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WHAT IF MY EMPLOYER TELLS ME NOT TO FILE A WORKERS'
COMPENSATION CLAIM OR THREATENS TO FIRE ME IF I DO?
In most states, it is a violation of the workers' compensation laws to retaliate against an employee
for filing a workers' compensation claim. If this happens, immediately report it to your local
workers' compensation office.
While the federal government administers a workers' comp program for federal and certain other
types of employees, each state has its own laws and programs for workers' compensation. For
up-to-date information on workers' comp in your state, contact your state's workers'
compensation office. (You can find links to the appropriate office in your state on the State
Workers' Compensation Officials page of the U.S. Department of Labor's website.)
In general, an employee with a work-related illness or injury can get workers' compensation
benefits regardless of who was at fault -- the employee, the employer, a coworker, a customer, or
some other third party. In exchange for these guaranteed benefits, employees usually do not
have the right to sue the employer in court for damages for those injuries.
IF I AM INITIALLY TREATED BY AN INSURANCE COMPANY
DOCTOR, DO I HAVE A RIGHT TO SEE MY OWN DOCTOR AT
SOME POINT?
State workers' compensation systems establish technical and often tricky rules in this area. Often,
you have the right to ask for another doctor at the insurance company's expense if you clearly
state that you don't like the one the insurance company provides, although there is sometimes a
waiting period before you can get a second doctor. Also, if your injury is serious, you usually have
the right to a second opinion. And in some states, after you are treated by an insurance
company's doctor for a certain period (90 days is typical), you may have the automatic right to
transfer your treatment to your own doctor or health plan, while the worker's compensation
insurance company continues to pay the bill. Because the insurance company is paying, don't
hesitate to go to a doctor who specializes in your injury or illness -- even if the cost is great.
To understand your rights, get a copy of your state's rules or, if necessary, research your state
workers' compensation laws and regulations in the law library.
CAN I BE TREATED BY MY OWN DOCTOR AND, IF NOT, CAN I
TRUST A DOCTOR PROVIDED BY MY EMPLOYER?
In some states, you have a right to see your own doctor if you make this request in writing before
the injury occurs. More typically, however, injured workers are referred to a doctor recruited and
paid for by their employers.
Your doctor's report will have a big impact upon the benefits you receive. Keep in mind that a
doctor paid for by your employer's insurance company is not your friend. The desire to get future
business from your employer or the insurance company may motivate a doctor to minimize the
seriousness of your injury or to identify it as a preexisting condition. For example, if you injure
your back and the doctor asks you if you have ever had back problems before, it would be unwise
to treat the doctor to a 20-year history of every time you suffered a minor pain or ache. Just say
"no" unless you really have suffered a significant previous injury or chronic condition.
WHAT KIND OF BENEFITS WILL I RECEIVE?
State workers' compensation systems establish technical and often tricky rules in this area. Often,
you have the right to ask for another doctor at the insurance company's expense if you clearly
state that you don't like the one the insurance company provides, although there is sometimes a
waiting period before you can get a second doctor. Also, if your injury is serious, you usually have
the right to a second opinion. And in some states, after you are treated by an insurance
company's doctor for a certain period (90 days is typical), you may have the automatic right to
transfer your treatment to your own doctor or health plan, while the worker's compensation
insurance company continues to pay the bill. Because the insurance company is paying, don't
hesitate to go to a doctor who specializes in your injury or illness -- even if the cost is great.
To understand your rights, get a copy of your state's rules or, if necessary, research your state The
workers' compensation system provides replacement income, medical expenses, and sometimes,
vocational rehabilitation benefits -- that is, on-the-job training, schooling, or job placement
assistance. The benefits paid through workers' compensation, however, are almost always
relatively modest. If you become temporarily unable to work, you'll usually receive two-thirds of
your average wage up to a fixed ceiling. But because these payments are tax-free, if you received
decent wages prior to your injury, you'll fare reasonably well in most states. You will be eligible for
these wage-loss replacement benefits as soon as you've lost a few days of work because of an
injury or illness that is covered by workers' compensation.
If you become permanently unable to do the work you were doing prior to the injury, or unable to
do any work at all, you may be eligible to receive long-term or lump-sum benefits. The amount of
the payment will depend on the nature and extent of your injuries. If you anticipate a permanent
work disability, contact your local workers' compensation office as soon as possible; these
benefits are rather complex and may take a while to process.
Social Security Benefits for the Permanently Disabled
If you're permanently unable to return to work, you may qualify for Social Security Disability
benefits. Social Security Disability will, over the long run, provide more benefits than workers'
compensation -- but be forewarned that these benefits are hard to get. They are reserved for
seriously injured workers. To qualify, your injury or illness:
must prevent you from doing any "substantial gainful work," and
must be expected to last at least twelve months or to result in death.
If you think you may meet the above requirements, contact your local Social Security office.
DOES WORKERS' COMPENSATION COVER ONLY INJURIES OR
DOES IT ALSO COVER LONG-TERM PROBLEMS AND
ILLNESSES?
Your injury need not be caused by an accident -- such as a fall from a ladder -- to be covered by
workers' compensation. Many workers receive compensation for injuries that are caused by
overuse or misuse over a long period of time -- for example,
repetitive stress injuries such as carpal tunnel syndrome or back problems. You may also be
compensated for some illnesses and diseases that are the gradual result of work conditions -- for
example, heart conditions, lung disease, and stress-related digestive problems.
Are You Covered by Workers' Compensation?
Most workers are eligible for workers' compensation coverage, but every state excludes some
workers. Exclusions often include:
•
business owners
•
independent contractors
•
casual workers
•
domestic employees in private homes
•
farm workers
•
maritime workers
•
railroad employees, and
•
unpaid volunteers.
•
Check the workers' compensation law of your state to see whether these exclusions affect
you.
Federal government employees are also excluded from state workers' compensation coverage,
but they receive workers' compensation benefits under a separate federal law.
In addition, some states do not require workers' compensation coverage of employers having
fewer than a designated number of employees -- three to five, depending on the state. So, if you
work for one of these employers, you may be excluded from the state program.
ARE ALL ON-THE-JOB INJURIES COVERED BY WORKERS'
COMPENSATION?
WORKERS' COMPENSATION COVERS MOST, BUT NOT ALL, ON-THE-JOB INJURIES. THE WORKERS'
COMPENSATION SYSTEM IS DESIGNED TO PROVIDE BENEFITS TO INJURED WORKERS, EVEN IF AN
INJURY IS CAUSED BY THE EMPLOYER'S OR EMPLOYEE'S CARELESSNESS. BUT THERE ARE SOME
LIMITS. GENERALLY, INJURIES THAT HAPPEN BECAUSE AN EMPLOYEE IS INTOXICATED OR USING
ILLEGAL DRUGS ARE NOT COVERED BY WORKERS' COMPENSATION. COVERAGE MAY ALSO BE
DENIED IN SITUATIONS INVOLVING:
self-inflicted injuries (including those caused by a person who starts a fight)
injuries suffered while a worker was committing a serious crime
injuries suffered while an employee was not on the job, and
injuries suffered when an employee's conduct violated company policy.
Q&As Workers' Comp
CAN I EVER SUE MY
EMPLOYER IN COURT
OVER A WORK-RELATED
INJURY?
Yes. If you are injured because of some
reckless or intentional action on the part
of your employer, you can bypass the
workers' compensation system and sue
your employer in court for a full range of
damages, including punitive damages,
pain and suffering, and mental anguish.`
Vocational Management Consultants
715 S. King Street, Suite 205
Honolulu, HI 96813
Ph. 808-538-8733
Fax 808-538-8744
WHO PAYS WORKERS'
COMPENSATION
BENEFITS?
In most states, employers are required to
purchase insurance for their employees
from a workers' compensation insurance
company (also called an insurance
carrier). In some states, however, very
small companies (with fewer than three
or four employees) are not required to
carry workers' ompensation insurance. In
some states, larger companies that are
clearly financially stable are allowed to act
as their own workers' compensation
insurance companies (also called self-
insuring).
When a worker is injured, his or her claim
is filed with the insurance company or
self-insuring employer, which pays
medical and disability benefits according
to a state-approved formula.
DO I HAVE TO BE INJURED
AT MY WORKPLACE TO BE
COVERED BY WORKERS'
COMPENSATION?
No. As long as your injury is job-related,
it's covered. For example, you will be
covered if you are injured while traveling
on business, doing a work-related errand,
or even attending a required business-
related social function.
WHAT IS WORKERS'
COMPENSATION?
Workers' compensation is a state-
mandated insurance program that
provides compensation to employees
who suffer job-related injuries and
illnesses. While the federal government
administers a workers' comp program for
federal and certain other types of
employees, each state has its own laws
and programs for workers' compensation.
For up-to-date information on workers'
comp in your state, contact your state's
workers' compensation office. (You can
find links to the appropriate office in your
state on the State Workers' Compensation
Officials page of the U.S. Department of
Labor's website.
In general, an employee with a work-
related illness or injury can get workers'
compensation benefits regardless of who
was at fault -- the employee, the
employer, a coworker, a customer, or
some other third party. In exchange for
these guaranteed benefits, employees
usually do not have the right to sue the
employer in court for damages for those
injuries.