Workers’ Compensation is supposed to be there to get coverage for injured workers after an on-the-job accident. This coverage is essentially no-fault, and it should pay you even in cases where a lawsuit would be impossible, such as if you or your employer was responsible for your injuries.
While lawsuits might be allowed against third parties, getting compensation from your employer and their insurance carrier is often the most straightforward way to get benefits. Our attorneys can review your case, look into your options, and help you get the benefits you need.
For your free case evaluation with our Workers’ Compensation lawyers, call the Law Office of John J. Sheehan at (617) 925-6407.
What Workers Does Workers’ Compensation Cover in Rockland?
Workers’ Compensation is designed to cover nearly all employees. The legal definition of employer is intentionally written to be very broad so that it covers all kinds of workers.
Independent Contractor vs. Employee
First, the definition broadly includes anyone doing work for someone else, whether there is a contract or not. This often lumps in many “independent contractors” who might not be aware that they qualify for coverage.
This general presumption that contractors are employees looks at how they perform their work. Independent contractors are often classified correctly if their work is…
- Under their own control
- Outside the scope of what the employer usually does, and
- Performed under an independent business name or by a trade worker.
Otherwise, they may be misclassified, and our Workers’ Compensation attorneys can help them get Workers’ Compensation. However, we will need to review your situation to determine whether you are properly classified.
Other Industries/Workers
There are a few explicit industry carve-outs, meaning there is no coverage for shipping workers, interstate commercial carriers, athletes, and taxi drivers. There is also an explicit inclusion of student workers.
Optional Coverage
Seasonal, casual, and part-time (i.e., under 16 hours per week) domestic workers (e.g., cleaners, nannies, cooks) can be opted in or out of coverage. Sole proprietors and some corporate officers/directors can also opt in for coverage under their company’s plan.
Should I Sue or Use Workers’ Comp?
Workers’ Compensation should cover all work-related injuries. This broadly means that whether you can blame the accident on someone or whether it is a true “freak accident,” Workers’ Compensation covers it.
Workers’ Comp Only
However, there are a few situations where you would not typically be able to sue. Employers are generally immune from lawsuits by employees, meaning that you likely cannot sue your employer even if they did something wrong. You also typically cannot sue if you hurt yourself.
In these situations, there may be no other option for compensation.
Lawsuits Available
However, when accidents are caused by outside third parties, you may be able to sue them. This could include a driver crashing into you while you were running deliveries or working on roadside construction. It can also include the manufacturers of defective gear or equipment.
Even when a lawsuit is available, Workers’ Compensation should still cover you without the need to prove fault. You may be able to file a separate lawsuit to cover the other damages Workers’ Compensation does not cover.
What Does Workers’ Comp Pay for?
If you were hurt in an accident, you usually face damages for medical care costs, lost earnings, and pain and suffering. Workers’ Compensation does not pay for pain and suffering, but it does cover all medical care and a portion of lost wages.
Most medical care should be covered, and injured workers should not have to shell out for treatment for a work injury under Workers’ Compensation.
The amount of coverage for your lost wages will depend on your degree of disability and the projected length of your disability. Most calculations are based on your AWW – your average weekly wage over the previous year.
- Temporary total incapacity pays 60% of your AWW for up to 156 weeks.
- Partial incapacity pays 60% of the difference in wages after your injury, capped at 75% of what your total incapacity benefits would be (i.e., 75% of 60% of your AWW). This lasts for up to 260 weeks, but certain cases can be extended to 520 weeks.
- Permanent and total incapacity pays 2/3 of your AWW for as long as you are injured, subject to cost of living adjustments.
- Significant facial scarring and other specific injuries pay one sum equal to the statewide AWW times a certain multiplier, dependent on the injury.
Some benefits are subject to a cap at the statewide AWW and certain minimums.
When Can I Start Getting Workers’ Comp?
Workers’ Compensation benefits usually are not paid until after you have been out of work for 6 days. When they start, you will not be paid back for the first 6 days unless you make it to 21 days of disability.
These do not need to be sequential. Many people take a few days off of work after an injury, then try to go back, only to find their incapacity is severe enough to have to stay away longer.
As for when you get the pay:
- Wage-loss benefits are typically paid weekly
- Medical benefits are paid to the provider as they arise
- Specific injury payments are made in a lump sum.
Who Decides Whether I am Disabled/Incapacitated?
The question of whether you are incapacitated and unable to work will often be made in court. Your employer will likely deny your case, meaning that we need to file to have your case decided by the Department of Industrial Accidents (DIA).
We can appeal denials by your employer and ask for “conciliation” – a reconsideration process. If that fails, the DIA will refer your case to an administrative judge for conferences and hearings to decide your claim.
As part of this process, you will undergo medical examinations, and the judge will take the doctors’ assessments into account. The judge is not a doctor, and these assessments will truly be where your case is decided, as the judge will rely on the medical experts’ findings.
It is vital to get our own medical exams to counter any adverse findings by the employer/insurance carrier’s doctors.
Call Our Workers’ Comp Attorneys in Rockland Today
For a free case review, call the Law Office of John J. Sheehan’s Workers’ Compensation attorneys at (617) 925-6407