Workers compensation is personal injury insurance that is provided by the employer covering injuries resulting from workplace accidents. According to federal law, each state must provide a workers compensation insurance system that generally serves as an administrative board overseeing the filing of workers compensation personal injury claims.
The rules for collecting a workers compensation insurance claim vary among the states, but all states require that the personal injury actually occurred in the performance of a job-related task, regardless of the location, and claims can include injuries that do not worsen until after the scheduled work hours.
The ultimate determination of who is an actual employer is established by who is required to provide workers compensation insurance protection for a particular employee. Employers must provide insurance coverage for every valid employee in exchange for a certain level of personal injury liability immunity if the worker is injured on the job. This stipulation does not mean an employer cannot be sued in standard court in situations involving legal non-compliance with safety codes and regulations, but it does allow protection for the employer who is actually diligent in following all major operational safety rules.
Workers Compensation Insurance Company Responsibilities
The workers compensation insurance company is primarily responsible to the employer and their own company profit margins. Limited payouts are the goal of the insurance adjuster, although many times they will not contest an injury claim initially if the employer agrees that the injury claim is valid. However, the insurance provider will also have legal input regarding the injury claim, so the situation can become adversarial even when the employer is compliant with uncontested reporting.
How the Filing Process Works
Workers are covered for injuries that occur on the job when the injury severity renders the worker unable to work for seven calendar days. The injury should be reported as soon as it is known, and an injury report should be filed immediately. After a worker has been unable to work for seven days, the medical and income replacement coverage is retroactive to the day of the injury. Workers compensation insurance covers medical bills resulting from the injury, as well as provisions for income replacement based on the injured worker’s rate of pay.
Workers are paid two-thirds of their standard net wage, not including tax deductions, and those who work second jobs may be able to collect on the lost second income as well in certain states. After the claim is allowed, income replacement coverage is paid in two week increments and is retroactive to the day following the injury occurrence. The injured worker is allowed to return to work when the medical professionals treating the workplace injury release the patient.
It is important to remember that workers compensation claims always include a potential second negligent party, as the employer and insurance provider both have legal input into defending the claim. Insurance companies that utilize bad faith tactics can be particularly problematic, including ceasing workers compensation payments at any time during the injury recovery process.
In addition, industrial accidents that occur as a result of substandard work equipment can also establish standing for a defective product claim. Even though the workers compensation system is structured in a manner that supposedly protects the employer as well as the worker, the worker still has legal options in situations of extreme negligence. Even though it may create a contentious relationship with an employer, it is never a good idea for the injured worker to attempt handling a workers compensation insurance claim themselves without professional legal advise.
Christopher Steven is an avid blogger from Tulsa, Oklahoma who is passionate about encouraging safety for all communities while working with the Gorospe & Smith Personal Injury Lawyer Firm in his own community to educate and promote safety and accident prevention.