicated, or under the influence of illegal drugs; and
  • Injuries in which the employee was acting in a reckless manner.

Other legal issues generally involve who is and is not covered by workers compensation. There are several classes of workers who are not entitled to workers' compensation benefits, including:

  • Business owners;
  • Independent contractors;
  • Federal employees, as determined under the state's scheme;
  • Domestic employees in private homes;
  • Farm workers;
  • Maritime workers;
  • Railroad employees; and
  • Unpaid volunteers.

It is important to note that workers compensation laws can vary by state. Additionally, workers compensation does not cover claims that are brought against an employer based on the employer themselves. This includes claims for discrimination, harassment, and/or wrongful termination.

Finally, you generally cannot recover workers compensation if you have already taken your employer to court and recovered damages for your injury. Workers compensation was intended to bypass the process of judicial review, and thereby enable employees to recover money for injuries that they suffered on the job without having to fight their employer in court.  

However, most states will allow you to recover both your workers compensation benefits as well as any damages arising out of a personal injury lawsuit. This would only be if your employer engaged in willful, deliberate, or intentional conduct; and, your injury was a direct result of that conduct. 

Are There Any Defenses?

When an injured worker is attempting to prove that they were injured on the job, but the injury did not appear until after they were fired, there are many defenses available to an employer or their insurance carrier. These include, but may not be limited to:

  • The worker's injury was not compensable, given a workers compensation statute;
  • The injury did not actually occur in the course and scope of their employment;
  • An unreasonable amount of time passed between when the employee was fired and when the injury allegedly appeared; and/or
  • The injury was caused by the employee's own intentional conduct.

As previously mentioned, workers compensation is a specific type of personal injury law. As such, it is helpful to mention some of the defenses commonly used in other personal injury claims:

  • Comparative or contributory negligence;
  • Assumption of risk;
  • Plaintiff did not state a claim;
  • Statute of limitations; and/or
  • No mitigation of damages

Injuries Caused by the Illegal Conduct of the Worker

Although the employer's fault may not be at issue in a workers' compensation case, an employee's certainly is. If an employee who files for workers' compensation benefits is shown to be guilty of illegal conduct, they will probably be denied workers' compensation benefits.

If an employee was injured while committing grossly negligent conduct (such as breaking workplace rules), they may be prevented from collecting benefits. Negligent conduct will not be a bar to recovering workers' compensation benefits in every jurisdiction.

Jurisdictions do vary on this, so you will want to check or have an attorney check the laws where you live and work. Also, the level of misconduct may influence whether or not you are awarded benefits.

Examples of Illegal or Negligent Conduct that Can Block Workers' Compensation Benefits

As mentioned above, it is possible to not receive workers' compensation based on the actions that led to the injury. Here are some examples of behavior, illegal and negligent, that can lead to the employee being barred from compensation:

  • Failing to follow workplace safety regulations and being injured as a result;
  • Being injured doing work but while committing a crime;
  • Being injured at work, while engaging in horseplay;
  • Committing fraud in order to receive workers' compensation benefits, including: making false statements, and faking or exaggerating an injury; and/or
  • Being injured while on the job, but also while intoxicated due to alcohol or drugs.

Exceptions to the Bar of Recovery for Workers Compensation Benefits

There are several exceptions in which the employee will still be permitted to recover benefits, despite having been engaged in illegal activity at the time of their injury. These exceptions are:

  • If the Employer Permits the Illegal Activity: Depending on where you live and what laws govern, if your employer approved the illegal activity which brought about your injury, then you, the injured worker, will not be preventing from receiving workers' compensation benefits.
    • The employer may give their approval of the activity either by telling you verbally, or they may give the approval in writing. It is also possible for the employer to give tacit approval if they knew illegal activity was being conducted by their employee, and they did nothing to stop it.
  • If the Employee Was Unaware of the Illegal Conduct: Also depending on the laws where you live and work, it may be that a worker will not be denied workers' compensation benefits if it can be shown that they did not understand that the activity they were engaged in was illegal.
    • Additionally, courts will generally award benefits if it can be shown that the injury occurred in the course of an act that was a violation of some law or policy, but it was one that was trivial. Of course, negligence does not rise to the level of an intentional crime, so if the injury was caused by an act of negligence, or an act lacking intent, you are more likely to recover workers' compensation benefits.
  • Type of Illegal Activity: If a crime was, in fact, committed, a court will take into consideration the nature of the crime-in other words, how serious a crime was committed. This varies by jurisdiction.
    • Some jurisdictions have determined that the unlawful attempt to injure another person is the only crime which can prevent the receiving of benefits. In other jurisdictions, instead of denying benefits to a person who was injured while committing an illegal act, a court will instead reduce the amount of benefits they receive. How much of reduction benefits will depend on the seriousness of the crime committed.

How Can A Lawyer Help Me With My Issues With Workers' Compensation?

If you wish to pursue a workers compensation claim, or experiencing issues related to your workers compensation claim, you should consult with an experienced and local workers compensation attorney. Workers' compensation laws are state laws, so they can vary from state to state and be confusing. You should file the proper workers' compensation insurance forms required by your employer as soon as you are injured on the job. If the claim is denied, an experienced workers' compensation attorney familiar with workers' compensation law can advise you of your rights and options in contesting the denial of your claim. Working with a local lawyer will ensure you receive the most relevant legal advice regarding your rights and course of action. An experienced workers compensation lawyer can help you determine how to file your claim and collect evidence, and will also be able to represent you in court, as needed.

Call our office today at 212-994-7777 or complete the convenient online contact form to set up a consultation.