How do I know whether I am covered by workers' compensation?

Q: How do I know whether I am covered by workers' compensation?

A: Determining whether or not you are covered by workers' compensation can sometimes be complicated. Generally, there are two main factors that determine your status: first, whether you are an employee, and second, whether your injury occurred as a result of your employment. It should be noted that neither of these factors is an absolute guarantee that you will be covered by workers' compensation. For example, depending on the rules in place in your state, some employees (such as agricultural workers) are not covered by workers' compensation. Also, if you were intoxicated at work or intentionally injured yourself, you might not be covered by workers' compensation. When in doubt, you should contact an experienced workers' compensation attorney, who can advise you of your rights.

Q: If an employee is receiving workers' compensation benefits, but returns to work, does the employee still get to receive workers' compensation benefits?

A: The answer to this question is "maybe." If the return to work enables the employee to receive wages equal to or greater than he or she was earning prior to the injury, then it is likely benefits will be stopped. If, however, the employee is still experiencing a wage loss due to his or her injury, he or she may continue to receive wage loss benefits, although the benefits will most likely be for a lesser amount.

Q: Can an employee recover workers' compensation benefits, no matter what he or she did, because it is a "no-fault" system?

A: No. Although most injuries are covered by workers' compensation, that does not mean that employees have free reign to injure themselves, or act in any manner in which they choose, and then collect benefits. Generally, if an employee sustains injures as a result of intoxication or illegal drug use, benefits may not be payable.

Q: Can an employee recover workers' compensation benefits, even if he or she was not actually at the workplace when injured?

A: The answer to this question will depend on the laws in your particular state, and the facts of the specific case. Generally speaking, if the injury "arises out of" and occurs "within the scope of employment," it is covered. For example, if an employee is a traveling salesperson and is injured in the hotel where he or she is staying for business purposes, compensation may be appropriately paid.

Similarly, if an employee is running an errand that takes him or her outside of the workplace, at the request of the employer, compensation benefits may be payable if an injury occurs in the course of running that errand. If the employee is on a business errand, but has stopped or deviated from that errand for personal reasons, then a closer examination of the rules and facts is necessary.

Finally, employees injured while attending an employer-sponsored recreational event, like a company picnic or outing, may be able to receive workers' compensation benefits even though they were not physically on the employer's premises at the time of the injury.

Q: I still have some questions about workers' compensation insurance coverage and whether I should sue for injuries. What should I do?

A: It's not often necessary to file a lawsuit against your employer for workplace injuries, and it may in fact disqualify you from collecting workers' compensation benefits. But it never hurts to speak with an attorney if you have questions about your injury, whether it's covered, what is considered reasonable compensation, etc. Find an experienced certified workers' compensation attorney in Sacramento.

If you've suffered a work-related injury or illness, you may be wondering whether to hire a workers' compensation attorney. The answer depends on the severity of your injury, the overall complexity of your case, and the actions of your employer (or its insurance company).

As a general rule, you may be able to get by without an work comp lawyer if all of the following statements are true:

• You suffered a minor workplace injury, such as a twisted ankle or a cut requiring a few stitches.
• Your employer admits that the injury happened at work.
• You missed little or no work due to your injury.
• You don't have a pre-existing condition that affects the same part of your body as the recent workplace injury (such as an old back injury from a car accident that was there before you slipped and hurt your back on the job).

Even in these relatively uncomplicated situations, it's often a good idea to contact a workers' compensation attorney for a free consultation about your case. The lawyer can walk you through the process, alert you to potential pitfalls, and give you an honest appraisal of whether you can handle the case on your own.

Q: I Want to Hire a Lawyer

The moment any complexity arises in your case is the moment you should hire an attorney. Here are some examples of situations that call for a lawyer’s intervention:

• Your employer denies your claim or doesn’t pay your benefits promptly. Employers and workers' comp insurers routinely reject bona fide workers' comp claims, confident that many workers will fail to appeal. Unfortunately, they're usually correct. Hiring a workers' comp attorney costs nothing up front (more on that later), and it gives you the best chance to receive a fair settlement or award for your injuries.
• Your employer's settlement offer doesn't cover all your lost wages or medical bills. If you're not sure a settlement offer is good enough, don't rely on the workers' compensation judge to make sure that you're getting a fair deal. Although workers' comp settlements must have judicial approval, judges will usually sign off on any agreement as long as it's not grossly unfair. If you really want someone to get you the best settlement possible, call an attorney.
• Your medical issues prevent you from returning to your prior job, limit what you can do at work, or keep you from performing any work at all. If you've suffered permanent disability—whether partial or total—you may be entitled to weekly payments (or a single lump sum) to make up for your lost wages. These cases can be very expensive for insurance companies, and they'll often stop at nothing to avoid paying you what you deserve. A knowledgeable workers' comp attorney is essential in cases involving permanent injuries or illness.
• You receive or plan to apply for Social Security disability benefits. If your settlement isn't structured properly, your workers' comp benefits could significantly lower Social Security disability payments. An experienced attorney will understand how to draft your settlement agreement to minimize or eliminate this offset.
• Your boss retaliates against you for filing a workers' comp claim. If your employer has fired you, demoted you, slashed your hours, reduced your pay, or engaged in any other form of discrimination because you filed a workers' comp claim, contact a workers' comp attorney immediately to protect your legal rights.
• You were injured because of a third party’s actions or your employer’s serious misconduct conduct. The workers' comp system was designed to prevent civil lawsuits for work-related injuries. However, you are permitted to sue outside workers' comp in certain situations, including when someone other than your employer contributed to your injury (such as a negligent driver who hit you while you were driving for work), your employer doesn’t have workers’ comp insurance, or your employer intentionally caused your injury. An experienced lawyer will be able to explain how the law applies to your situation.

What Your Attorney Will Do for You

In addition to making sure you file all the necessary forms and meet the deadlines, an experienced attorney will know how to gather the evidence needed to support your case, negotiate effectively with the insurance company, and write a settlement agreement to avoid unanticipated consequences. If you can’t agree on a good settlement, an attorney can prepare for and represent you at the hearing or trial. Learn more about what a good workers' comp lawyer should do and what to look for in a workers' comp attorney.

Tilting the Scales in Your Favor

The workers' compensation system may have been intended to provide prompt and fair compensation to injured workers. But now, it seems to work mostly for the benefit of employers and insurers. Plus, insurance companies have teams of highly trained lawyers on their side. Hiring a seasoned workers' comp attorney will go a long way toward tilting the scales in your favor. And because of the way workers comp attorneys charge for their services, your lawyer will only receive a limited percentage of what you win.

If you're in any doubt about your ability to handle your claim yourself, don't hesitate to call a workers' comp attorney for a free consultation.