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What To Know About Workers' Compensation

There is always a potential that you might be in an unavoidable position where an accident can happen, regardless of how typical or safe a career may seem. Working on oil drilling platforms, as a commercial fisherman, a construction worker, or even as an office assistant exposes you to a variety of potentially harmful situations on a daily basis.

In 2020, 2.7 million nonfatal occupational injuries were recorded by employers in the private sector, according to a Bureau of Labor Statistics press release. Even if the number of workplace injuries dropped from 2.8 million in 2019 to 2.7 million in 2020, a significant number of Americans still sustain an injury while at their place of employment each year. People may experience emotional anguish in addition to physical pain because they worry their employer will retaliate if they file for workers' compensation.

What Is Workers’ Compensation?

Workers' compensation, sometimes known as "workers comp," is a legally required program that offers benefits to employees who suffer injuries or illnesses as a result of their employment.

History Of Workers’ Compensation

One of the first instances of a workers' compensation system may be found in Ancient Sumeria in 2050 B.C., where a legislation was created to compensate injured employees. Similar regulations were also implemented in other countries of the world, including China and Ancient Greece.

Let's go forward in time to 1760, the start of the Industrial Revolution. The Industrial Revolution saw an explosion in the production of things in extremely large proportions and with new machinery. Large-scale manufacturing and new technology go hand in hand with the potential for dangerous working conditions. Workers who were hurt at work during this time period relied on the legal system to get paid for their damages. 

Move ahead again 150 years until 1911. State workers' compensation laws were first enacted in the United States in 1911 in Wisconsin, which was the first state to do so. Despite the fact that 36 other states passed workers' compensation laws during the next nine years, the last state, Mississippi, did not implement workers' compensation legislation for their employees until 1948.

Brief History of American Workers' Compensation Law

  • 1908: Federal Employers Liability Act (FELA)- This law was created to safeguard and compensate railroad employees who suffered workplace injuries.
  • 1911: Wisconsin Workers’ Compensation Act- Is regarded as the first state statute to properly address workers' compensation.
  • 1948: Mississippi Passes Workers’ Compensation Act – The last state to enact a workers' compensation statute was Mississippi in 1948.
  • 1990: Americans With Disabilities Act- This law was created to make it necessary for all establishments to be handicap accessible, allowing employees with disabilities to work in a secure atmosphere with appropriate modifications.

When Is An Attorney Necessary For A Workers' Compensation Claim? 

Statistics can help you understand how often workplace accidents and injuries are, but they can't tell you what to do next if you have an injury while working. Although workers' compensation claims are not the most complicated type of legal dispute, it is important to know when to engage an attorney and to have the correct lawyer defend you. The situations that could occur and are the most important ones for having a lawyer present are listed below.

  • Your claim is denied by your employer.
  • Your employer's settlement does not fully compensate you for your lost wages and other losses.
  • Your medical condition prohibits you from going back to work or necessitates major restrictions on your ability to perform your job duties.
  • A third party's acts or flagrant employee misconduct caused your injury. 

How To File For Workers' Compensation

  1. You must report an accident or injury to your employer- Making sure your employer is aware of any illnesses or injuries you sustain while working is your responsibility as an employee.
  2. Your employer should guide you through the necessary paperwork-Your employer is required to advise you of your rights, workers' compensation benefits, and how to resume work once you've informed them of the accident or injury.
  3. Your employer should report the accident and file the claim-The employer should typically send the claim form and any supporting papers to the workers' compensation insurance provider. Remember that a medical report will also need to be submitted by your doctor.
  4. The insurer approves or denies the claim- The insurer will decide whether to accept or reject your claim once it has been submitted.
  5. You return to work if able- You must give written notification to your employer and the insurance provider after you have healed from an accident and are able to go back to work. The insurance provider can be required to provide compensation for permanent disability, depending on the severity of the damage. Furthermore, many organizations have decided to put in place a structured return to work program with the goal of having employees back at work and productive as soon as feasible.

What To Do If Your Claim Is Denied? 

You must first realize that occasionally employers or their insurance providers may hunt for any excuse to reject your workers' compensation claim. Claim denials can occur for a number of reasons, including:

  • Late submissions.
  • Disputes over whether the injury was caused at work.
  • Your injury does not comply with state standards.
  • After quitting your work, you submitted a claim.

If one of these requirements has allegedly been compromised, but you claim otherwise, speak with a workers' compensation attorney right away. Workers' compensation lawyers can assist with any of your inquiries about the rejection of your claim and will fight for your rights.

Appealing A Workers’ Compensation Denial

You can begin the appeal procedure after learning the reasons your claim was rejected. The letter notifying you of the refusal should also provide a timeframe by which you can appeal; however, different states have different deadlines.

Be sure to communicate with your employer or your company's insurance provider to better understand the circumstances around the rejection since, in some cases, a denial can be as simple as a clerical mistake or misunderstanding and be remedied quite easily.

If you wish to appeal the workers' compensation denial after speaking with your employer or their insurance provider, you must get in touch with a knowledgeable workers' compensation lawyer. You will need to produce any documentation, including any medical records, that demonstrate the basis for the decision in order to give your attorney the best opportunity of successfully appealing your workers' compensation denial. Two examples of papers you may give your lawyer are a second medical report or a timesheet proving you were employed at the time the accident occurred.

Employer’s Legal Obligations Under Workers’ Compensation Laws

Under state workers' compensation legislation, companies are also required to comply with a variety of other requirements in addition to insurance, including posting notifications, informing workers of their legal rights, and delivering claim forms to injured workers.

An employer must put up signs in places where staff members often congregate during working hours. Listed on the poster or notification must be:

  • Important details on employee rights, particularly the entitlement to medical care.
  • Information on the workers' compensation benefits that are offered.
  • Name of the firm's workers' compensation insurance provider, the person in charge of adjusting claims, or state if the company is self-insured.

Workers' compensation claim papers must be delivered to injured employees by their employers within 24 hours of receiving notification of the work-related injury. Additionally, employers are required to give employees written information on their rights under the workers' compensation system (often in the form of a brochure).

Additional Rules and Laws Regarding Benefits and Workers' Compensation

Besides the standard regulations that control workers' compensation. Several acts have been put in place to fill the gaps and enable these employees to receive a type of workers' compensation since there are some professions that do not fall within the normal workers' compensation.

The Merchant Marine Act of 1920

The Merchant Marine Act of 1920, sometimes known as the Jones Act, is a federal law that provides much-needed protection to sailors who risk life and limb to escape perils on the high seas and in other navigable waterways.

Given that commercial maritime employees are not eligible for workers' compensation payments, unlike workers on land, the Jones Act's implementation represents a significant step for these individuals. Due to a lack of safety or carelessness on the part of their employer, workers who sustain injuries while working aboard a vessel may be entitled to compensation under the Jones Act. 

In addition, the Jones Act is as applicable to those working on fishing boats, cruise ships, and container ships as it is to those working on oil rigs.

Who Is Eligible To File A Jones Act Claim?

You must be working as a ship's crew and have spent 30% of your career aboard a ship to be eligible to make a Jones Act claim. Due to the Jones Act's coverage of the costs of medical care, missed income, and lodging during rehabilitation, it is quite comparable to workers' compensation.

In addition, if the damage you sustain prevents them you working again, the Jones Act entitles seamen to a larger sum of money as compensation for their pain and suffering, lost future earnings, and medical expenses in the event of catastrophic injuries like loss of limbs, paralysis, or wrongful death.

The Federal Coal Mine Health and Safety Act of 1969

The United Mine Workers were successful in their attempts to urge the U.S. Congress to have some form of workers' compensation. In doing so, President Nixon signed The Federal Coal Mine Health and Safety Act of 1969 on December 20th, 1969, which provided compensation for miners suffering from Black Lung Disease. Pneumoconiosis (CWP), silicosis, emphysema, and chronic obstructive pulmonary disease are only a few of the lung conditions that can develop as a result of exposure to coal mine dust under the umbrella term of "black lung disease."

The law's main objective is to establish uniform, nationwide standards for the health and safety of coal miners. It also included an income-maintenance provision that is exceptionally intriguing since it gave the federal government temporary control over workmen's compensation.

Who May File A Black Lung Benefits Claim? 

Any coal miners, both present and past (as well as particular transportation and construction workers who were exposed to coal mine dust) and their surviving dependents, such as surviving spouses, orphaned children, adult children with disabilities, and fully dependent parents, brothers, and sisters, may submit a claim.

Federal Employers Liability Act

If a railroad employee is hurt, becomes ill, or passes away while working as a consequence of their employer's negligence, they may claim for damages under the Federal Employers Liability Act (FELA). The surviving spouse, children, parents, or other dependant relatives of a deceased railroad employee may bring a claim against the railroad employer on their behalf through the personal representative of the deceased employee. Any employee injuries that are entirely or largely the result of the railroad employer's negligence will be held accountable.

The Longshore and Harbor Workers' Compensation Act (LHWCA)

A federal law known as the Longshore and Harbor Workers' Compensation Act (LHWCA) governs the payment of benefits to workers who become disabled as a result of workplace mishaps that occur on navigable waters within the United States or in close-by areas that are typically used for loading, unloading, repairing, or building vessels. It also includes the provision of medical assistance and services for vocational rehabilitation.

If the oil rig where you are now employed does not meet the provisions of the Jones Act, coverage may be available under the Longshore and Harbor Workers' Compensation Act (LHWCA).

Who Is Eligible For LHWCA?

The LHWCA benefits are usually more advantageous to the injured worker than the benefits provided by many state workers' compensation legislation. Additionally, unlike other state workers' compensation statutes, the LHWCA permits injured workers to receive payouts for permanent partial disability. However, the LHWCA has established two tests known as the status and situs tests in order to assist in determining who is qualified for LHWCA benefits. 

The Statues Test

The type of job an employee does is significantly important for the status test. To be eligible for LHWCA benefits, an employee must do at least a percentage of "maritime" duties. This suggests that using water or marine transportation must be a significant part of the employee's job.

The Situs Test 

The second evaluation criterion for LHWCA coverage is the situs test. The location where the employee often works for the company is the focus of the situs test. Only maritime employees who carry out their activities on, near, or close to navigable water are covered by the LHWCA. Additionally, if a person spends at least some of their time working on piers, wharves, dry docks, terminals, or other places often used by an employer when loading, unloading, repairing, dismantling, or building a vessel, they will typically pass the situs test.

Frequently Asked Questions

Q: What actions should I take if I am hurt at work?

A: When an injury occurs at work, you should notify your employer as quickly as possible. You should still report the accident even if you don't believe you were hurt because some injuries don't show up until after the occurrence.

Q: Do I require legal assistance for my workers' compensation claim? 

A: You might want to think about hiring a lawyer if your injury is serious or if you anticipate being incapacitated for a long period. 

Q: What would happen if my company lacked workers' compensation insurance? 

A: You will be able to sue the employer in civil court if your employer does not have workers' compensation insurance and you get hurt at work. Employers who do not have the proper insurance might also be subject to harsh penalties and legal action.

Q: What counts as an accident at work?

A: Any accident that occurs while you are working for your company or while you are on the clock is considered a work-related accident. This includes social gatherings hosted by your employer, such as company parties, even if they may not take place on business premises. 

Works Cited

“Employer-Reported Workplace Injuries and Illnesses – 2020.” Bureau of Labor Statistics, https://www.bls.gov/news.release/pdf/osh.pdf.

“45 U.S. Code § 51 - Liability of common carriers by railroad, in interstate or foreign commerce, for injuries to employees from negligence; employee defined.” Law.Cornell.Edu, https://www.law.cornell.edu/uscode/text/45/51.

Guide, Step. “Longshore and Harbor Workers' Compensation Act Frequently Asked Questions.” U.S. Department of Labor, https://www.dol.gov/agencies/owcp/dlhwc/FAQ/lsfaqs. 

“Jones Act | Wex | US Law | LII / Legal Information Institute.” Law.Cornell.Edu, https://www.law.cornell.edu/wex/jones_act.

“1969 – Federal Coal Mine Health and Safety Act passed.” Mine Safety and Health Administration (MSHA), https://www.msha.gov/1969-%E2%80%93-federal-coal-mine-health-and-safety-act-passed.“Pneumoconiosis.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumoconiosis.

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