How Does Workers' Comp Work?

Gilbert Fisher: As common as workplace injuries are it's often amazing to me how little the common person knows about workers' compensation law. Workers' compensation law is a specific area that was created from personal injury at large. Okay. So years ago, before there was a workers' compensation system, if someone got injured on the job, it was essentially the same process as if you were injured in say an automobile accident. You first had to prove that it was the other person's fault, and then you were able to recover your damages and damages could include things like lost wages, lost future earnings, pain and suffering, things like that. When the workers' compensation system was created, there was some give and take between employers and employees, more specifically labor unions, that wanted to bargain and create a system that was more efficient in treating injured workers and getting them the medical attention they need. So on the plus side for injured workers, one of the benefits that injured workers got by the creation of the workers' compensation system was what is called the no-fault system. In other words, if you were injured in the course of your employment and that injury arises out of your employment, you don't have to prove that it was your employer's fault. We don't care. It's a no-fault system, so you don't get more care or benefits or less care or benefits if it's your fault or if it's the employer's fault. It's a no-fault system. That's a plus. On the negative side, or I guess the plus side for the employer, they are protected from regular lawsuits for damages. So the workers' compensation is a system of benefits rather than damages. So you cannot recover your damages. You cannot recover lost wages or pain and suffering. What you get in place of those damages are benefits that are supposed to help you get through a work injury but certainly aren't designed to completely replace or compensate you for all the damage you may suffer. This is a key thing for people to keep in their mind when they have a work injury, because most people when they come in and first consult with an attorney, they're talking about damage concepts. Benefits, I like to equate kind of like if you think about benefits, well, what are benefits? It's kind of like life insurance, you know? If you determine that you want to buy a $5,000 life insurance policy and you die, your dependents are going to get $5,000 and that may be adequate, it may not be adequate, probably not going to be adequate. But you cannot hope to sue the insurance company and get more money than that $5,000. And that's kind of what happened when they created the work-comp system. The work-comp system was designed to provide certain benefits at a certain level, and the legislature set that level. And if your damages exceed that, you really can't hope to get any more. That's kind of a downside for injured workers. But nevertheless, if you understand the system, you can try to get the most out of those benefits. And there are three main benefits that you get in workers' compensation. The first is medical treatment. And the medical treatment is what the law says that you're supposed to get all of the medical treatment that's reasonably necessary to cure and relieve the effects of the injury. Now, the provision of those benefits are subject to some utilization review laws that define what reasonable and necessary are, probably in a way that a lot of injured workers would challenge as really being in their best interest, but nevertheless, there's no copays. There's no deductibles. If it's determined to be reasonable and necessary, you get that medical treatment, paid 100%. The next benefit is what's called temporary disability. And temporary disability is a benefit that's designed to temporarily replace your wages lost as a result of a work injury. So, for example, you have an injury, you injure your knee, and you have to have a knee surgery and it's going to take you six months before you get back to work. Temporary disability kicks in, and it's a benefit that pays you two-thirds of your average weekly wage while you're off. So it's not a full wage replacement, but it's two-thirds. So, for example, if you're making 300 a week, you'd get 200 a week. If you're making 900 a week, you'd get 600 a week, whatever two-thirds of your average weekly wage is. And the third benefit is what's called permanent disability. Now, permanent disability is a benefit paid when the doctors have essentially completed the medical treatment and they say, "You know what, there's not really much more we can do for you." But you're not back to where you were before the injury. They then look at the American Medical Association Guides and determine whether you have a ratable disability. And that will come out as a percentage like 3% or 19% or 86%, anywhere between 0% and a 100%. And there is literally a money chart that goes 1%, 2%, 3% all the way to 100% and says if you have a 1% disability and based on your average weekly wage, here's what you get, $10,800 or $8,700, or $60,000 something, right down to the penny what you get for that disability. And that's where I liken it to again the life insurance, because a lot of times people may have what is a relatively small disability, 12%, 15%, but yet, that injury is to their back and they rely on their back in their job and they're going to get displaced from their job because of that injury, but yet the rating is only 10% or 12%. So that 10% or 12% can't even hope to cover what their damages are. And that is the downside in the system. The law does provide in those cases a supplemental job displacement benefit, which is a voucher for retraining to help you get some new job skills and stuff, but, you know, it's not dollar for dollar what your damages are in many cases. Nevertheless, if you have a good workers' compensation attorney, they can make sure that the doctor addresses all the aspects of the disability, because a lot of times you'll see that a doctor will write a quick report and give a rating, but yet, for example, you may have had an orthopedic injury and they rate that but you've also had some additional injury such, for example, nerve damage and the doctors haven't rated that. Or you've been on medication throughout this process and now you've developed a stomach ulcer, no one had addressed that. So a good attorney will sit down with you and go over your case and what's going on. And then if you have to go back to the doctors and get that rating adjusted, they'll help you do that. So just as a recap, personal injury is a system where you sue someone based on their fault to recover damages. Workers' compensation is a no-fault system where if you were hurt at work, you're unable to sue your employer, they're protected against lawsuits, but you get specific benefits and an attorney can help you make sure that you get the most of those benefits. Narrator: If you or a loved one need help with a workers' compensation issue, call our office today.