Workers’ Comp and Third-Party Lawsuits
Some jobs are more likely to expose workers to hazardous conditions than others. However, even an office space could be the site of an accident. Employers must implement safety measures to reduce the potential of work-related injuries. Still, unexpected events can occur due to negligence.
Laws exist to reimburse workers after they sustained one or more injuries while on the job. A workers’ compensation claim provides a pathway for financial assistance. However, people can experience obstacles from their employer and the insurance company in pursuing this assistance.
Additionally, you might need to file a third-party lawsuit to recover more damages workers’ comp doesn’t cover. A workers’ compensation lawyer has the training needed to help you get compensation promptly following an accident.
How to Report a Workplace Accident?
Every year, around 2.7 million nonfatal injuries occur in the workplace. Many companies offer employees workers’ compensation benefits to pay for the expenses related to an accident. If you suffered from an injury or illness, you need to fill out a claim before you can receive money.
Immediately after the accident, report the incident to a manager or supervisor. Then focus on getting medical attention. Injured workers typically need to visit an approved physician. Once you have received emergency treatment, you must fill out the paperwork your employer gives you. You usually have 30 days to do so.
On the paperwork, you have to fill out the details of the accident. The required information usually includes the date, time, and location of the incident. You should describe the injury or sickness you have and the severity of the condition.
You keep a copy of the report as proof you followed the procedure on time. Your employer is the one who submits the paperwork to the correct state department. Once they file the claim, you need to wait for the insurance company to approve it.
The company contacts you about payment details if the insurer approves your claim. If you receive a rejection, you can request the insurance company reconsider. Alternatively, your state’s workers’ comp board allows people to file for a repeal. You can get the help of an attorney to make sure negotiations with the insurer end in your favor.
Why an Employer Might Fight a Claim?
Many companies fight workers’ comp claims even if they are legitimate. While their actions seem unfair, employers have multiple incentives to avoid payments.
A few common reasons are:
- Uphold their reputation. If an employer accepts a claim, they assume responsibility for an unsafe work environment. They might have concerns about their business’s image as a result. Severe injuries can lead to negative opinions if people hear about an incident. Managers might worry customers or clients will avoid their business, causing profits to decline.
- Insurance costs. Insurers base their prices on payroll size and the potential for accidents. The most at-risk jobs might pay over $3,200 in premiums every year. A successful workers’ comp claim could mean the insurer assumes another injury might occur. They raise the price of premiums, and an employer wants to avoid that outcome.
- Dislike of an employee. A few employers deny a claim due to personal reasons. They are less likely to help an injured employee who they dislike. A manager may believe a claim is false due to a strained professional relationship.
A company may be skeptical of a medical condition or do not view a person’s injury as severe. Remote workers can struggle with a denied claim if employers fail to see at-home accidents as work-related. Even workers’ comp claims can benefit from the help of a law firm.
Workers’ Comp Claims and Third-Party Lawsuits?
Workers’ comp aims to give employees compensation for injuries quicker than a lawsuit. However, companies fix the awarded money at a certain amount in advance. The value of compensation depends on the type and severity of your injuries.
While the law requires businesses to reimburse hurt workers, insurance companies do not like to pay. As a result, the money you receive might not be enough to cover all your expenses. You may need to seek additional reimbursement through a lawsuit.
In most cases, employees cannot sue an employer for workplace injuries if they are eligible for workers’ compensation. However, states may provide a few exceptions. The limited ability to file a lawsuit against a company is a trade-off for not having to prove negligence. In some cases, people need a lawyer to make the workers’ comp process proceed smoothly.
Another route to take is to start a third-party liability claim. A third-party lawsuit means the plaintiff seeks compensation from another person for their workplace injury. For example, you would take a co-worker to court if they share fault for the accident.
The third-party could be a manufacturer if a faulty piece of equipment caused an unsafe environment.
Other possible negligent parties include:
- Architects who made a hazardous design flaw.
- Contractors and subcontractors the employer hired.
- A vehicle driver if you were fulfilling business obligations.
- Property owners if you visited an area for work-related reasons.
Workers’ compensation might not let you claim pain and suffering for your injury, but a third-party liability claim could.
What Happens if an Employee Dies?
Employers annually report over 4,700 fatal occupation-related injuries. Workers’ comp allows victims to receive money to recuperate from damages. However, surviving family members are the ones to receive benefits if the employee dies as a result of an accident.
In many states, the spouse, children, and other dependents are the ones who receive death benefits. Children usually qualify if they are under the age of 25. A spouse might not get compensation if they and the deceased were separated sometime before the accident. A state could make parents eligible if they depended on a deceased worker who had no partner or children.
Multiple beneficiaries generally split the money. Several states have the spouse as first in line to obtain benefits. Families of the deceased also have to bear the financial burden of funeral and burial services. The decedent might have visited a hospital before passing, making the families obligated for accumulated medical expenses.
The law may determine the maximum amount a person can receive from death benefits. In some states, death benefits are around 66 percent of the deceased’s income. Payments are typically weekly, and minimum and maximum caps may apply.
Of course, payments only last for a specified amount of time. However, they may cease early under certain conditions. For example, the surviving spouse might no longer receive benefits if they remarry. Your lawyer can inform you of your right to benefits if a loved one has passed away due to their occupation.
Proving Negligence in a Third-Party Lawsuit
When you file a third-party lawsuit, you need to meet the requirements of negligence to win. The first element you must prove is the defendant’s duty of care. The other side must have been in a position where they had the legal obligation to prevent harm.
The opposing party’s behavior then violated their duty of care somehow. The individual should have known their actions would have led to an accident. Even inaction can result in negligence if another reasonable person might have proceeded differently.
The next element of negligence is the causation of the incident. When the defendant did not fulfill their legal duty, the resulting event directly caused bodily harm. Additionally, they should have predicted the connection between their actions and the plaintiff’s injury.
Random acts of nature are unforeseeable, so the court is less likely to hold a defendant liable in those circumstances. Lastly, you need to prove how your injuries caused one or more damages. Damages included lost wages and medical expenses.
In some cases, the answer to who was negligent is straightforward. Other times, the fault can be unclear. The opposing side may try to fight the allegations against them by denying their liability or accusing you of causing the accident. An experienced personal injury lawyer will know how to prove liability and refute the opposing counsel’s accusations.
Ways Insurers Deny Workers’ Comp Claims
#1. Delay Approval
Insurers have ways to deny or at least devalue a workers’ comp claim. They do not have the injured person’s interests in mind, and adjusters aim to save the company money. You can expect one of their possible strategies to be a delay in your claim.
An insurer might wait to approve a claim with the hope you return to work to avoid further missed wages. You may need a workers’ comp lawyer if you have waited an unreasonable amount of time for reimbursement.
#2. Reject a Referral
The authorized physician you see is the one who primarily cares for you after a workplace injury. The doctor may refer you to a specialist depending on the nature of your injuries. An insurance adjuster may step in and deny the referral, forcing you to put a hold on your treatment.
The delay in medical care can put your health at risk, and the insurance company might use it against you. The adjuster may attempt to downplay the seriousness of your injuries by claiming you aren’t receiving further medical care.
#3. Record a Statement
Insurances adjusters tend to ask claimants for a recorded statement. The statement is your version of events, but companies have methods to use your words against you. Some of them make the request soon after the accident. You might not have had a chance to see a doctor and do not know the extent of your condition.
An adjuster uses your unawareness to their advantage. Their line of questions could make your statement become proof you are not severely hurt. Some people struggle to remember the details of the incident clearly. You might forget a necessary piece of information but remember it later when you have had time to process the event.
If the insurance company finds that you left details out, they can argue your statement is inconsistent. You do not have to give a recorded statement to the insurer. You can refuse to provide one until you have had a chance to speak to an attorney.
#4. Request a Signed Authorization Form
The insurer could insist your policy does not cover the treatment you need. An adjuster might dispute the necessity of medical care as well. If you plan to proceed with your healthcare treatment, they might ask you to sign an authorization form.
Authorization forms give insurance companies the ability to collect current and past medical records. The adjuster will gather some information not related to the work accident. They can then use those records to dispute your current injuries by blaming them on previous or pre-existing conditions. An attorney can help you avoid rejected compensation based on your medical history.
Evidence for a Workers’ Comp Lawsuit
The defendant may hire a defense team to avoid paying for damages. To increase the possibility of compensation, your attorney investigates the accident thoroughly. During the investigation, they collect pieces of evidence to build your case and refute the opposing party’s claims.
This evidence proves your injury took place at work and is serious. For example, a co-worker or customer might have seen what occurred. As long as the judge deems them reliable, their testimony gives your argument credibility.
Your attorney might bring forth an expert witness as well. Expert witnesses can lend their knowledge to confirm the nature of the accident. An example would be a doctor with an area of expertise related to your injury.
The other side might try to downplay your injuries, but they are likely not medical professionals. A doctor must confirm the full extent of your condition, attesting to your claim. You should provide a copy of your medical records to your attorney.
Additionally, the bills you collect help establish the link between your injury and the damages incurred. Your lawyer may advise you to see a physician soon after the workplace accident to ensure they document your injuries and any necessary treatment can begin.
Photos and Videos
Another way to build your case and increase compensation is to have picture or video proof. You or someone you know should capture photos of your injuries. If your case goes to trial, the judge and jury can see how the accident occurred and how badly it affected you.
You may also want to record or take pictures of the work area where the accident occurred. You can show how the environment at your job was unsafe and attributed to your accident. This evidence can bolster your claim and make it more likely that you will receive compensation.
A workers’ comp claim may appear relatively straightforward, however, issues can arise and risk your right to compensation. Whether your employer or the insurance company, parties often work against your interests.
Contact an experienced workers’ comp lawyer to help you fight for your rights after a workplace accident. Don’t worry about whether you have the financial means to cover your expenses. Let a skilled workers’ compensation attorney ensure you receive fair treatment and the compensation you deserve.
I represent individuals in Missouri and Illinois in all types of personal injury cases. In my short time here I have obtained a judgment for $2.5 million and settled a large class action lawsuit for a confidential amount.
I love the city of St. Louis and support it and give back whenever I can. Recently I was appointed by Mayor Francis Slay to serve on the Advisory Board for the Gateway Mall.
I am married to my lovely wife Lauren and we have two beautiful daughters, Mia and Bridget.