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The Workers’…"><meta name="robots" content="index,follow,noodp"><meta name="has-remarketing" content="1"> <meta name="is-logged-in" content="0" /> <meta name="page-type" content="Onward: Other" /> <link rel=canonical href=https://onward.justia.com/justia-legal-resources-workers-compensation-law-center-2/ ><link rel=alternate hreflang=es href=https://avanza.justia.com/recursos-legales-de-justia-centro-de-ley-de-compensacion-de-trabajadores/ ><link rel=amphtml href=https://onward.justia.com/amp/justia-legal-resources-workers-compensation-law-center-2/ ><meta name="trigger-ga" content="1"><link rel=publisher href=https://company.justia.com/ ><link rel=icon type=image/svg+xml href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_144.svg><link rel=icon type=image/png sizes=144x144 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_144.png><link rel=icon type=image/png sizes=128x128 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_128.png><link rel=icon type=image/x-icon sizes="16x16 24x24 32x32 48x48 64x64 96x96 128x128" href=https://justatic.com/v/20240606b/shared/images/justia/justia.ico><link rel=apple-touch-icon type=image/png sizes=57x57 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_57.png><link rel=apple-touch-icon type=image/png sizes=72x72 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_72.png><link rel=apple-touch-icon type=image/png sizes=114x114 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_114.png><link rel=apple-touch-icon type=image/png sizes=144x144 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_144.png><link rel=apple-touch-icon-precomposed type=image/png sizes=57x57 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_57.png><link rel=apple-touch-icon-precomposed type=image/png sizes=72x72 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_72.png><link rel=apple-touch-icon-precomposed type=image/png sizes=114x114 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_114.png><link rel=apple-touch-icon-precomposed type=image/png sizes=144x144 href=https://justatic.com/v/20240606b/shared/images/justia/jbutton_flat_144.png><link rel="shortcut icon" type=image/vnd.microsoft.icon sizes="16x16 24x24 32x32 48x48 64x64 96x96 128x128" href=https://justatic.com/v/20240606b/shared/images/justia/justia.ico><link rel=alternate type=application/rss+xml title="Legal Marketing & Technology Blog » Feed" href=https://onward.justia.com/feed/ ><link rel=stylesheet type=text/css media=all href=https://justatic.com/v/20240606b/ash/css/core.css><link rel=stylesheet type=text/css media=all href=https://justatic.com/v/20240606b/ash/css/onward.css> <script type=application/ld+json>{ "@context": "https://schema.org", "@type": "BlogPosting", "name": "Justia Legal Resources: Workers’ Compensation Law Center", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://onward.justia.com/justia-legal-resources-workers-compensation-law-center-2/" }, "headline": "Justia Legal Resources: Workers’ Compensation Law Center", "image": { "@type": "ImageObject", "url": "https://onward.justia.com/wp-content/uploads/2024/11/Justia-Legal-Resources-Workers-Compensation-Law-Center-Cover-1024x538.png", "width": "1024", "height": "538", "representativeOfPage": "http://schema.org/True" }, "datePublished": "2024-11-05T18:06:04-08:00", "dateModified": "2024-11-07T18:38:44-08:00", "author": [ { "@type": "Person", "name": "Chris Skelton", "url": "https://onward.justia.com/author/chrisskelton", "description": "As a member of the Editorial Team, Chris creates and updates content across the Justia Portal. He received his BA and JD from Stanford University, after which he received a license to practice law in California. Chris closely follows many professional and college sports, and he is a passionate fan of the Oregon Ducks." } ], "publisher": { "@type": "Organization", "name": "Justia Onward - Legal Marketing & Technology Blog", "logo": { "@type": "ImageObject", "url": "https://justatic.com/v/20240606b/branding/logos/justia.svg", "height": "60", "width": "200" } }, "articleBody": "<p>When someone gets injured on the job, they may need significant treatment and may miss time from work while they recover. The workers\u2019 compensation system aims to address these concerns by providing reimbursement for medical costs and partial replacement for lost wages. To get these benefits, an injured employee does not need to prove that their employer did anything wrong. Still, pursuing workers\u2019 compensation is not always straightforward. The <a href=\"https:\/\/www.justia.com\/workers-compensation\/\">Workers\u2019 Compensation Law Center<\/a> at Justia provides insights on how the process unfolds. Here are some answers to basic questions that an injured worker might raise.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-18328\" src=\"https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Workers-Next-to-Boxes-on-a-Shipping-Company.png\" alt=\"Workers Next to Boxes on a Shipping Company\" width=\"960\" height=\"629\" srcset=\"https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Workers-Next-to-Boxes-on-a-Shipping-Company.png 960w, https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Workers-Next-to-Boxes-on-a-Shipping-Company-300x197.png 300w, https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Workers-Next-to-Boxes-on-a-Shipping-Company-768x503.png 768w\" sizes=\"(max-width: 960px) 100vw, 960px\" \/><\/p>\n<h2>Who Is Covered by Workers\u2019 Compensation?<\/h2>\n<p>An injured worker must be an employee, rather than an independent contractor, <a href=\"https:\/\/www.justia.com\/workers-compensation\/eligibility-for-benefits\/\">to qualify<\/a> for these benefits. Even if a business labels a worker as an independent contractor, they still are considered an employee if they meet the definition of this term under state law. The employer must have workers\u2019 compensation insurance, although almost all states require most employers to sign up for this coverage. The employee must not work in a field explicitly exempted from workers\u2019 compensation, such as some agricultural or domestic work. Finally, the injury must have arisen from the employee\u2019s work.<\/p>\n<h2>How Long Do I Have To Report an Injury?<\/h2>\n<p>A worker should <a href=\"https:\/\/www.justia.com\/workers-compensation\/reporting-a-work-injury\/\">report their injury<\/a> to the employer as soon as possible, even if they are unsure about its severity. They may have about 30 days to submit the report, but the deadline is much shorter in some states, potentially around 10 days. Other states simply require reporting as soon as possible without stipulating a specific number of days. The deadline for reporting an injury should not be confused with <a href=\"https:\/\/www.justia.com\/workers-compensation\/time-limits-in-workers-compensation-claims\/\">the deadline<\/a> for filing a workers\u2019 compensation claim. An injured employee may have a year or more to file the claim.<\/p>\n<h2>Why Are Workers\u2019 Compensation Claims Denied?<\/h2>\n<p>While some denials arise from minor issues like failing to submit required documentation, others involve more significant problems with the claim. An insurer might argue that the injury did not arise from the employee\u2019s job duties, or that they did not meet the deadlines under state law for reporting the injury or filing the claim. Or the insurer might question whether the injury has affected the worker to the extent that they are alleging. A worker whose claim is denied may <a href=\"https:\/\/www.justia.com\/workers-compensation\/denials-of-workers-compensation-claims\/\">appeal the decision<\/a> within the agency responsible for administering these benefits. Ultimately, they might pursue an appeal in state court.<\/p>\n<h2>How Will My Doctor Affect My Claim?<\/h2>\n<p>A doctor who treats an injured worker will diagnose their condition and determine their course of treatment. They may testify during proceedings related to the claim, in which their written reports also may play a key role. Input from the doctor <a href=\"https:\/\/www.justia.com\/workers-compensation\/getting-medical-treatment\/the-role-of-a-doctor-in-a-workers-compensation-claim\/\">may affect<\/a> not only the medical benefits that a worker receives but also their wage replacement benefits. This is because the doctor will determine when the employee can go back to work and whether they will need to have restrictions on their job duties at that point. If an injury leaves the employee with permanent limitations, the doctor\u2019s analysis of their condition may affect their access to permanent disability benefits and vocational rehabilitation.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-18324\" src=\"https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Doctor-Checking-a-Patient.png\" alt=\"Doctor Checking a Patient\" width=\"960\" height=\"629\" srcset=\"https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Doctor-Checking-a-Patient.png 960w, https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Doctor-Checking-a-Patient-300x197.png 300w, https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Doctor-Checking-a-Patient-768x503.png 768w\" sizes=\"(max-width: 960px) 100vw, 960px\" \/><\/p>\n<h2>What Is an Independent Medical Examination?<\/h2>\n<p>An insurer that is skeptical about the opinion of the doctor who treated an injured worker may ask for an <a href=\"https:\/\/www.justia.com\/workers-compensation\/independent-medical-examinations\/\">independent medical examination<\/a> as a second opinion. While these doctors are supposed to be neutral, they are retained by the insurer and thus may have an incentive to favor their position. The IME may address issues such as the cause of the injury, the diagnosis, the extent of the appropriate treatment, and how long the worker needs to be away from the job to recover. A claimant should review the report of the IME doctor and address any obvious inaccuracies with the doctor and the insurer.<\/p>\n<h2>Should I Take a Settlement for My Claim?<\/h2>\n<p>A <a href=\"https:\/\/www.justia.com\/workers-compensation\/workers-compensation-settlements\/\">lump sum settlement<\/a> provides a worker with a single payment or a set of structured payments. This can allow them to get access to funds efficiently, but it does not make sense in every situation. A worker who has suffered serious or complex injuries may not want to accept a settlement that covers future medical costs because this might not account for all the treatment that they might eventually need. Before agreeing to a lump sum for these costs, they should think carefully about what the worst-case scenario would require. In some cases, a worker might be able to limit a settlement to wage replacement benefits.<\/p>\n<h2>Can I Get Benefits for an Accident While Commuting To Work?<\/h2>\n<p>Under the \u201cgoing and coming rule,\u201d you generally <a href=\"https:\/\/www.justia.com\/workers-compensation\/eligibility-for-benefits\/the-work-related-requirement\/\">cannot get benefits<\/a> for injuries that occurred while you were commuting to or from your workplace. You also likely cannot get benefits for an injury during a lunch break if you are away from your workplace. However, a worker might be able to get benefits in certain situations, such as when they were doing something for their employer during their commute or their lunch break. They likely will be covered if they get injured at a company-sponsored event outside the workplace, especially if the employer requires or strongly incentivizes attendance.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter size-full wp-image-18327\" src=\"https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Person-Looking-a-Paper-Concerned.png\" alt=\"Person Concerned Looking at a Paper\" width=\"960\" height=\"629\" srcset=\"https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Person-Looking-a-Paper-Concerned.png 960w, https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Person-Looking-a-Paper-Concerned-300x197.png 300w, https:\/\/onward.justia.com\/wp-content\/uploads\/2024\/11\/Person-Looking-a-Paper-Concerned-768x503.png 768w\" sizes=\"(max-width: 960px) 100vw, 960px\" \/><\/p>\n<h2>What Happens If an Insurer Breaks the Rules?<\/h2>\n<p>To minimize their costs, workers\u2019 compensation insurers sometimes may unreasonably deny a claim, or unreasonably defend a denial during the appeals process. This means that a worker may not get benefits as soon as they should have. An insurer that acts in <a href=\"https:\/\/www.justia.com\/workers-compensation\/insurance-company-penalties\/\">bad faith<\/a> may be ordered to pay a penalty and interest on late payments. Penalties also may be applied when an insurer fails to make payments as required under a court order or settlement agreement, or if the insurer does not decide whether to accept or deny a claim within the legally specified deadline after receiving the report of the injury.<\/p>\n<h2>Can I Reopen a Claim To Get More Benefits?<\/h2>\n<p>You may be able to <a href=\"https:\/\/www.justia.com\/workers-compensation\/reopening-a-workers-compensation-claim\/\">reopen your claim<\/a> if your condition gets worse after the claim was closed. Certain other situations also may justify reopening the claim, such as an error by the court or fraud by the insurer. Reopening a claim that resulted in a settlement may be more challenging, since these agreements often provide for a full and final release of claims arising from the injury. Reopening a claim that was previously denied also may be difficult and may require presenting medical evidence that was not available at the time of the denial.<\/p>\n<h2>Can I Sue Someone Else for an Injury on the Job?<\/h2>\n<p>Although an employee rarely can sue an employer or a coworker, they may be able to <a href=\"https:\/\/www.justia.com\/workers-compensation\/third-party-claims-based-on-work-injuries\/\">sue a third party<\/a> that caused an injury while they were on the job. For example, perhaps a careless driver hit them, or perhaps they used a defective product. A third-party claim can allow an injured employee to recover more compensation, such as the full amount of their lost income and damages for pain and suffering. However, this would require proving the fault of the defendant, whereas access to workers\u2019 compensation does not hinge on proving fault.<\/p>\n<h2>Final Thoughts<\/h2>\n<p>Laws governing the workers\u2019 compensation system may be highly technical and vary from state to state. Justia provides a <a href=\"https:\/\/www.justia.com\/workers-compensation\/workers-compensation-laws-50-state-survey\/\">50-state survey<\/a> of workers\u2019 compensation laws that describes some of these nuances, such as deadlines for reporting an injury, waiting periods for receiving benefits, and amounts available for wage replacement. Someone pursuing a claim should consider <a href=\"https:\/\/www.justia.com\/workers-compensation\/working-with-a-workers-compensation-lawyer\/\">working with a lawyer<\/a>, especially if their injury is serious or if its connection to their job is not obvious. An attorney also can advise them on whether they should bring claims against third parties. In the meantime, the Workers\u2019 Compensation Law Center offers a readable overview of some key concepts in this area. Like the other <a href=\"https:\/\/www.justia.com\/legal-guides\/\">Justia Legal Guides<\/a>, it furthers our mission of making the law free and accessible to all.<\/p>\n<strong class=\"ui-heading2\">Related Posts<\/strong>\n<ul>\n <li><a href=\"https:\/\/onward.justia.com\/justia-legal-resources-foreclosure-law-center\/\">Justia Legal Resources: Foreclosure Law Center<\/a><\/li>\n <li><a href=\"https:\/\/onward.justia.com\/justia-legal-resources-products-liability-law-center\/\">Justia Legal Resources: Products Liability Law Center<\/a><\/li>\n <li><a href=\"https:\/\/onward.justia.com\/justia-legal-resources-adoption-law-center\/\">Justia Legal Resources: Adoption Law Center<\/a><\/li>\n<\/ul>" }</script> <script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 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href=https://onward.justia.com/justia-legal-resources-workers-compensation-law-center-2/ ><div class=inner-wrapper><header><h1 class="entry-title" itemprop="name">Justia Legal Resources: Workers’ Compensation Law Center</h1><meta itemprop="headline" content="Justia Legal Resources: Workers’ Compensation Law Center"><div class=author> <span itemprop=author itemscope itemtype=https://schema.org/Person><a href=https://onward.justia.com/author/chrisskelton class="url fn author-chrisskelton author-30 post-author-link" rel=author target=_self itemprop=url><span itemprop=name>Chris Skelton</span></a></span></div><div class=published-date> <time datetime=2024-11-05T18:06:04-08:00 class="post-date published" itemprop=datePublished>November 5, 2024</time></div><div class=post-metadata> <a href=https://avanza.justia.com/recursos-legales-de-justia-centro-de-ley-de-compensacion-de-trabajadores/ >Spanish</a></div><div class=featured-image itemprop=image itemtype=http://schema.org/ImageObject 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itemprop="height" content="60"><meta itemprop="width" content="200"></div></div><div class=visuallyhidden>Updated: <span> <time datetime=2024-11-07T18:38:44-08:00 class=updated itemprop=dateModified>November 5, 2024</time> </span></div><div class=entry-info><div class=sharelinks xmlns=http://www.w3.org/1999/html><div class=wrapper> <a class=twitter data-endpoint="https://twitter.com/intent/tweet?via=OnwardJustia&text=Justia%20Legal%20Resources%3A%20Workers%E2%80%99%20Compensation%20Law%20Center&url=https%3A%2F%2Fj.st%2F59U4&original_referer=https%3A%2F%2Fonward.justia.com%2Fjustia-legal-resources-workers-compensation-law-center-2%2F" target=_blank data-directive=j-iframe-popup data-width=600 data-height=600 data-category=Navigation data-action="Social Media" data-label=Twitter> <span class=share-logo> <svg class=ui-icon width=20 height=20 viewBox="0 0 80 80" title=Tweet role=img> <use xlink:href=/justatic/shared/images/icons/social-icons-sprite.svg#twitter-alt1></use> </svg> <span 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data-endpoint="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fonward.justia.com%2Fjustia-legal-resources-workers-compensation-law-center-2%2F%3Futm_medium%3Dsocial%26utm_source%3Dfacebook%26utm_campaign%3Donward-2024-11-05-18322" target=_blank data-directive=j-iframe-popup data-width=600 data-height=600 data-category=Navigation data-action="Social Media" data-label=Facebook> <span class=share-logo> <svg class=ui-icon width=20 height=20 viewBox="0 0 80 80" title=Share role=img> <use xlink:href=/justatic/shared/images/icons/social-icons-sprite.svg#facebook-alt1></use> </svg> <span class=share-tag>Share</span> </span> </a></div></div><p> <em>Approximate Read Time: 5 Minutes</em></p></div></header><div class="content _content-links-semibold" itemprop=articleBody><div class=_hidden id=subscribe-box data-modal-class=-subscribe data-focus-element=#subscription-email><div class=content> <strong class=ui-heading2>Just One More Thing...</strong><p class=intro>We can’t send you updates from Justia Onward without your email.</p><form id=subscribe-form action method=post data-directive=j-newsletter-subscribe-form data-parsley-trigger=focusout class=ui-simple-form novalidate> <label class="ui-field floating-label" for=form-name> <span class="-floating-label flabel">E-mail</span> <input type=email name=EMAIL id=mce-EMAIL title="Enter e-mail" placeholder="Enter e-mail" required class=ffield data-required=true> </label><div class=g-recaptcha data-sitekey=6Lc8e9QZAAAAALXCMYspBhWr45nC7vkovxjiIKzP data-size=invisible data-callback=recaptchaOnSubmit></div> <button data-gtm-type=click data-gtm-category=Newsletters data-gtm-label="Onward Newsletter" data-gtm-action=Submission class="ui-button _display-inlineb -red _ttransform-uppercase">Send Me Updates</button></form><p class=_no-margin-bottom>Unsubscribe at any time.</p></div></div><div class=entry-cta data-directive=j-sticky-sidebar> <strong class=title>Never miss an update with our  Justia Onward newsletter.</strong> <a data-gtm-type=click data-gtm-category=Navigation data-gtm-action=Content data-gtm-label="Onward - Newsletter Button" href=# class="ui-button -red" data-directive=j-lightbox data-lightbox-ref=#subscribe-box>Send Me Updates</a></div><div class=entry-content><blockquote> Workers’ compensation makes benefits available regardless of fault, but this does not always mean that the process goes smoothly. The Workers’ Compensation Law Center provided by Justia describes what to expect and consider in these situations.</blockquote><p>When someone gets injured on the job, they may need significant treatment and may miss time from work while they recover. The workers’ compensation system aims to address these concerns by providing reimbursement for medical costs and partial replacement for lost wages. To get these benefits, an injured employee does not need to prove that their employer did anything wrong. Still, pursuing workers’ compensation is not always straightforward. The <a href=https://www.justia.com/workers-compensation/ >Workers’ Compensation Law Center</a> at Justia provides insights on how the process unfolds. Here are some answers to basic questions that an injured worker might raise.</p><p><img decoding=async loading=lazy class="aligncenter size-full wp-image-18328" src=https://onward.justia.com/wp-content/uploads/2024/11/Workers-Next-to-Boxes-on-a-Shipping-Company.png alt="Workers Next to Boxes on a Shipping Company" width=960 height=629 srcset="https://onward.justia.com/wp-content/uploads/2024/11/Workers-Next-to-Boxes-on-a-Shipping-Company.png 960w, https://onward.justia.com/wp-content/uploads/2024/11/Workers-Next-to-Boxes-on-a-Shipping-Company-300x197.png 300w, https://onward.justia.com/wp-content/uploads/2024/11/Workers-Next-to-Boxes-on-a-Shipping-Company-768x503.png 768w" sizes="(max-width: 960px) 100vw, 960px"></p><h2>Who Is Covered by Workers’ Compensation?</h2><p>An injured worker must be an employee, rather than an independent contractor, <a href=https://www.justia.com/workers-compensation/eligibility-for-benefits/ >to qualify</a> for these benefits. Even if a business labels a worker as an independent contractor, they still are considered an employee if they meet the definition of this term under state law. The employer must have workers’ compensation insurance, although almost all states require most employers to sign up for this coverage. The employee must not work in a field explicitly exempted from workers’ compensation, such as some agricultural or domestic work. Finally, the injury must have arisen from the employee’s work.</p><h2>How Long Do I Have To Report an Injury?</h2><p>A worker should <a href=https://www.justia.com/workers-compensation/reporting-a-work-injury/ >report their injury</a> to the employer as soon as possible, even if they are unsure about its severity. They may have about 30 days to submit the report, but the deadline is much shorter in some states, potentially around 10 days. Other states simply require reporting as soon as possible without stipulating a specific number of days. The deadline for reporting an injury should not be confused with <a href=https://www.justia.com/workers-compensation/time-limits-in-workers-compensation-claims/ >the deadline</a> for filing a workers’ compensation claim. An injured employee may have a year or more to file the claim.</p><h2>Why Are Workers’ Compensation Claims Denied?</h2><p>While some denials arise from minor issues like failing to submit required documentation, others involve more significant problems with the claim. An insurer might argue that the injury did not arise from the employee’s job duties, or that they did not meet the deadlines under state law for reporting the injury or filing the claim. Or the insurer might question whether the injury has affected the worker to the extent that they are alleging. A worker whose claim is denied may <a href=https://www.justia.com/workers-compensation/denials-of-workers-compensation-claims/ >appeal the decision</a> within the agency responsible for administering these benefits. Ultimately, they might pursue an appeal in state court.</p><h2>How Will My Doctor Affect My Claim?</h2><p>A doctor who treats an injured worker will diagnose their condition and determine their course of treatment. They may testify during proceedings related to the claim, in which their written reports also may play a key role. Input from the doctor <a href=https://www.justia.com/workers-compensation/getting-medical-treatment/the-role-of-a-doctor-in-a-workers-compensation-claim/ >may affect</a> not only the medical benefits that a worker receives but also their wage replacement benefits. This is because the doctor will determine when the employee can go back to work and whether they will need to have restrictions on their job duties at that point. If an injury leaves the employee with permanent limitations, the doctor’s analysis of their condition may affect their access to permanent disability benefits and vocational rehabilitation.</p><p><img decoding=async loading=lazy class="aligncenter size-full wp-image-18324" src=https://onward.justia.com/wp-content/uploads/2024/11/Doctor-Checking-a-Patient.png alt="Doctor Checking a Patient" width=960 height=629 srcset="https://onward.justia.com/wp-content/uploads/2024/11/Doctor-Checking-a-Patient.png 960w, https://onward.justia.com/wp-content/uploads/2024/11/Doctor-Checking-a-Patient-300x197.png 300w, https://onward.justia.com/wp-content/uploads/2024/11/Doctor-Checking-a-Patient-768x503.png 768w" sizes="(max-width: 960px) 100vw, 960px"></p><h2>What Is an Independent Medical Examination?</h2><p>An insurer that is skeptical about the opinion of the doctor who treated an injured worker may ask for an <a href=https://www.justia.com/workers-compensation/independent-medical-examinations/ >independent medical examination</a> as a second opinion. While these doctors are supposed to be neutral, they are retained by the insurer and thus may have an incentive to favor their position. The IME may address issues such as the cause of the injury, the diagnosis, the extent of the appropriate treatment, and how long the worker needs to be away from the job to recover. A claimant should review the report of the IME doctor and address any obvious inaccuracies with the doctor and the insurer.</p><h2>Should I Take a Settlement for My Claim?</h2><p>A <a href=https://www.justia.com/workers-compensation/workers-compensation-settlements/ >lump sum settlement</a> provides a worker with a single payment or a set of structured payments. This can allow them to get access to funds efficiently, but it does not make sense in every situation. A worker who has suffered serious or complex injuries may not want to accept a settlement that covers future medical costs because this might not account for all the treatment that they might eventually need. Before agreeing to a lump sum for these costs, they should think carefully about what the worst-case scenario would require. In some cases, a worker might be able to limit a settlement to wage replacement benefits.</p><h2>Can I Get Benefits for an Accident While Commuting To Work?</h2><p>Under the “going and coming rule,” you generally <a href=https://www.justia.com/workers-compensation/eligibility-for-benefits/the-work-related-requirement/ >cannot get benefits</a> for injuries that occurred while you were commuting to or from your workplace. You also likely cannot get benefits for an injury during a lunch break if you are away from your workplace. However, a worker might be able to get benefits in certain situations, such as when they were doing something for their employer during their commute or their lunch break. They likely will be covered if they get injured at a company-sponsored event outside the workplace, especially if the employer requires or strongly incentivizes attendance.</p><p><img decoding=async loading=lazy class="aligncenter size-full wp-image-18327" src=https://onward.justia.com/wp-content/uploads/2024/11/Person-Looking-a-Paper-Concerned.png alt="Person Concerned Looking at a Paper" width=960 height=629 srcset="https://onward.justia.com/wp-content/uploads/2024/11/Person-Looking-a-Paper-Concerned.png 960w, https://onward.justia.com/wp-content/uploads/2024/11/Person-Looking-a-Paper-Concerned-300x197.png 300w, https://onward.justia.com/wp-content/uploads/2024/11/Person-Looking-a-Paper-Concerned-768x503.png 768w" sizes="(max-width: 960px) 100vw, 960px"></p><h2>What Happens If an Insurer Breaks the Rules?</h2><p>To minimize their costs, workers’ compensation insurers sometimes may unreasonably deny a claim, or unreasonably defend a denial during the appeals process. This means that a worker may not get benefits as soon as they should have. An insurer that acts in <a href=https://www.justia.com/workers-compensation/insurance-company-penalties/ >bad faith</a> may be ordered to pay a penalty and interest on late payments. Penalties also may be applied when an insurer fails to make payments as required under a court order or settlement agreement, or if the insurer does not decide whether to accept or deny a claim within the legally specified deadline after receiving the report of the injury.</p><h2>Can I Reopen a Claim To Get More Benefits?</h2><p>You may be able to <a href=https://www.justia.com/workers-compensation/reopening-a-workers-compensation-claim/ >reopen your claim</a> if your condition gets worse after the claim was closed. Certain other situations also may justify reopening the claim, such as an error by the court or fraud by the insurer. Reopening a claim that resulted in a settlement may be more challenging, since these agreements often provide for a full and final release of claims arising from the injury. Reopening a claim that was previously denied also may be difficult and may require presenting medical evidence that was not available at the time of the denial.</p><h2>Can I Sue Someone Else for an Injury on the Job?</h2><p>Although an employee rarely can sue an employer or a coworker, they may be able to <a href=https://www.justia.com/workers-compensation/third-party-claims-based-on-work-injuries/ >sue a third party</a> that caused an injury while they were on the job. For example, perhaps a careless driver hit them, or perhaps they used a defective product. A third-party claim can allow an injured employee to recover more compensation, such as the full amount of their lost income and damages for pain and suffering. However, this would require proving the fault of the defendant, whereas access to workers’ compensation does not hinge on proving fault.</p><h2>Final Thoughts</h2><p>Laws governing the workers’ compensation system may be highly technical and vary from state to state. Justia provides a <a href=https://www.justia.com/workers-compensation/workers-compensation-laws-50-state-survey/ >50-state survey</a> of workers’ compensation laws that describes some of these nuances, such as deadlines for reporting an injury, waiting periods for receiving benefits, and amounts available for wage replacement. Someone pursuing a claim should consider <a href=https://www.justia.com/workers-compensation/working-with-a-workers-compensation-lawyer/ >working with a lawyer</a>, especially if their injury is serious or if its connection to their job is not obvious. An attorney also can advise them on whether they should bring claims against third parties. In the meantime, the Workers’ Compensation Law Center offers a readable overview of some key concepts in this area. Like the other <a href=https://www.justia.com/legal-guides/ >Justia Legal Guides</a>, it furthers our mission of making the law free and accessible to all.</p> <strong class=ui-heading2>Related Posts</strong><ul> <li><a href=https://onward.justia.com/justia-legal-resources-foreclosure-law-center/ >Justia Legal Resources: Foreclosure Law Center</a></li> <li><a href=https://onward.justia.com/justia-legal-resources-products-liability-law-center/ >Justia Legal Resources: Products Liability Law Center</a></li> <li><a href=https://onward.justia.com/justia-legal-resources-adoption-law-center/ >Justia Legal Resources: Adoption Law Center</a></li></ul><p> <a href=https://avanza.justia.com/recursos-legales-de-justia-centro-de-ley-de-compensacion-de-trabajadores/ > Lee este artículo en Español en Justia Avanza. </a></p></div></div><div class="post-disclaimer sides-margin _bg-justia-blue _no-margin"><p class=_no-margin> Justia offers premium website, blogging, and online marketing solutions for law firms. 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He received his BA and JD from Stanford University, after which he received a license to practice law in California. 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