Three Things to Know About Workers’ Compensation Insurance

State and federal laws in the United States require many employers to carry what’s known as workers’ compensation insurance. It’s an insurance policy that’s designed to (a) protect employers from a lot of lawsuits and (b) help injured workers get money in their hands quickly after an accident.

Pretty simple, right? In theory, yes. In practice, no. Workers’ compensation laws are fairly complex. To make matters worse, they’re often drawn to benefit employers and insurance companies, not injured workers. Here are three important features of workers’ compensation that are important to understand.

Workers’ Compensation is a No-Fault System

There are two ways to structure rules regarding insurance claims – fault and no-fault.

Under a fault system, the person (or parties) responsible for an accident is financially liable for resulting harm. More specifically, their insurance company is on the hook for paying out claims because their insured party is at fault. At the same time, a party who is responsible for an accident can be partly or entirely barred from recovering compensation.

Before an accident victim can recover compensation under a fault system, fault has to be established. That’s often quite time consuming, because fault is often contested. No one will want to accept responsibility, so it can take time to investigate and get a clear picture of what happened and who’s to blame. 

Under a no-fault system, fault does not have to be established in order for an accident victim to be able to recover compensation. After a car accident, for example, parties in a no-fault state simply turn to their own insurance providers for money to pay for things like medical bills and the cost of replacing or repairing damaged property. It doesn’t matter who caused the accident – the victim’s own insurer pays. 

Workers’ compensation is a no-fault system. However, its the employers who have the insurance. If a worker gets hurt on the job, he or she can file a claim for benefits, regardless of whether or not they contributed to their own injuries. Similarly, it typically doesn’t matter if an employer caused an accident. Benefits are available, regardless of who caused or contributed to the accident.

Why is a No-Fault System Important?

Workers’ compensation has to be a no-fault system in order for it to accomplish what it’s designed to do. If fault were an issue, employers wouldn’t be protected against an onslaught of personal injury lawsuits. 

Similarly, if fault needed to be established, it could really extend the length of time it takes to resolve a claim. When a worker is injured on the job, that’s time they probably don’t have when faced with rising medical costs and lost wages. So, a no-fault system helps to ensure that employees who need money can get it faster than if they had to pursue compensation through a contested civil lawsuit.

Workers Have to Get Hurt While Performing Job-Related Tasks to Qualify for Workers’ Compensation

Generally speaking, an employee must be injured at work or while performing an essential job-related task or duty in order to be eligible to receive benefits from a workers’ compensation insurance policy. So, a worker doesn’t necessarily have to get hurt on a job site or in an office to qualify for benefits. As long as a worker is performing a task that’s necessary to do their job, an injury might qualify them for benefits. 

For example, let’s say a worker is driving a truck to haul materials to a construction site. On the way to the site, the worker gets into an accident. Since they were performing a job-related task, they might be able to secure benefits from their employer’s workers’ comepnsation insurance policy.

What if that worker got into an accident while driving to work that morning? In that case, the injuries stemming from the accident likely wouldn’t qualify. That’s because, generally speaking, traveling to and from work doesn’t count as part of a job. Injuries must be sustained at work or while performing an essential job-related task.

Similarly, many states prohibit workers from recovering benefits if they’re injured on a break. Lunch breaks are typically considered to be an employee’s own personal time. So, most accidents that happen on a break from work-related activity aren’t covered by workers’ compensation insurance. However, it’s important to note that a worker may qualify if they skip their break and eat while continuing to do their job.

In the end, it ultimately boils down to what a worker was doing at the moment they suffered an injury.

Workers’ Compensation Only Provides Limited Benefits

Workers’ compensation insurance was designed to keep injured workers financially stable after a job-related accident. That’s it. Financially stable, and nothing more. So, injured workers are only entitled to certain benefits after they get hurt. While specific benefits (and calculations thereof) vary from state to state, workers’ compensation typically covers costs associated with:

  • Medical bills
  • Lost wages
  • Temporary and/or permanent disability, and
  • Death.

Medical bills are generally paid in full, as long as the expenses are necessary and appropriate. However, most injured workers have to seek care from a pre-approved medical doctor. Insurers reserve the right to deny benefits if workers see their own doctor. 

Other benefits aren’t paid in full. When it comes to lost wages or temporary disability, for example, workers often receive a percentage of what they earned before they got hurt. For permanent disability benefits, payments are often calculated based on the degree to which an employee is impaired or disabled.

So, workers’ compensation benefits might not be enough to keep an injured worker afloat after an accident. While any stream of income can help, many workers are often forced to look at other options to supplement their workers’ compensation benefits. Some qualify for Social Security Disability benefits. Others might have to consider another type of job – one that can be done with their current injury or disability. 

It’s important to note that employees waive their right to sue their employer under the worker’s compensation system. However, that doesn’t mean that an injured worker can’t file a lawsuit if someone other than their employer caused them to get hurt. Injured workers can also consider pursuing compensation from co-workers, product manufacturers, property owners, or other negligent third parties. Employers might even be liable if their actions rose to the level of gross negligence.

By filing a lawsuit, injured workers can potentially recover damages for things that aren’t compensated under the workers’ compensation system, including pain and suffering and emotional distress. Any money obtained through a personal injury lawsuit can help to offset the financial stress a worker faces after an on-the-job accident.

Worker fallen down while carrying cardboard boxes in warehouse

Can Texas Employees Sue Their Employer if They Were Injured at Work?

Most states require employers to buy workers’ compensation insurance coverage for their employees. Texas is not one of those states. Employers who do not have workers’ comp are referred to as non-subscribers.

Employers must follow filing and notice requirements of the Texas Workers’ Compensation Act, even if the employer does not buy workers’ comp insurance.

While an employer may try to save money by not purchasing workers’ comp insurance, the employer opens itself up to workplace accident lawsuits by employees.

How Does the Workers’ Compensation System Protect Employers?

Workers’ compensation laws in Texas limit actions employees can take against employers for an injury at work. An injured employee must go through the workers’ comp system to seek benefits for a work-related injury. Benefits through workers’ comp are limited to:

  • Receive necessary and reasonable medical treatment for work-related injuries and illnesses;
  • Receive income benefits (a part of lost wages); and,
  • Burial expenses and death benefits for dependents in the event of a work-related death.

The workers’ comp system is a no-fault system. The employee does not need to prove negligence or wrongdoing by the employer to receive workers’ comp benefits. However, workers’ comp laws shield an employer from further liability for a workplace accident.

In most cases, an employee cannot sue an employer after being injured at work. The employee is limited to the benefits available under The Workers’ Compensation Act.

If the employer is a non-subscriber, the employee may have a right to sue the employer for damages and losses related to an on-the-job injury.

If an employer is a non-subscriber, the employer loses the right to use certain defenses to an employee lawsuit for damages. Employers that do not have workers’ compensation insurance cannot raise certain defenses including:

  • The injured employee knew of a specific danger or risk and accepted it;
  • Another employee’s negligence caused the person’s injuries; or,
  • The injured employee’s negligence contributed to the cause of the employee’s injury.

An employer may buy other insurance coverage that covers employees, including health, accident, or disability insurance. Buying other types of insurance coverage is not a substitute for workers’ compensation insurance.

If the employer does not have workers’ comp coverage, the employee may sue the employer for damages after being hurt at work.

Other Situations That Might Result in an Employee Lawsuit

Employees may sue employers in some other situations. The lawsuits can result in more compensation for a workplace injury.

If an employer intentionally causes an employee’s injury, the employee may sue the employer. Also, if an employer is grossly negligent, the employer could be held liable for damages in a civil claim.

Some federal laws protect certain employees, such as railroad workers, harbor workers, and longshoremen. These federal laws may also give certain employees rights to sue their employers for damages.

An injured worker may also have a claim against a third-party. Third-party claims may involve a defective product. Third-party claims may also involve negligence by a subcontractor or other individual not employed by the employer.

For instance, a third-party claim may arise after a car accident caused by another driver that occurred while an employee is on-the-job. The employee may have a claim against the other driver under Texas personal injury laws.

Why Would an Employee Want to Sue an Employer for Damages?

As stated above, an employee hurt at work is usually limited to the benefits provided by the workers’ compensation system. However, those benefits are restricted.

For example, an employee does not receive full compensation for all lost wages. The employee is only entitled to receive partial income benefits.

In a lawsuit against an employer, an employee may recover compensation for additional damages. Damages that might be recoverable in a personal injury lawsuit include, but are not limited to:

  • Additional medical treatment that might not have been deemed necessary under workers’ compensation;
  • Full compensation for all loss of income, including future loss of income or decreased earning capacity;
  • Physical pain and suffering, including scarring, disfigurement, and permanent disability;
  • Emotional distress and mental anguish; including depression, PTSD, and loss of quality of life;
  • Cost of personal care and help with household chores; and,
  • Other out-of-pocket expenses and financial losses related to the accident or the employee’s injury.

Filing a lawsuit against the employer or a third-party may result in full compensation for all damages.

The employee needs to prove negligence by the employer or the third party before the employee could recover compensation for the injuries, losses, and damages.

Talking to an attorney as soon as possible can be very beneficial for learning about your rights and options after a workplace injury.

Man suffering from neck pain after car accident injury

Should You Call a Lawyer if You’re Sore After a Car Accident?

Knowing when to call a lawyer after a car accident can be difficult. The truth is that it is never too early to contact a lawyer about a car accident. Obtaining advice about your legal rights and your options for recovering compensation for damages is helpful after any traffic accident.

Why am I Sore After my Car Accident?

It is common to experience some soreness when you are involved in a car accident. Even a minor “fender-bender” or low-impact car accident can result in serious injuries. The impact of the collision jolts and twists your body in unnatural positions, which can cause a variety of injuries.

Additionally, an airbag deploying or seatbelt locking could cause an injury. Violently striking the dashboard, steering wheel, door, or window can cause injuries. Also, debris flying through the air can strike your body, causing additional injuries.

Common car accident injuries include, but are not limited to:

  • Whiplash and neck injuries
  • Shoulder and back injuries
  • Head and brain injuries
  • Broken bones and fractures
  • Lacerations and puncture wounds
  • Internal bleeding and organ damage
  • Amputations
  • Burns
  • Spinal cord injuries

Any of the above injuries can cause aches and pains. The severity and type of injury typically dictate the level of soreness or pain a person experiences. Also, a person’s overall health and age can be additional factors in how long it takes to heal and the pain involved in healing.

Soft tissue injuries can cause soreness after a car wreck, such as injuries to tendons, muscles, and ligaments. Ruptured discs, hairline fractures, and pinched nerves can also cause soreness.

Unfortunately, it can be difficult to detect certain types of car accident injuries, such as soft tissue damage. It can also take days or weeks for the soreness to intensify. Therefore, an accident victim may not realize immediately following a car crash that the accident caused an injury.

When Should you see a Physician?

While some soreness after a car accident is common, soreness that persists or intensifies could be a sign of a severe injury. Because it is never wise to try to diagnose yourself, seeing a doctor after a car accident is always a good idea, regardless of whether you believe you were injured in the wreck.

Only a doctor can correctly diagnose car accident injuries and develop a treatment plan. Seeing a doctor immediately or soon after a car accident protects your health. It also helps protect your legal rights.

If the soreness is an indication of a more severe injury, you need to know about the injury as soon as possible so you can receive medical treatment. Prompt medical treatment increases your chances of recovering fully from an accident injury.

However, prompt diagnosis of a car accident injury also improves your chance of recovering full compensation from the driver who caused the car crash. Insurance companies use delays in medical care to claim that the car accident did not cause a victim’s injuries.

The insurance company argues that the injury could have occurred after the crash. In some cases, if medical care was not sought until several weeks or a couple of months after a car crash, it can be more challenging to prove that the collision caused the injuries.

Therefore, it is a good idea to see a physician for a full examination after a car accident. Your physician can document your current symptoms and diagnose any hidden injuries that you may not be aware of immediately following the accident.

Damages Caused by Car Accident Injuries

Depending on the type and severity of your car accident injury, you may be entitled to significant compensation from the at-fault driver. The value of a car accident claim depends on several factors including, but not limited to:

  • The type of injuries you sustained;
  • The severity of your injuries.
  • Your financial losses;
  • Whether you sustained permanent impairments;
  • The available insurance coverage; and,
  • Whether you may have been partially at fault for the cause of the car accident.

Common damages that are included in car accident claims are:

  • Cost of medical treatment;
  • Personal care costs;
  • Loss of income;
  • Future loss of income or diminished earning potential;
  • Permanent disabilities and impairments;
  • Physical suffering and pain;
  • Emotional distress and mental anguish;
  • Loss of quality or enjoyment of life; and,
  • Other financial losses associated with the accident or your injuries.

An experienced car accident lawyer can help you investigate the cause of the car accident and gather evidence to prove fault and liability. The attorney can also help you document damages to maximize compensation for a personal injury claim.