Worker's Compensation: Everything You Need to Know

Workers compensation is a claim against an employer by an employee for injury and lost income as a result of injury. In the United States, there are two basic legal classes of workers compensation: Federal employee workers compensation law and state laws and regulations covering other workers. This article will focus largely on California state law. There are other states that will differ to some extent, but the information covers the fundamental issues of workers compensation.

Claims issues

  • All employers must take out insurance to cover workers compensation claims under state laws. (Workers whose employers are uninsured can be paid compensation from a state fund if necessary.)
  • A formal claim for compensation must be made under state law in order for compensation to be awarded.
  • The claim consists of two basic elements, your deposition and the employer's response.
  • A judge will hear both sides, examine medical evidence, and decide the case.
  • Employers and employees may contest and appeal claims and decisions for compensation.
  • If awarded, compensation benefits payable are calculated on formulas created by statute.

Workers compensation issues

This is an illustration of a workers compensation case:

  1. Worker A had an accident at work.
  2. Employer B sent Worker A to their company doctor as the primary treating physician.
  3. Worker A was evaluated as fit for light duties after 4 weeks treatment. 
  4. Employer B's insurer disputed the payment of compensation pending an investigation.
  5. Worker A, dissatisfied, found a new doctor to make an independent assessment in preference to the company's doctor.
  6. Worker A made a formal claim for compensation with the court.
  7. Employer B offered to mediate the claim to settle out of court.
  8. Worker A hired a lawyer to represent him in the mediation.
  9. A settlement was reached almost immediately, saving both parties time and money.

As you can see, this wasn't a simple process. Although in many cases straightforward, workers compensation claims can be extremely complex. Depending on the nature of the situation, you may require:

  • Professional advice during your treatment and before making your claim: You must clearly understand each stage of the process and each issue involved in your claim.
  • Expert medical support and testimony: This information is proof of your claim, which may be contested by the employer's medical advisers.
  • A specialist workers compensation lawyer: The legal elements of workers compensation cases, particularly the many different types of filing processes, have to be done properly.