Dealing with a serious injury at work is hard enough. Unfortunately, many insurance companies make it harder than it should be. Some of the most common things I see insurance companies doing to make things harder are:
- Taking longer than they should to accept your workers compensation claim and start paying benefits
- Not telling you that you have some choice of which doctor you see
- Failing to approve the medical treatment and testing you need
- Not filing the Form WC-6 Wage Statement that tells you how your weekly workers compensation check was calculated
- Not paying temporary partial disability benefits when you are working a light duty job
These are just a few of the things I see workers compensation insurance companies do wrong. There are a number of others as well.
One of the questions I get asked a lot is whether you can sue the workers compensation insurance company when they do something wrong. This article discusses how a workers compensation claim resembles a lawsuit as well as the differences between the two.
How does a workers compensation case work?
A workers compensation case provides you with benefits that cover a lot of your damages when you suffer an injury at work. Workers compensation pays for medical treatment and testing you need because of your injury. It also pays benefits when you are out of work because of your injury. In addition, it pays you benefits if you suffer a permanent impairment as a result of your work injury.
One advantage of workers compensation is that it works fairly quickly. You should get very quick authorization to get in and see a doctor for your injury. If your injury takes you out of work, your wage loss benefits should start within 21 days of when the doctor takes you out of work.
This means that you get benefits much faster than you do in a lot of other types of cases. This can be very important when you are out of work and need medical treatment to recover from your injury.
Unfortunately, as I mentioned earlier, insurance companies often do not do what the law requires them to do. This can result in your benefits being delayed or even denied. When this happens, you need to know what action you need to take.
What are the main differences between a workers compensation case and a personal injury case?
Some people want to file a personal injury lawsuit against their employers for their injuries at work. “Exclusive remedy” usually prohibits you from doing this. There are exceptions though, but you will almost certainly need to talk to an attorney to find out if your case meets the exceptions.
Workers compensation does have some things about it that are better than a personal injury case. One is that you do not have to prove that your employer did something wrong in order to receive workers compensation benefits.
Workers compensation is what is called a “no fault” system. This means that fault does not matter. You can recover workers compensation benefits for on the job injuries regardless of whether the injury was your employer’s fault, nobody’s fault, or even your own fault. In personal injury cases, you usually have to prove that the person or business you are suing did something wrong in order to recover anything.
Another advantage of workers compensation is that you receive benefits fairly quickly. Personal injury cases often take longer in order for you to receive anything.
Of course, there are definitely disadvantages with workers compensation. The main disadvantage is that workers compensation is a “limited benefits” system. That means that not all of your damages are covered under workers compensation. The big thing that workers compensation does not cover is pain and suffering.
Can I file a lawsuit against the workers compensation insurance company?
Generally, you cannot file a lawsuit against the workers compensation insurance company, but you do have the right to pursue your workers compensation case in the workers compensation court system. Workers compensation has its own court system for addressing disputes with the insurance company about your benefits.
The reason that you cannot file a separate lawsuit is known as “exclusive remedy”. The basic idea of exclusive remedy is that workers compensation is your remedy when you suffer an on the job injury. This principle generally prohibits you from filing a different type of lawsuit against your employer or their insurance company for your on the job injuries.
The good news is that workers compensation does have its own court system for fighting about your workers compensation benefits. You or an attorney representing you can request a hearing in front of a workers compensation judge. The judge has the power to hear your case and award you benefits.
I strongly recommend that you talk with a workers compensation attorney before requesting a hearing. There are special rules that apply in the workers compensation court system so it is very important to have someone representing you who knows those rules.