What is Workers’ Compensation and How Does it Work?

What is Workers’ Compensation and How Does it Work?

what is workers compensation lawsuit

Every year, nearly 3 million American workers are injured on the job. As a result of their injuries, many require medical treatment, lose wages from time off work, and may need physical or occupational therapy to return to work. Others may be partially or fully disabled and unable to return to the same job. Workers’ compensation ensures that employees are protected when they are injured or become ill due to their employment.

Workers’ compensation results from a series of laws enacted over more than a century to protect workers in America when they become sick or injured at the workplace. It is a complex subject, and if you have been injured at work, you likely have many questions:

  • What is workers’ compensation?
  • How does workers’ compensation work?
  • How to file for workers’ compensation?
  • Can I get a workers’ compensation lawsuit loan?

This article will address each of these questions, so you will better understand the protections that are your right.

What is Workers’ Compensation?

Workers’ Compensation, commonly referred to as “workers’ comp,” is a federally- and state-mandated form of insurance that all employers must carry (except in Texas and Wyoming), even if they employ just a single person. If an employee is injured or becomes sick or disabled as a result of their job, workers’ compensation insurance covers essential benefits for the damaged employee, including medical care and lost wages.

Workers’ compensation provides the following basic benefits:

  • Medical care for work-related injury or illness.
  • Temporary disability benefits to replace lost wages due to lost work time.
  • Permanent disability benefits for employees who cannot return to work due to the injuries suffered.
  • Supplemental job displacement benefits provide retraining or skill development to enable an injured employee to qualify for another type of work.
  • Death benefits paid to surviving spouses, children, or dependents in the case of a fatal workplace injury.

Beyond providing money to cover these expenses for injured employees, workers’ compensation laws have also created a system for applying for benefits, distributing the funds, and limiting the employer’s liability. In the normal course of worker’s compensation claims, there should be no need to file a workers’ compensation lawsuit.

Workplace Injuries Covered by Workers’ Compensation

Workers’ compensation covers countless workplace injuries. According to the National Safety Council (NSC), the most common are:

  • Exposure to harmful substances or environments: This includes exposure to electricity, chemicals, radiation, and noise.
  • Overexertion and bodily reaction: These are non-impact injuries from lifting, bending, or carrying too much weight, and repetitive motion injuries like carpal tunnel syndrome.
  • Slips, trips, and falls: This covers a wide range of issues, including slippery floors, stair hazards, and falling from ladders or scaffolding.

Workers’ compensation covers so many types of injuries that it’s easier to list what is not covered:

  • Injuries resulting from the employee’s own intoxication or drug use.
  • Injuries resulting from self-harm or from a fight the injured employee starts.
  • Injuries resulting from illegal behavior.
  • Injuries resulting from violations of company policy or safety regulations.

Workers’ compensation protects both employees and employers in the event of an injury:

  • Employees qualify for workers’ compensation without regard to who was at fault.
  • Employees are eligible for workers’ compensation no matter how many hours they work*.
  • Employees can not be fired for filing for workers’ compensation.
  • Employers with workers’ compensation insurance typically cannot be sued for workplace injuries or illness.

*However, only workers defined as “employees” are covered by workers’ compensation. Workers’ compensation does not cover those classified as independent contractors or volunteers.

How Does Workers’ Compensation Work? Step-by-Step

If you are an employee who suffered an injury or illness due to your employment, workers’ compensation is your right. Let’s see how workers’ compensation works, so you meet the required deadlines and get the medical care and benefits you need.

Step 1 – Report the Injury or Illness Promptly

If you are injured on the job, you must notify your supervisor as soon as possible. In the case of a gradually developing issue like an illness or carpal tunnel syndrome, report it as soon as you learn that your employment or worksite caused it. The workers’ compensation process begins when you file the report. Your employer will provide a claims form you must fill out.

If you fail to report your workplace injury within 30 days, you may lose your workers’ compensation rights and benefits.

Step 2 – Get Medical Treatment Early or Immediately in an Emergency

If you have suffered a workplace injury, seek medical attention promptly. Early treatment gives you the best chance of making a full recovery. It is also an essential step for proving the injury occurred on the job. If you wait days or longer to seek medical care, you make it easier for your employer or the insurance company to argue that your injury is not work-related.

Notify the medical staff and billing personnel that your illness or injury is work-related. They will provide the medical services approved under workers’ compensation guidelines and may postpone billing. You may have to pay out of pocket for this initial care and then get reimbursed from your workers’ compensation benefits.

If you need immediate care, go to your closest emergency room. If you don’t require emergency treatment, get first aid and see a doctor.

Step 3 – File Your Workers’ Compensation Claim

Complete the workers’ compensation forms provided by your employer in Step 1. These forms must be completed and filed with the workers’ compensation insurance company and with your state’s department for workers’ compensation.

You must file your workers’ compensation claim by the deadline provided to ensure you can collect the benefits you are due.

Step 4A – The Insurer Investigates Your Workers’ Compensation Claim

A representative of the insurance company that carries your employer’s workers’ compensation policy will investigate your claim. This serves two purposes:

  • To understand the scope of your injuries and the medical care and other benefits you will need.
  • To catch and limit occurrences of workers’ compensation fraud.

The workers’ compensation investigation takes some time. Meanwhile,

Step 4B – Get Continuing Medical Care for Your Injury or Illness

After your initial medical care, you may have additional care, surgeries, medication, or therapy prescribed to treat your workplace injury or illness. A Claims Administrator will be assigned to your case, who will coordinate your continuing medical care. This person may be a member of the insurance company, a third-party company, or your employer’s internal claims department. The Claims Administrator expedites the delivery of the workers’ compensation benefits you are entitled to.

Typically, you will be required to choose from specific doctors or care facilities to provide the continuing workers’ compensation medical care.

Step 5 – Workers’ Compensation Benefits are Paid

If your workers’ compensation claim is approved, you will begin to receive payments to reimburse you for past medical care, pay for current and future required care, and to replace lost wages. In most states, these payments come from the Workers’ Compensation Board of the state where you are employed.

If your claim is rejected, you can appeal the decision to your state’s Workers’ Compensation Appeals Board.

How to File for Workers’ Compensation?

Your employer will provide you with your state’s workers’ compensation claim form. Or, you can search online for “[state] workers’ compensation claim form” and download it free online. Then, complete just the “employee” section of the form, sign and date it, and return it to your employer. If you return it in person, you can request a receipt. If you mail it to your employer, use certified mail and request a return receipt to document its sent and received date.

Can I Get a Workers’ Compensation Lawsuit Loan?

Unlike the vast majority of personal injury claims, workers’ compensation claims are typically settled within a reasonable time frame. And generally, workers’ compensation is considered “no-fault.” This protects both employers and employees. Injured employees receive cash benefits and medical care, and employers with legally-mandated workers’ compensation insurance are protected from lawsuits filed by the injured employee.

So, if you are receiving workers’ compensation benefits, you cannot sue your employer for the injury.

Why We Cannot Provide Workers’ Compensation Lawsuit Loans for Most Claims

Workers’ compensation benefits are managed and dispersed in most states by a State Workers’ Compensation Board. These state boards do not participate in legal funding like workers’ compensation lawsuit loans, and, in most states, workers’ compensation attorneys have no authority to accept legal funding.

We cannot and will not provide legal funding for workers’ compensation where it is prohibited by law. We can never fund these claims in Arkansas or Virginia, due to their specific laws.

However, there are some circumstances where you might file a workers’ compensation lawsuit, and in these cases, Tribeca may be able to provide you with a lawsuit loan.

Cases That May Qualify for Workers’ Compensation Lawsuit Loans

In general, there are three circumstances under which we can provide workers’ compensation loans:

  • States where attorneys distribute workers’ compensation benefits (see below).
  • Third-party worker’s compensation claims.

Every state has its own workers’ compensation laws. While all provide the rights and benefits for employees, each has different ways of administering and regulating the program. Five states allow workers’ compensation benefits to be distributed by attorneys who can accept workers’ compensation lawsuit loans:

  • Connecticut
  • Georgia
  • Illinois
  • Louisiana
  • Missouri

In these five states, we can offer workers’ compensation lawsuit loans to provide cash advances on your future compensation payments.

However, other circumstances may allow us to support your workers’ compensation claim — i.e. when a third-party shares fault for your injury or illness.

Workers’ Compensation Third-Party Claims

While workers’ compensation cases typically do not assign fault to the employee or the employer, third-party actors are not as protected. If a third party is involved in an injury or illness that is the subject of your workers’ compensation claim, you have more options.

Example: You are a driver for Coca-Cola making a delivery to a Walmart store. The loading dock is crowded and disorganized, and, as a result, your vehicle is hit by a Pepsi-Cola driver, and you are injured. In this case, your workers’ compensation claim will still be managed as described above, but now, you may choose to file a separate lawsuit against both Walmart and Pepsi-Cola for their part in your injuries.

You will need to hire an attorney to represent you if you wish to file a workers’ compensation lawsuit against third-party actors who contributed to your injury or illness. This type of lawsuit potentially represents a much larger compensation than most workers’ compensation claims because these third-party lawsuits allow you to sue for pain and suffering in addition to compensation for the specific damages you have suffered, like medical bills and lost wages.

If you file a third-party workers’ compensation lawsuit, we may be able to assist you with a lawsuit loan! 

How to Know if You Qualify for a Workers’ Compensation Lawsuit Loan?

While workers’ compensation laws vary from one state to the next, all are designed to provide essential protections to both employees and their employers in the event of a workplace injury, illness, or death. Because of the various laws throughout the country, Tribeca can provide workers’ compensation lawsuit loans only in the following circumstances:

  • Employees injured at the workplace in Connecticut, Georgia, Illinois, Louisiana, and Missouri.
  • Employees injured at the workplace in part due to the negligence of a third party.

If either of these circumstances applies in your workers’ compensation lawsuit, we can help you pay your current bills while you wait for the compensation to be funded.

Why Choose Tribeca Lawsuit Loans

Tribeca Lawsuit Loans is committed to helping plaintiffs find justice in a cast array of civil cases throughout the U.S. We charge just a simple, non-compounding interest rate and no application fees. Our application form is straightforward, and there is nothing to lose to find out what we can do for you. If you need a workers’ compensation lawsuit loan or another form of legal lending, please contact us, or call us at (866) 388-2288. We will be happy to assist you in your fight for just compensation.

Press Release: Tribeca Capital Announces New Initiative to Help Plaintiffs Injured on the Job

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