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Worker’s Compensation

10 Basics of Workers’ Comp Everyone Should Know

Schwartz Lawfirm Sep 02, 2021

The reality is that work-related fatalities and injuries still occur. In 2018, 5,250 people died from job-related accidents or illnesses — that’s 3.5 per 100,000 full-time injured workers in the U.S.

However, your employer and their insurers are on the hook for causing life-altering accidents. Insurers paid a whopping $13.2 billion in combined losses or 82% of total premiums for 2019.

If you’ve been injured on the job, it’s essential to know your rights and the benefits you’re entitled to. Workers’ compensation laws vary by state, so here’s what you need to know before submitting a claim.

Defining Worker’s Compensation

Workers’ compensation provides a financial settlement to an employee who has been injured or become ill due to their job. The payout you receive from workers’ comp can help with medical bills and lost wages while recovering from your work-related injury or illness.

Injuries are caused by accidents, while illnesses are caused by exposure to hazardous substances at work. In either case, worker’s compensation pays for medical bills and lost wages while you recover.

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Usually, worker’s compensation pays approximately 60% of lost wages. However, workers can opt for short-term disability or long-term disability to cover the gap between workers’ comp insurance and wages.

In Louisiana, worker’s compensation is a no-fault policy. This means that you don’t need to prove your employer was at fault to receive worker’s compensation benefits. As long as you did not willfully or negligently cause your own injury, it doesn’t matter who is at fault for the accident. If it happened at work, you could apply for worker’s compensation.

Now that you know the basic definition of workers’ compensation let’s take a closer look at why filing a claim for this fundamental right is a matter of timeliness and can be challenging to navigate.

1) Your Employer Pays for Workers’ Compensation Insurance

Your employer is also responsible for providing workers’ compensation insurance, which covers your benefits. If workers’ compensation insurance isn’t provided, workers may sue their employers for negligence, or the court may find their employer.

In Louisiana, it’s rare for injured workers to be left in the lurch because workers’ compensation coverage is required by law.

2) Benefits are Restricted to Certain Circumstances

Workers’ comp benefits are for workers who have:

  • Been injured on the job
  • Been injured by their illness at work
  • Have contracted a work-related condition

If your injury or illness occurred off the job, workers’ compensation wouldn’t cover any of your medical expenses or lost wages.

Workers’ compensation only pays for medical bills and lost wages while recovering from your injury or illness. It does not pay for the cost of hiring lawyers or rehabilitation costs for workers who are permanently disabled due to their workplace injury or illness.

If workers are permanently disabled, they will need to establish a workers comp settlement and claim and file for long-term disability.

There are also some essential exemptions to consider. Even if you are legally employed, your claim may be denied due to the nature of your job. Common positions exempt from workers’ compensation requirements in most states include:

  • Undocumented Employees
  • Seasonal Employees
  • Home Care Providers

3) You Must Act Quickly to Meet Filing Deadlines

If workers’ comp insurance will pay your medical bills and lost wages, you need to file the claim as soon as possible. Each state has workers’ compensation claim regulations that workers must follow. If you don’t file your workers’ comp claim promptly, you may not receive workers comp benefits.

If you’re experiencing pain you believe is related to a workplace injury, but your circumstances prevent you from filing your claim in time, you may still have options. At Schwartz Law, we can review your case to determine if you qualify for disability or if civil litigation may be an option for you.

4) Any Injury Could Have Merit In a Worker’s Comp Claim

An injury doesn’t have to be life-altering to qualify for a worker’s comp claim. Many less-serious injuries may be eligible. These include:

  • Burns
  • Sprains
  • Strains
  • Reactions to toxic substances
  • Ergonomic injuries (i.e., carpal tunnel syndrome)

Each of these injuries varies in more than just severity — they also differ in compensation. For example, in Louisiana, the maximum compensation for an injury to a leg can be as high as $110,250.

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Furthermore, partially disabled workers who experience a drop in earnings can receive additional wage loss benefits for up to 10 years.

The most important consideration is whether the injury in question legitimately prevents you from doing your job. For example, you likely won’t win a worker’s comp claim because just your feet are sore at the end of the day.

However, if a co-worker drops a heavy box on your foot and you sprain your ankle as a result, you may have a case. That’s especially true if you’re unable to work with your injury.

There’s no “standard” case, either. As attorneys, we see a range of rare and even unusual circumstances winning workers’ comp claims. For example, altercations with customers could result in worker’s comp approvals if the incident’s details qualify.

The bottom line is that if your employer doesn’t reasonably accommodate your physical needs, they can be held liable for failing to adjust your duties accordingly.

Don’t hesitate to call us to discuss your case if you’re not sure you have a qualifying injury — through 20 years of experience, we’ve seen it all.

5) Plenty of Free Resources Exist to Help With Your Claim

The claims process is not easy, which is why workers must have an experienced workers’ comp lawyer by their side.

Fortunately, there are lots of free workers comp resources available that you can use to your advantage.

The workers’ compensation lawyers at Schwartz Law Firm offer free consultations and aggressive representation throughout Louisiana’s workers’ comp claim process. At Schwartz Law Firm, we are dedicated to workers comp law and helping workers get the benefits they deserve.

Below, you’ll find a list of helpful workers’ compensation resources you can use when navigating claims in Louisiana. Your workers’ comp case is unique to you and your situation—there’s no one-size-fits-all solution for all workers.

Similarly, every state has its own workers’ compensation laws. If you’re unsure about workers comp where you live and would like to find out more, you can learn about your local regulations on the U.S. Department of Labor website.

6) If Your Claim Is Denied, You Still Have Rights

The workers’ compensation system is designed to prevent workers from being exploited at work.

The law requires your employer to pay workers’ compensation benefits if you’re hurt on the job, but this doesn’t mean that workers’ comp claims will always be approved.

Employers can deny workers’ comp claims in a variety of ways, including:

  • Citing pre-existing conditions that were not reported before your workers’ comp injury.
  • Accusing you of making a workers’ comp claim fraudulently or accusing you of other wrongdoing.
  • Denying workers’ comp benefits due to workers who are no longer employed at their company.
  • Rejecting workers’ compensation claims for workers they see as less valuable (e.g., part-time workers).

If the claim is denied, there are still some things you can do. In cases where your employer either won’t pay or denies your workers’ comp claim, you should first file an appeal.

In worker’s comp appeals, you can defend yourself and your workers’ comp claim against the employer’s accusations. You can also call up a worker’s compensation lawyer to help you navigate through workers’ comp appeals. If this appeal doesn’t work out, other options for workers who have had their workers’ comp claims denied.

If the workers’ compensation administration denies your appeal, you should contact a workers’ compensation lawyer to explore all of your options. A workers’ compensation attorney can investigate a workers’ comp claim denial and guide your next steps.

The attorneys at Schwartz Law Firm are committed to the workers’ comp cause and have won over $500 million for our clients over the years. We put workers first and know how to get results that are fair for workers.

Always consult us before taking any action against the workers’ comp administration. A workers’ comp lawyer can ensure that you have everything they need to get workers’ comp benefits.

7) Injured Employees May Still Be Able to Sue Their Employer

Injured employees can still sue an employer for on-the-job injury or illness for various reasons. This is true even if the employee is receiving workers’ compensation benefits.

The workers’ compensation system does not prevent workers from suing their employer for workplace injuries or illnesses that occur while at work.

At Schwartz Law Firm, we handle workers’ compensation injury cases for workers denied benefits. We can also advise you about instances in which your employer may be liable for negligence or abuse. If you feel your rights have been violated at work, call us immediately. The faster you pursue your case, the better your chance to recover financially and physically.

8) Worker’s Comp Doesn’t Cover Pain and Suffering

There aren’t a lot of workers comp policies that cover pain and suffering, which is a key reason why workers file a lawsuit against their employer. Some workers’ compensation benefits reimburse workers for medical expenses related to their on-the-job injury or illness. Still, workers may need additional treatment if they are in chronic pain. That’s why many individuals choose to hire attorneys in Louisiana, even with workers’ compensation or short-term disability benefits.

9) Your Employer Isn’t Required to Hold Your Job Open

If you do decide to pursue short or long-term disability or file suit against your employer, you should know that it can be a long and often protracted process. In the meantime, and as you heal, your employer may decide to fill your position.

According to workers’ compensation laws in Louisiana, employers aren’t required to hold workers’ jobs open while receiving workers’ comp benefits or any other kind of workers’ comp. If you suffer a workplace injury that causes you to miss work for an extended period, the employer isn’t obligated to wait for you.

For instance, if your injury is so severe that you cannot work for one year, your employer still needs someone to fill your duties. They are free to hire someone to cover your job role, and they aren’t obligated to give you your job back once you recover.

10) Insurers May Investigate You to Verify Claim Details

After employees file a workers’ compensation claim, their company’s workers’ compensation insurance provider may want to investigate the details of the accident or illness. The workers’ comp insurer assumes that workers file fraudulent claims to obtain workers’ comp benefits illegally.

If you discover that your employer has filed an investigation request against you because they believe you have made a workers comp claim fraudulently, don’t ignore it. Once workers’ comp insurers suspect illegal activity, they will keep a close eye on you and your workers’ compensation benefits.

If you have made a legitimate worker’s comp claim, you have nothing to worry about. However, you should never make statements or sign paperwork regarding your case without an attorney present.

Conclusion

Having workers’ compensation insurance can help workers get better quicker, and it may even help workers avoid going into debt to pay their medical bills. However, workers need to file these confusing and often lengthy claims correctly to receive workers’ comp benefits.

Employees often file a workers’ compensation claim without the proper paperwork or give incorrect information when filing their claim. Doing so could put them at risk of having their workers’ compensation benefits revoked.

Workers also must be careful not to speak with insurers until after they have talked to an attorney, as doing so can further compromise workers’ legal rights. At Schwartz Law, we understand workers’ compensation laws and workers’ compensation claims. We can help workers through the workers’ compensation claim process to ensure employees receive all benefits they deserve.

 

About Author: Schwartz Lawfirm

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Managing Partner

Schwartz Law Firm was founded by Christopher Schwartz in 1997. After obtaining his MBA and law degrees, Christopher Schwartz served as a Workers Compensation claims adjuster. This experience gave him a view of the system from the inside and inspired him to begin his own practice. Christopher Schwartz has successfully represented many injured employees in Longshore claims, Jones Act claims, and Personal Injury claims. He is a tough negotiator, whose track record includes multi-million dollar verdicts and settlements.