Workers’ compensation benefits can protect you, your business, and your employees from the financial and legal consequences of workplace accidents. Millions of Americans are hurt every year in on-the-job incidents. Industries like aviation, construction, and transportation are especially dangerous, accounting for an above-average number of injuries and deaths every year.
As a business owner, you understandably want to cut costs where you can. There are numerous reasons you might consider a workers’ compensation insurance policy to be an expense that affords few benefits. However, foregoing workers’ comp insurance can be a costly mistake.
The workers’ compensation lawyers at Pond Lehocky assist injured workers in obtaining benefits under the law. With this perspective, we can also speak to how these laws protect and benefit companies with employees.
Is Workers’ Comp Insurance Required?
Having workers’ compensation insurance is more than just a smart business decision — it is the law.
State law requires most employers with at least one employee to carry workers’ comp insurance. Employers who intentionally choose not to do so can be convicted of a third-degree felony, which carries a potential $15,000 fine and up to seven years in prison.
How Does Workers’ Comp Insurance Work?
In simple terms, workers’ comp insurance pays your employees if they become injured or ill while on the job. Your workers’ comp insurer pays out covered claims so you do not have to pay these expenses yourself.
After your employee reports a workplace accident to you and you notify your workers’ comp insurer, the insurer will take over. They will investigate your employee’s claim and, if they approve it, pay your employee the benefits they are entitled to receive under state law. The insurer will typically pay these benefits until your employee either returns to work or reaches the point of maximum medical improvement.
Other benefits are available for workers who cannot return to their previous position or go back to work at all, as well as to the families of workers who pass away in workplace accidents. While injured employees are the primary beneficiaries of workers’ comp insurance, this type of coverage can also be an advantage to employers. Workers’ comp benefits are an exclusive remedy, meaning injured workers are generally prohibited by law from filing personal injury lawsuits against their employers since compensation is available in another form.
Are Businesses Required by Law to Offer Workers’ Comp Insurance?
Most businesses that have at least one employee are required to have workers’ comp insurance. This includes employers whose employees could be hurt on a job site located within or outside the state. It also includes employers under a contract of hire with the state.
There are three ways an employer can satisfy the requirement to have workers’ comp insurance.
- First, they can purchase a policy through the State Workers’ Insurance Fund.
- Second, they can take out a policy through a private insurance provider.
- Lastly, they can seek approval from the Department of Labor and Industry to self-insure.
Failing to maintain a policy when legally required to do so is a criminal offense. It can also expose the employer to civil liability — a worker who is hurt while working for an employer without workers’ comp coverage can sue the employer directly for damages.
Exceptions to Workers’ Comp Coverage
Although most employers are required to carry workers’ compensation insurance, this requirement is not universal. Some employers and business owners do not need to purchase a workers’ compensation policy. This group includes federal workers, railyard workers, and longshoremen.
Other employers exempt from providing workers’ comp insurance include sole proprietors, general partners, and those with a religious objection that is approved by the Department of Labor and Industry. Additionally, certain agricultural and domestic workers and those who assemble products from home do not need to be covered.
What Does Workers’ Comp Insurance Cover?
In general, workers’ compensation benefits cover an employee’s medical expenses and a portion of their lost wages if they are injured on the job. Specifically, the policy pays all reasonably necessary medical costs the employee incurs until they can return to work or no longer receive any physical improvement from treatment. Under workers’ compensation laws, employees who miss at least seven days of work due to their injuries are entitled to receive wage benefits starting on the eighth day.
This benefit is calculated at approximately two-thirds of the employee’s pre-injury wages. A worker will continue to receive this benefit until they return to work or reach a maximum amount set by law.
What if I Can’t Return to Work?
Additional benefits are available to address cases where a worker is not able to return to their job despite medical treatment. Similarly, workers who cannot earn as much as they did before their accidents due to permanent disabilities or limitations can also receive additional benefits.
All of these workers’ comp benefits are available to employees who suffer an injury or illness while at work and on the job. Benefits generally do not depend on whose fault led to the accident. Whether you, your employee, or a combination of the two were negligent, workers’ comp benefits would still be available to your employee.
Injuries Not Covered by Workers’ Comp
Not every workplace injury is covered by workers’ comp. One notable exception is injuries that follow from the employee’s intentional misconduct. For example, an employee who smokes marijuana before reporting for work might not receive workers’ comp benefits if they lose their balance and fall off a ladder.
Similarly, employees who race one another using powered equipment could be excluded from receiving benefits if they hurt themselves. Deliberate misuse of power tools in a manner that the tools were not designed for is a clear example of misconduct that would prevent a worker from receiving benefits.
Workers who are concerned about whether their injuries will be covered or whose claims have been denied should reach out to Pond Lehocky as soon as possible. Our knowledgeable workers’ compensation attorneys routinely assist workers in appealing wrongfully denied claims and securing the benefits they deserve.
What Is an Employer’s Responsibility if an Employee Is Injured at Work?
Although the insurer will pay an injured employee the workers’ compensation benefits they are due, this does not mean the employer has no responsibilities after a workplace accident. Employers have several responsibilities to handle once they learn that an employee has been hurt. Specifically, the employer should:
- Render first aid to the employee if the injury is minor.
- Direct the employee to a preferred physician or the employee’s pre-designated physician for evaluation and treatment.
- Assist in arranging transportation for critically injured employees by ambulance or other means.
Further, the employer should investigate the incident promptly and attempt to preserve as much evidence as possible. This involves inspecting the site of the accident, taking photographs, collecting physical evidence (such as defective equipment), and speaking with witnesses who saw the accident. The employer must complete numerous forms to document the accident and report it to their workers’ comp insurer.
Additionally, employers should remain in contact with the employee, the employee’s physician, and the insurer. This becomes even more crucial as the employee nears the end of their treatment and prepares to return to work.
Can an Employee Still Claim Workers’ Comp if Their Injury Was Their Own Fault?
Injured workers and their employers often assume that an employee is ineligible for workers’ comp benefits if they caused their own injuries. This assumption is false.
Workers’ compensation laws are considered “no-fault,” meaning an employee can receive benefits even if their carelessness was the primary or sole cause of the accident. There are only two situations where an employee’s actions could deny them workers’ compensation benefits.
The first is if the employee is drunk or under the influence of drugs at the time of the accident. The other is if the employee is engaging in intentional misconduct, such as horseplay or roughhousing. Workers’ compensation does not cover injuries that result from such behaviors.
What Happens if an Employee Is Injured at Work But Not on the Clock?
Workers may still be entitled to recover workers’ comp benefits if they are off the clock but still on the job. The determining factor in this situation is often whether the employee’s actions at the time of the accident were for the benefit of the employer. If so, their workers’ compensation claim will likely succeed.
For example, suppose that a construction worker has finished their scheduled shift and clocked out for the day. Before they head home, however, their employer asks them to make a delivery to another job site. While making the delivery, the employee gets injured in a car accident.
Because the delivery was an activity that benefited their employer, the employee would likely be entitled to workers’ comp benefits.
Let Our Team Help with Your Workers’ Comp Concerns
Workers’ compensation law can be deceivingly complicated for both workers and their employers. Do not wait until you have a denied claim or questionable accident to seek experienced legal help — turn to Pond Lehocky for insightful, authoritative answers for your pressing workers’ comp concerns.
Pond Lehocky fights to ensure you receive the maximum compensation possible for your pain and suffering, including your medical bills. With over 250 years of combined experience and a track record of over 100,000 successful cases, our expert attorneys are more than qualified to represent you.
To schedule a free, no-obligation consultation with our legal team, contact us today to schedule a consultation.
