How Does Workers’ Comp Work?

How Does Workers’ Comp Work?

Steven Schwartzapfel -Founding Partner Aug 17, 2022

For more than 35 years, Steven Schwartzapfel, the founding member of Schwartzapfel Lawyers P.C., has been one of New York’s most prominent personal injury attorneys. Steve represents clients in all types of personal injury cases. His experience, skill, and dedication have enabled Schwartzapfel Lawyers P.C. to recover hundreds of millions of dollars for their clients.

All employers in the US must carry workers’ compensation insurance for any employee with a work-related injury or impairment. This helpful insurance guarantees that you’ll receive benefits payments to help cover the cost of medical and related bills while you recover.

Still, many American workers don’t know how workers’ comp works, whether they qualify, or what to do when their workers’ comp claim is denied. That’s where we come in.

Schwartzapfel Lawyers can help you get the benefits you need and are entitled to when you contact us today online or at 1-800-966-4999.

How Does Workers’ Compensation Work?

Workers’ compensation is a federally mandated type of insurance that all legal employers must carry to account for workplace injuries sustained by federal and state workers. Workers’ compensation insurance provides medical and disability benefits for injured workers, provided they were injured on the job and/or while in the performance of regular work duties.

The main benefit of workers’ comp is that injured workers don’t have to contribute to these payments. This allows injured workers to rest, recover, and pay for their medical bills without having to worry about lost income or medical debt.

Workers’ compensation insurance is not intended to compensate employees whose injuries were due to the fault of another party; rather, it serves to protect workers in relation to general workplace safety concerns. In fact, workers’ compensation cases only apply if no one is determined to be at fault. Moreover, workers’ compensation payout amounts aren’t determined by either perceived or actual carelessness (with a few exceptions) or by an employer’s fault.

What Does Workers’ Compensation Coverage Include?

Workers’ compensation insurance coverage applies to any injuries that result from an accident while on the job. These job-related injuries often include but are not limited to:

  • Broken and/or fractured bones; bruises
  • Carpal tunnel syndrome
  • Back injuries and/or neurological damage from repetitive movement
  • Lung injuries from an injured worker having inhaled one or more toxic substances
  • Auto accident injuries
  • External lacerations; internal bleeding
  • Blindness and/or other visual disabilities
  • And more

Additionally, certain comp insurance policies include death benefits or support for spouses and dependents (e.g., children).

According to workers’ compensation law, business owners, independent contractors, and regular employees can enter the claims process. The key aspect when determining whether your injuries qualify for workers’ compensation insurance is:

  • Whether you sustained the injuries while on the job. Note, too, that injuries do not have to occur at the workplace if your job duties required you to be elsewhere.
  • Whether you sustained your injuries while carrying out your normal part-time or full-time duties.

Consider this: If you’re injured while lifting a heavy box for your employer, that injury is compensated under workers’ compensation insurance. If, however, you leave the workplace to grab lunch at home and are injured while on the way there, injuries from that accident are not necessarily covered by workers’ comp.

To speak with a Schwartzapfel Lawyers workers’ comp specialist, dial 1-800-966-4999 now!

How Are Workers’ Compensation Benefits Paid?

Workers’ compensation benefits are distributed as weekly cash benefits and medical care expenses paid to health care providers. Your total workers’ comp coverage benefits are contingent on:

  • The current and predicted cost of your medical expenses, including past and future medical bills as well as recurring expenses for things like medication or physical therapy
  • The level of responsibility, if any, that you are assigned for your injuries

Note: As cash benefits are paid weekly, you don’t have to worry about not having enough for immediate medical costs or purchases.

Who Pays Workers’ Comp Benefits?

Many workers believe that workers’ comp benefits are paid by their employers. In reality, these benefits are paid by workers’ compensation insurance companies. As directed by your Workers’ Compensation Board, both weekly cash benefits plus medical care expenses are paid by your workplace’s insurance carrier.

Therefore, if your workers’ compensation claim is denied or contested, it’s likely because of the insurance carrier and not your employer (though employers may be responsible in some cases). If this happens to you, you should contact Schwartzapfel Lawyers today at 1-800-966-4999 for qualified legal representation and a free case evaluation.

Eligibility for Workers’ Comp Benefits

The key elements of eligibility for workers’ compensation benefits are whether your injuries occurred while on the job or at work and whether they occurred while you were carrying out your normal duties.

So long as you sustained your injuries doing what you would normally do at the workplace, they should be covered by workers’ compensation. However, there are some exceptions.

What Injuries Are Not Covered by Workers’ Comp?

Certain injuries may not be covered by workers’ compensation insurance. Specifically, your injuries are not covered when:

  • Your injuries are self-inflicted. Self-inflicted injuries can technically be accidental — circumstantial evidence, eyewitness accounts, camera footage, and other evidence may contribute to a jury or judge’s decision.
  • You received your injuries while under the influence of drugs or alcohol. Blood alcohol tests may be taken to reveal this information.
  • You were violating a company policy or federal or state law at the time of the injury.
  • You were not on the job at the time of the injury, as demonstrated in the example case of the employee injured while going home for lunch.

For instance, if an employee is injured while stealing merchandise from a store, injuries they sustained during the theft attempt are not covered by workers’ compensation insurance.

Are Injured Workers Eligible for Disability Benefits?

Yes. Workers are eligible for disability benefits when a workers’ comp claim is denied or contested and time passes between a medical treatment charge and them receiving workers’ compensation benefits. Normally, however, you cannot receive both workers’ comp disability benefits and benefits from another program simultaneously.

If you receive disability benefits from another source while your workers’ compensation claim is sorted, the total payments you received from that first program may be deducted from your workers’ compensation award or weekly payments.

For more on disability benefits and your rights, call Schwartzapfel Lawyers today at 1-800-966-4999.

How Long Do You Have to File a Workers’ Comp Claim?

According to New York State law, you have 30 days to report an injury to qualify for a workers’ compensation claim. Of course, it’s always wise to immediately file a claim so that you can get medical attention quickly and get your bills paid at the earliest opportunity.

However, you also have up to two years to file a workers’ compensation claim if an injury causes other damage after the fact. For example, if you suffer an initial injury, like a brain injury, and receive compensation payouts for it, then discover that the brain injury led to the loss of mobility a year later, you could retroactively receive benefits for the loss of mobility payments as well.

Lastly, injured workers must report a claim for occupational hearing loss within 90 days for their medical payments to qualify for workers’ compensation insurance.

What If You Are Denied Workers’ Compensation?

Although insurance companies are legally obligated to provide payouts to injured workers, they will sometimes try to deny claims for any number of reasons. When this occurs, you can contest the claim and take your case to court with a workers’ compensation lawsuit.

When this happens, you must:

  • Prove your injuries qualify for workers’ compensation benefits on your claim form
  • Prove that you sustained your injuries on the job and while abiding by workplace rules
  • Prove that you received medical bills or other expenses for those injuries

Can Attorneys Help with Denied Workers’ Comp Claims?

Doing that is much easier with knowledgeable New York workers’ comp attorneys on your side. The right attorneys can provide numerous benefits to your workers’ comp claim, including:

  • Gathering evidence on your behalf. This is doubly useful if you must spend time recovering from your injuries to reach maximum medical improvement.
  • Negotiating with insurance companies. In many cases, the right legal team can call an insurance company and threaten litigation if they deny your claim. This can sometimes circumvent the need for a full lawsuit and result in you getting your payments quickly in a lump sum.
  • Fight for you in court if the case does proceed to a lawsuit or arbitration. In these cases, having strong legal representation is vital to maximize your benefits and make sure your case is presented properly.

You should specifically seek out licensed, qualified workers’ compensation lawyers. With decades of experience, Schwartzapfel Lawyers is the right choice for your case — just check out our client testimonials page to see for yourself.

Contact Schwartzapfel Lawyers Today!

If you’re injured on the job and have exorbitant medical bills, don’t wait for them to sink your finances. Instead, get the benefits you are entitled to by contacting Schwartzapfel Lawyers today. As knowledgeable New York workers’ comp attorneys, we’ve helped injured workers just like you recover millions of dollars in payouts from insurance companies and negligent parties.

Let us get started on your case with a free evaluation and consultation. Contact Schwartzapfel Lawyers today at 1-800-966-4999!

Sources:

Schwartzapfel Lawyers, P.C. | Fighting For You

Workers’ Compensation Understanding the Claims Process | NY.gov

Workers’ Compensation | US Department of Labor | US Department of Labor

What is Workers’ Compensation? | NY.gov

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