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Guide to Workers’ Compensation Law

Workers’ Compensation is a system of laws in every state that provides compensation to employees who become injured while carrying out their job duties. Although workers’ compensation can be an incredibly beneficial safety net for workers, it is not always a simple system to navigate. There are some exceptions to the general rules about who is covered under the program and what kind of benefits they can obtain. Below is a basic guide to workers’ compensation laws and the parts of it that can be confusing.

If you have any questions about how these laws may apply to you or think you may have a personal injury case that goes beyond workers’ compensation, call our work accident injury lawyers at 212-736-5300 or fill out our contact form.

How It Works

The workers’ compensation system is meant to benefit both the employee and the employer. Most states require employers to buy some form of workers’ compensation insurance, whether it is through a private insurance company, a state-run fund, or by proving that they are self-insured. It is important to note that the kind of insurance your employer has will not affect your ability to recover workers’ comp benefits; as long as you are eligible, you are legally entitled to them. Because of this insurance, employees are provided with a “safety net” that ensures they will receive benefits if an accident happens while they are on the job. In return, the insurance also protects employers from any potential lawsuits an injured employee might file; under workers’ comp law, employees cannot sue their employers for work-related accident damages. Essentially, when filing a workers’ compensation claim, you are requesting benefits from the insurance provider, not suing your employer.

This is because workers’ compensation is a no-fault system. In order to qualify for benefits, an employee simply has to demonstrate that they were injured or contracted an illness in the course of performing their job duties. The potential negligence of the employer or employee and how it contributed to the accident does not factor in; regardless of fault, the employee can receive benefits if his injuries were job-related. Because of this program, injured workers can receive necessary coverage for medical care, disability, lost income from missed work, and treatment related to rehabilitation.

Who Is Covered?

If the employer has workers’ compensation insurance, employees will be eligible for benefits as long as they meet certain criteria:

  • The injured party is an employee. In order to qualify for workers’ compensation benefits through the employer, the injured person must be an official employee. Independent contractors—freelancers or gig workers, for example—typically do not qualify as employees who are eligible for these benefits.
  • The claimant was injured or became ill while performing job duties. In order to receive benefits through workers’ comp, the injured person has to show that his injury occurred while performing job duties or work-related tasks. For example, a construction worker who was dismantling scaffolding and fell in the process would likely be able to make a claim for benefits. In some cases, defining “work-related tasks” is a bit unclear; if a worker was injured while on his lunch break, for example. In situations like these, contacting a workers’ compensation lawyer may be helpful.
  • The claimant files an accident report within the state’s deadline. Every state has a different deadline by which an accident report has to be filed in order for the claim to be considered valid. The general rule of thumb is to file the report as soon as possible after the accident occurs. In New York, for example, the injured party only has 30 days to file an accident report, or the claim will not be considered valid.

Workers’ compensation is a wide-reaching program; it is meant to help most workers in case of accidents. However, there are some workers who are not covered under state programs and would need to look elsewhere for compensation. These include:

  • Federal employees: Employees of the federal government are covered by the Federal Employee’s Compensation Act, or FECA, which is administered by the U.S. Department of Labor. Through this act, they receive similar benefits to those provided by state-sponsored workers’ comp programs if they become injured at work or contract a disease as a result of dangerous work conditions.
  • Specific industry workers, such as coal miners: The Department of Labor also administers benefits for specific groups of workers, including longshore and harbor workers, coal miners, and employees of the Department of Energy.
  • Independent contractors: Independent contractors are not considered employees and are not covered by any workers’ compensation program. There is sometimes contention about what differentiates an independent contractor from an employee, as there are situations in which some employers have tried to classify employees as independent contractors to avoid having to buy workers’ comp insurance. If you have questions about your employment status, a workers’ compensation attorney may be able to assist you.
  • Volunteers: Volunteers for non-profit organizations are not covered under workers’ compensation if they are injured in the course of performing their volunteer work.

What Are the Benefits?

Exact laws about benefits vary by state, but most workers’ compensation benefits include coverage for:

  • Medical treatment: Employees receiving workers’ comp benefits are entitled to compensation for medical treatment related to their work-related injury. This typically includes doctors’ visits, prescriptions, and surgery that may be needed to restore the injured worker to a state well enough to return to work.
  • Rehabilitation costs: If the employee requires treatments like physical therapy or other therapeutic care, workers’ compensation will typically cover those costs in addition to basic medical treatment. Additionally, if the employee needs to be retrained in certain skills in order to return to work, tuition and other costs associated with that would also fall under this category.
  • Permanent or temporary disability: If a worker becomes disabled, either partially or totally, as a result of a work accident, workers’ comp will provide benefits. Disability benefits often fall into two main categories: permanent partial disability and permanent total disability. Permanent partial disability means a worker has been impaired in some capacity, but is not incapable of returning to some form of work eventually. Permanent total disability means that a worker has been so severely injured they will likely never be able to return to work. To determine the amount of disability benefits a worker will receive, a doctor examines the worker and assigns him a number that indicates the severity of his disability. That number is then used to calculate weekly benefits. For example, in New York, an injured worker’s weekly benefits are calculated by multiplying two-thirds of the worker’s average weekly pay by the percent they are found to be disabled.
  • Lost wages because of missed work: Because the worker’s injury will likely keep him from being able to work, an important part of workers’ compensation is wage replacement. The formula differs depending on the state, but most workers are paid approximately two-thirds of their typical wage. Additionally, the maximum amount of time that workers can receive wage benefits or the age at which they would stop receiving these benefits varies by state. Finally, it is noteworthy that workers’ compensation wage benefits are not taxed.
  • Survivor benefits: If the work accident resulted in death, most states allow for the deceased worker’s loved ones to collect survivor benefits if they were financially dependent on the worker. This compensation can be a percentage of the worker’s wages or a lump sum, depending on the state.

Note that workers’ compensation benefits do not cover pain and suffering. Compensation for the physical and emotional pain that comes from enduring a traumatic accident and its aftermath can only be obtained through a third-party personal injury claim.

Personal Injury Claims vs. Workers’ Compensation

Although workers’ compensation is beneficial to workers in many ways, there are some limits to what it covers. Not only is pain and suffering not covered under workers’ comp, but there are also limits to the amount of benefits a worker can receive. For example, in New York, the current maximum amount of weekly benefits a worker can receive is $966.78. In situations like these, a worker might feel the benefits they are receiving are not sufficient to cover their expenses, or perhaps they feel their work accident was so life-altering that they are not being properly compensated for their pain. In these cases, if you feel that negligence contributed to causing your accident, filing a personal injury claim if an option you will want to pursue.  Oftentimes injured workers are not even aware of their right to bring a personal injury claim in addition to a workers compensation claim.  For example, you might think your injury was caused by the negligence of your employer, but, depending on the facts, the law may impose liability on another entity, such as a construction site owner or general contractor, for failing to ensure the site was operated safely.  This is why we strongly recommend contacting a qualified work accident law firm like Block O’Toole & Murphy following any injury at work.

If applicable, filing a personal injury lawsuit allows you to make a claim for various damages, including medical costs, property damage, loss of current and future income, loss of enjoyment of life, pain and suffering, and emotional trauma. These cases, depending the facts, can be worth many millions of dollars.  It is also possible to file a workers’ compensation claim and bring a personal injury lawsuit at the same time; however, it is important to note that you cannot sue your employer. As discussed previously, workers’ compensation insurance protects the employer from legal action. You can, however, file a claim against a third party if their negligence contributed to causing your accident, such as a manufacturer of defective equipment or a contractor that did not provide the proper safety equipment.

Contact a Work Accident Lawyer Today

Whether you are considering bringing a personal injury lawsuit or simply want to navigate the process of filing a workers’ compensation claim, the expert work accident lawyers at Block O’Toole & Murphy are here to help you. Our firm has handled countless personal injury cases in which workers were severely hurt on the job. We serve New York and New Jersey.

Select results in work injury cases—third-party personal injury lawsuits in particular—include:

  • $15,000,000 settlement for the surviving family of an HVAC worker who was tragically crushed by a falling air chiller in a work accident
  • $12,000,000 settlement for a Manhattan laborer who fell while working on the number 7 subway extension project and suffered serious injuries, including blindness in one eye and multiple fractures
  • $11,500,000 settlement for a 35-year-old union construction worker who suffered serious wrist injuries, including Complex Regional Pain Syndrome, after a work-related accident with a defective saw
  • $11,000,000 settlement in a Brooklyn case for a masonry foreman who fell three stories after he stepped on a temporary unsecured hole cover
  • $10,875,000 jury verdict for a union worker who suffered severe internal injuries after he fell on a piece of uncapped steel rebar at a Brooklyn construction site
  • $10,500,000 settlement for the surviving family of a union laborer who sustained a 12-centimeter laceration to his neck when a defective saw kicked back; he tragically died from his injuries
  • $7,400,000 settlement for a worker who fell three feet from a beam during a Brooklyn construction project, suffering injuries that required multiple surgeries
  • $7,300,000 settlement for a construction worker who unfortunately required a below-the-elbow amputation of his right arm after a serious steel demolition accident
  • $7,000,000 settlement for a 25-year-old carpenter who was struck in the face by a five-pound metal clamp that fell from above
  • $7,000,000 settlement for a worker who fell 30 feet down an elevator shaft in Manhattan, resulting in serious crush injuries that required nine surgeries

To view more of our successful work accident results, visit our Verdicts and Settlements page.

If you or a loved one has been injured in a work accident, you deserve to get your life back on track. If your accident happened in New York or New Jersey, dial 212-736-5300 or fill out our online contact form to schedule a FREE, no-obligation legal consultation.

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