Why you could be refused benefits

While the introduction of Worker’s Compensation Benefits have helped the majority of workers injured or diseased by work, there are of course gaps in every system. Especially legal systems where laws can be changed constantly and re-written.ome of the reasons you may need to hire a lawyer to help you with your claim:

Some of the reasons you may need to hire a lawyer to help you with your claim:

  • If you’re uncomfortable or unable to understand any part of the process of filing a claim – In this case it is always best to seek a lawyer’s services as they will have the knowledge to help you out. If you claim in an incorrect fashion, then the claim can be voided and you will lose out on your compensation.
  • Your employer won’t file or produce a report for your injury – Unfortunately this is the most common reason that workers hire lawyers to help them in their claims. Workplaces often don’t like to produce injury reports as it portrays them in a bad light, can often highlight bad health and safety practices, poor work conditions and mismanagement and invites OSHA to scrutinise the company. In this case you would certainly have to hire a lawyer to aid you in your claim
  • The insurance company threatens to refuse paying your compensation – This can often happen if certain procedures aren’t kept, for example your workplace misfiled documents, you have failed to appear at hearings or the insurance company suspects fraud. In most cases you would have to hire a lawyer to track the problem and deal with it effectively
  • You have returned to work after the injury has healed, then become injured again and the insurance company refuses to restart your benefits – This can often happen due to the insurance company wanting you to file a new claim for the injury, or that their records system has become confused by the injury occuring twice. This doesn’t always call for a lawyer, as you can normally organise this with the company yourself, however if the indurance company is difficult to deal with or will not fix the situation then you will need a lawyer.
  • If your work injury has caused scarring to always visible areas i.e. Head, face or hands – In this case you may be able to collect extra payments for the scarring as it may cause you to not be hired at another workplace. This kind of case always requires legal representation as you require someone with expertise in persuasion and legal knowledge.
  • If you are offered a lump sum of money to pay for your future medical bills, rather than a monthly stipend – This case is always complicated as the workplace or insurance company will often do this so that they can save money in the long-term due to inflation, not including certain bills they know you can’t foresee and other reasons. If you are happy with the settlement, then by all means accept it, but it is always best to seek legal advice with a lawyer experienced with it so they can tell you about any possible future expenses they can foresee.
  • If you’re offered a lump sum of money to settle your claim, rather than going through the process of filing the claim – You should always seek a lawyer in this case as accepting the settlement will often cause you to lose some of your rights.
  • You’re informed a petition has been created to refuse, modify or pause your benefits – These cases always require a lawyer as a party will have seen an error or what they believe is something wrong in your claim and you will need legal counsel and representation to fight their perception of the claim.

We hope this guide has been helpful, and as ever, if you have any questions or would like some guidance or information, then please do contact us!

What to do when you are injured at work

When injured at work, it’s important that you take steps to aid your recovery, but to also make sure that you fulfill your obligations in order to apply for worker’s compensation. There are naturally then, 3 major steps that you must take.

Step 1: Immediate first aid

More important than anything when you’re injured at work is to first obtain medical treatment as soon as possible. Gain immediate first aid at work to aid in any medical procedures later. Once this is done, you must see a healthcare provider that has been authorized by the Worker’s Compensation Board, unless it is an emergency situation. Your workplace should be able to provide you a list of authorized providers in your state, or you can search online for one. It may also be

It may also be necessary to use an authorized pharmacist or diagnostic provider if required by your state. As long as the case is not disputed, the cost of your necessary medical expenses

As long as the case is not disputed, the cost of your necessary medical expenses will be paid for by your employer or their insurance carrier. The health care provider, may however, ask you to fill in paperwork stating that you will pay for the costs if the Workers’ Compensation board disallows the claim or you do not pursue workers’ compensation.

Step 2: Notify your supervisor/manager of the incident & injury

Get in touch with your manager or supervisor, inform them of the injury, how it happened, and when, as soon as sensibly possible. If the injury requires you to find urgent medical treatment, then do that first, and get in touch with your supervisor as soon as the injury is under controlled. Otherwise, inform them before you seek treatment so they are aware of the situation and take steps themselves to enable your workers compensation claim.

If you do not notify your supervisor within 30 days of the accident that caused the injury, then you will lose your right to the Worker’s Compensation benefits.

If you have an occupational disease, rather than an accident causing injury, then you must inform your supervisor/manager within 2 years after coming under disability due to the disease, or within 2 years of you finding out that the disease is related to the workplace.

Step 3: Apply for Workers’ Compensation Benefit

Approach your employer asking for a Workers’ Compensation Benefit claim form – normally a C-3 form. You must then mail this to your state’s nearest Workers’ Compensation board. As above, if you do not do this within a certain time-frame, you will lose your right to claim for the compensation.

What to do afterward

After the previous steps have been taken, it is then advisable to do everything in your own best interests. Your first priority should be to make sure you do everything your doctor tells you to, to aid in a quicker recovery from your injury. You should also have an examination performed by an independent doctor so that you have a valid, unbiased second opinion on your condition.

You should also go back to work as soon as practically possible so that your financial situation isn’t too badly effected.

Finally, you should ensure you go to any hearings that are organized for your case by the Workers’ Compensation Board, or again, you may lose your right to compensation benefits.

Hopefully, this guide has given you some good information on what to do in the unfortunate event you do suffer from an injury at work. Remember, if you have any questions, don’t hesitate to get in touch with us!

What is Worker’s Compensation?

Worker’s Compensation laws were created in order to provide benefits to workers who are injured on the job or contract a work-related disease. In America, there are five types of benefits that are generally available to someone if they can prove they were injured due to a work-related issue or disease.  This means that the worker then has the “right to compensation”. They may collect money for:

  • Loss of Earnings benefits for disabilities (as this will affect the earnings they can gain in the future due to the incident)
  • Medical Benefits (as they will have to pay for cures, medical aids & associated costs with caring for their injury)
  • Specific Loss benefits (Losing a specific body part I.E., hand, leg, eye, due to the work carried out)
  • illegally-employed minor’s benefits (due to language not always being clear, a company may believe someone is legally employed, though the state or federal government disagrees. In this case, the worker is entitled to compensation just as a legally employed worker is)
  • Death benefits (If a worker is killed while on the job due to the work being carried out, his dependants or immediate family members are entitled to the compensation, the costs of the funural will also be paid by the employer directly to the funeral home)

Why were workers’ compensation laws enacted?

Before workers’ compensation laws were enacted, the only way a worker could claim compensation for their injuries was to prove the employer was negligent, which caused their injury. In this case, it was up to the worker to prove the onus of responsibility lied on the employer and it was only due to their negligence that the worker was injured.

This held many problems as not only would the employer normally have more resources and money to spend on disproving the workers’ claim but that the burden of proof laid on the injured worker, at a time when sometimes they were unable to return to work and investigate. It would in the majority of cases become a case of workers’ word against employers, which ended up in an unfair trial.

The employer would often win these cases by claiming the worker was injured by not following safety procedures, that the injury was caused by a fellow worker, or it was caused by an ordinary workplace hazard, rather than negligence. This enables them to avoid responsibility.

The rare times a worker would win the case, the worker would often have delays in the being paid the money owed from the court case, as well as having high costs in hiring an attorney to take their case and fight for their rights. The employer would also often have to pay inordinate amounts of money compared to the injury received. Finally, the times where a worker could work while the court case was going on, they would encounter very stressful situations in the workplace due to frictions with managers and other co-workers.

Due to all of these problems, both employers and workers favor the new workers’ compensation laws. They mean that the worker is automatically entitled to the new benefits, which are a predictable amount, meaning companies can budget for the loss. Workers no longer have the difficulty of bringing a case to the courts, while companies are protected from a worker asking for a larger amount.

This would be fine, if it wasn’t for the fact that in the real world, laws often get amended, changed and sometimes completely re-written. This means workers are now often left suffering with no recourse. Therefore, workers are now having to hire attorneys to fight for their rights, and this is why the system doesn’t always work.