Individuals who suffer an occupational illness or injury may be eligible to file a claim for various types of workers' compensation benefits.
The amount of time it takes to resolve a workers' compensation claim, either at a hearing or via settlement, will usually depend on:
- The extent of your injuries
- The amount of time it takes to treat for your injuries
- The insurance company you are dealing with
- Whether the insurance company challenges your claim
- Whether or not your case resolves via settlement
- Whether or not there is a third-party component to your claim that must settle or go to trial
One of the most important steps you can take to expedite your workers' compensation claim is to retain legal counsel to represent you as early on in the process as possible.
Your attorney can help you file your claim and work to resolve it as quickly as possible. Your lawyer can also help you negotiate with your employer's insurance company and represent you at any legal hearings. During every stage of your claim, your workers' compensation lawyer will work hard to pursue and recover the monetary benefits you deserve for your workplace injury or illness.
Common Workplace Occurrences that Lead to Injuries
Several workplace accidents may lead to a workers' compensation claim, including:
- Motor vehicle accidents that occur on a job site or while driving a work vehicle
- Slip-and-fall accidents that occur on the job premises
- Accidents that occur on construction sites where individuals must work around heavy and dangerous equipment every day
- Fall accidents, including falls from ladders and scaffolding, that occur on a job site
- Explosions that occur on a construction site and result in severe burn injuries
- Exposure to hazardous or toxic chemicals in the workplace
If you suffered an injury or illness in any of these workplace occurrences, a skilled workers' compensation lawyer can review the facts and determine your eligibility for filing a successful workers' compensation claim.
In addition to filing your claim for benefits, your lawyer can help you negotiate with insurance company representatives and work to pursue the highest amount of benefits you deserve for your workplace injury.
Who Can Recover Workers' Compensation Benefits?
Workers' compensation benefits are a type of no-fault benefit. Consequently, to recover these benefits, an injured or ill worker does not have to prove fault on the part of someone else.
To qualify for benefits, the worker must ordinarily have suffered an occupational injury or illness within the scope of their employment. In other words, they must have suffered their injury or illness while working or performing a job-related function.
In most circumstances, workers are not eligible for workers' compensation benefits if they suffer injuries in a motor vehicle accident while traveling to or coming from work.
In fact, if your employer’s insurance company believes you did not suffer your injury while on the job, it will likely dispute the claim. Sometimes, your attorney can challenge that claim denial and file an appeal. However, these disputes may cause significant delays in resolving your workers’ compensation claim.
Workers eligible to file a claim can recover several different types of benefits.
First, they may recover the costs of their related medical treatment expenses and a portion of their lost earnings. These benefits can help because medical treatment bills can mount up quickly. Moreover, when a worker suffers a severe injury or illness, they may need to miss a significant amount of work to attend medical visits and recover from their condition.
In addition, injured workers may receive vocational rehabilitation benefits if their injury or illness prevents them from returning to their former job or occupation.
Injured workers can also recover a variety of permanency benefits. To recover a permanent partial disability (PPD) benefit, the worker must have suffered a permanent injury, such as a head injury, spinal cord injury, soft tissue injury, or paralysis injury, that is unlikely to get better over time. A medical provider must determine that the worker suffered a permanent injury.
Providers will then usually express their permanency rating as a percentage impairment. For example, a worker may suffer a 10 percent impairment to their neck or back due to their workplace injury. The percentage that a medical provider assigns as a permanency rating translates into a certain number of weeks of monetary benefits for the injured worker.
The injured worker and the employer's insurance company may reach a settlement regarding permanency cases. In other words, they may agree on a percentage impairment to an injured body part.
Alternatively, the insurance company may offer the injured worker a lump sum settlement. However, never accept one of these settlements unless a lawyer reviews it because they often fail to adequately compensate injured workers for all their past and anticipated medical complications.
Moreover, if a worker accepts a lump sum settlement to resolve their workers' compensation claim, the case closes, and they cannot reopen their case if their medical condition worsens over time.
A skilled workers' compensation attorney in your area can help you maximize the benefits you recover as part of your claim, answer all your questions, and help you make informed and intelligent decisions throughout your case.
Possible Third-party Claims Arising from Workplace Accidents
In some instances, there is a third-party component to a workers' compensation claim. These so-called comp/third-party cases may take longer to resolve since multiple insurance companies are typically involved.
As part of a workers' compensation claim, an injured worker does not have the authority to file a claim or lawsuit against their employer. However, in certain situations, they may file a third-party claim against a negligent, careless, or reckless third party in their case.
Some of the most common instances where an injured worker may file a third-party personal injury claim or lawsuit include cases involving:
- Motor vehicle accidents involving work vehicles on a construction site, where the accident victim suffers a permanent or disabling injury due to another driver’s negligence
- Premises accidents, where the property owner fails to maintain their premises in a reasonably safe condition for the benefit of workers
- Product malfunction cases, where a piece of equipment on a job site explodes or otherwise malfunctions, causing the worker to suffer serious injuries
- Negligent repair cases, where a repair facility fails to perform the necessary work on machinery or equipment that individuals use at their job, the equipment malfunctions, and injuries result
A skilled workers' compensation lawyer can determine if you are eligible to file a third-party claim in addition to your claim for workers’ compensation benefits.
Third-party claims are fault-based claims, while workers' compensation claims are no-fault claims. Therefore, the injured worker must establish their legal burden of proof to recover monetary damages in a third-party personal injury claim or lawsuit.
First, the injured worker must show that the at-fault party owed them a legal duty of care they subsequently violated – or breached – in some way. Usually, this means that the at-fault party acted unreasonably, recklessly, or carelessly under the circumstances.
In addition, the injured worker must establish that as a direct and proximate result of the other party's negligent actions or inactions, the subject accident occurred that led to physical injuries and damages.
When workplace accident victims can satisfy this legal burden of proof, they can recover third-party damages in addition to the benefits they receive from their workers' compensation claim.
Settling or Litigating a Third-party Claim
To receive a third-party settlement, in addition to your workers' compensation benefits, a personal injury attorney can submit the necessary claim documents to the insurance company on your behalf.
Those documents may include copies of incident reports, police reports, witness statements, medical records, medical bills, injury photographs, and photographs of any property damage.
The insurance company for the at-fault individual or entity will then review these documents and determine whether or not to accept fault for the accident. The parties can negotiate a favorable settlement offer if the insurance company accepts fault.
In some comp/third-party cases, insurance company adjusters are skeptical. They may feel that the accident victim already recovered sufficient monetary compensation as part of their workers' compensation claim. Therefore, they may opine that the injured worker is not entitled to additional third-party compensation.
Moreover, insurance companies will do everything possible to avoid a significant monetary payout in a third-party case. Rather, insurance companies want to try and settle these cases as quickly and cheaply as possible.
A skilled personal injury attorney on your side can help you negotiate with the insurance company and work to secure a favorable monetary result. The negotiation process may continue back and forth until the parties either resolve their case or reach an impasse.
If the parties cannot favorably settle their case, the injured worker’s attorney may need to file a lawsuit and pursue the case further in court. However, litigating a case may extend the time it takes to ultimately reach a favorable resolution.
Even after filing a personal injury lawsuit, the parties may still resolve their case through settlement. However, the court will establish various deadlines, including a discovery completion deadline, settlement conference date, and trial date.
If the parties still do not resolve their case by the end of litigation, they may take their case to a jury trial and allow a jury to decide the outcome of all issues in dispute. Instead of taking their case to trial, however, the parties can consider alternative dispute resolution (ADR) proceedings, like mediation or binding arbitration.
Recovering Additional Monetary Damages in Your Third-party Claim or Lawsuit
Injured workers who can file a third-party claim or lawsuit may be eligible to recover additional monetary compensation over and above their workers' compensation benefits.
First, injured workers may recover 100 percent of their lost income through a third-party claim, not only the percentage that workers' comp covers. They may also recover compensation for their intangible losses as part of a third-party claim or lawsuit.
For example, they can recover monetary damages for all of their:
- Inconvenience
- Mental distress
- Past and future pain and suffering
- Loss of spousal companionship
- Permanent disability or disfigurement
- Lifetime care costs
- Loss of enjoyment of life
- Loss of the ability to use a body part
A knowledgeable work injury lawyer will do everything possible to help you maximize your third-party damages and secure the highest available recovery for you, either via a favorable monetary settlement or litigation result.
Why You Need Legal Help
After a work injury, always consult with a workers’ comp attorney. Consultations are free, and the lawyer will evaluate your situation and legal options with no risk to you.
If you do not seek a legal evaluation, you might:
- Struggle to receive the full workers’ compensation benefits you deserve
- Accept a lump sum payment that does not cover your future expenses and treatment
- Fail to realize you have the right to file a third-party claim
When you have injuries, you should never have to worry about your legal rights. Leave this in the hands of a skilled attorney.
Speak to an Experienced Workers' Compensation Attorney Today
If you recently sustained an injury or illness while working at your job, you should take prompt legal action right away. Otherwise, you may inadvertently waive your right to recover the monetary benefits and compensation you deserve.
First, a workers’ compensation attorney in your area can determine your eligibility for filing a claim for benefits, along with a potential third-party personal injury claim.
If you can move forward, your lawyer can assist you with every step of the claims-filing process and work to secure the benefits and damages you deserve as quickly and efficiently as possible. By having experienced legal counsel on your side every step of the way, you significantly increase your chances of maximizing your monetary recovery and becoming whole again after your workplace accident. Contact a personal injury attorney in New Jersey today.
