In most jurisdictions, workers’ compensation is a right that protects employees from incurring into severe economic loss as result of an injury or ailment suffered as a result of a workplace accident or physical work conditions. Statutes set out the general provisions and clauses that the state agencies, employers and workers must follow in order to sustain the workers’ compensation system, while administrative rules provide the guidelines to ensure that fair and efficient processes are in place to support the system.
Workers’ Compensation Systems
The practice of sustaining a workers’ compensation system is not limited to regulations and contracts between employers and their staff. There are many parties involved, from insurance companies to medical practitioners, and from specialized attorneys to politically-motivated interest that engage in lobbying efforts. From a legal point of view, the workers’ compensation system is a complex regulatory affair that is filled with bureaucratic maneuvers, ambiguities, caveats, intricacies, loopholes, ulterior motives, and even malfeasance.
In essence, the system should not be so complex. As with other risk and liability management schemes, workers’ compensation should largely be a no-fault system whereby an employee can submit a claim for an unintentional injury sustained on the job, or an ailment developed due to circumstances directly related to the performance of work duties. The actual process isn’t so cut and dry. Workers’ compensation claims are frequently investigated, challenged, and often given lesser importance than they should command. For major employers, workers’ compensation premiums and accumulating claims can increase to the point that they place constraints on operating expenses. For insurance companies, a busy claims pipeline can put a burden on their operational workflow.
Benefits
The fundamental benefits of workers’ compensation include medical treatment and some form of relief for lost wages. In some jurisdictions, the replacement of lost wages is also referred to as disability insurance. In countries where health care is considerably expensive, such as in the United States, the first benefit of workers’ compensation is to ensure that the injured or sick worker does not have to bear the burden of medical expenses. This may include emergency services, hospitalization, and rehabilitative therapy. The amount of coverage is usually promulgated by statute, but it may be augmented by employers.
Compensation for lost wages due to workplace accidents is the second fundamental benefit. This benefit works on the assumption that the inability of the employee to return to work is entirely due to the injury sustained on the job.
The compendium of court cases related to complaints from injured employees who claim that the health care received was inadequate is quite impressive, but it isn’t as massive as the claims arising from workers who feel they were unfairly compensated in terms of replacement wages.
Injuries and Health Conditions
Generally speaking, if a worker sustains an injury while performing his or her duties during working hours, he or she would be entitled to enter a claim for workers’ compensation; whether the injury occurred at the workplace or at an off-site location. This can be a single occurrence or an injury sustained due to the repeated performance of duties. For the purpose of a claim submission, even social functions that are sponsored by the employer, such as holiday parties, can be considered as working hours.
Not all workplace injuries, however, are grounds for a claim. In cases where alcohol or substance abuse may be involved, claims are often summarily rejected. Employees who become injured as a result of a fistfight need not submit a claim either.
Adverse working conditions can also lead to medical issues and illnesses. Some jurisdictions even recognize that high-stress jobs can also lead to mental health issues, and thus workers’ compensation claims can be filed in such cases.
The high incidence of rejected claims and inadequate compensation often necessitates proper representation. Personal injury attorneys who accept cases related to workplace injuries and illnesses serve their clients’ interests to make sure claims do not lose validity. In cases where employer negligence or malfeasance are suspected, it is highly advisable to consult an attorney. A good rule of thumb is to consider the severity of the injury or ailment. A workers’ compensation claim for a slight sprain or a common cold should not generally merit legal advice, but more serious health conditions may.
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