Workers’ compensation exists to help employees who have been injured on the job (or developed an occupational illness or condition, i.e. carpal tunnel syndrome, hearing loss, or injuries from repetitive work over time), providing them with lost wage benefits and coverage for medical treatment. Various factors are used to determine whether workers’ compensation benefits should be paid, including what caused the injury or illness, when the worker reported it, and whether medical evidence supports a work related injury.
Nature and Cause of the Injury
An employee’s injury or illness must arise in the course and scope of their work to qualify for workers’ comp benefits. However, injuries suffered while off the clock may not qualify for benefits, such as those suffered while commuting to or from work, or injuries resulting from misconduct like horseplay or working while intoxicated. THERE ARE EXCEPTIONS TO THESE SITUATIONS WHICH MAY ALLOW COVERAGE. As a result, a worker needs thorough documentation of the nature and cause of the injury to ensure the acceptance of their workers’ comp claim.
Timely Reporting and Filing
The workers’ compensation law imposes deadlines on reporting work injuries or occupational illnesses to employers. In New York, employees should notify their employers of workplace injuries or occupational diseases as soon as possible, but usually no later than 30 days after a workplace accident or the diagnosis of an occupational disease. Furthermore, workers have two years to file a formal claim with the Workers’ Compensation Board. Employees should also confirm that their employers report claims to the employer’s workers’ compensation insurer.
Medical Evidence and Treatment
The strength of a worker’s medical evidence is critical to their claim. Medical evidence must link an injury or illness to an employee’s work, and demonstrate the need for treatment, rehabilitation, and time off from work. Furthermore, workers can protect their rights to benefits by following their doctor’s prescribed treatment. Employers and insurers might assume that a worker who ignores treatment or skips appointments may have recovered from their injury or illness and can return to work.
Employment and Coverage Status
Workers must establish that they have an employer–employee relationship with an employer to qualify for workers’ comp benefits from that employer. Independent contractors are not entitled to workers’ compensation benefits from the companies for whom they work. However, just because a worker is called an independent contractor does not necessarily make it so. There are many situations where an “independent contractor” is really an employee and is entitled to workers comp coverage.
Contributing Factors and Disputes
Various contributing factors may complicate an employee’s workers’ compensation claim, such as pre-existing conditions, recklessness or intentional conduct, or substance abuse. Although workers can obtain benefits for aggravation of pre-existing injuries or conditions, employers and insurers may have the right to deny coverage for injuries that workers sustained through their intentional or reckless misconduct. These contributing factors can provide insurers with grounds to contest liability or limit a worker’s benefits. As a result, employees should seek experienced legal counsel to advocate for their rights and interests in the event a dispute arises over their workers’ compensation claim.
Contact a Workers’ Compensation Claim Today
Have you been hurt on the job or because of repetitive job duties? If so, you could be entitled to workers’ compensation benefits—though your employer or their insurer could make it harder for you to access these benefits than it should be. Don’t make the mistake of trying to pursue your claim yourself. Workers’ compensation is very complex. There are many rules and requirements which a layperson is not going to know. Instead, contact Fessenden Laumer & DeAngelo, PLLC, for a free, no-obligation consultation with a workers’ compensation attorney in Western New York. We’ll explain more about your rights and how we can help you assert them.
