Workers’ compensation is a mandatory system legislated by all 50 states and the District of Columbia to protect persons who are injured on the job. Employers in the District of Columbia and Maryland are either required to purchase workers’ compensation insurance or be certified as self-insured. In Virginia, employers with three of more employees are required to carry workers’ compensation insurance or be certified as self-insured. It is a no-fault system, which means that even if an injury or medical condition is caused by the person who is hurt, benefits are still available. Employees are generally not permitted to sue their employers for injuries, even if the employer was negligent in causing the injury. On the other hand, if the injured worker was negligent which results in an injury, a workers’ compensation claim may be pursued. If a worker were intoxicated at the time of the incident which resulted in injury, or intentionally injured himself/herself, then benefits would not be available. In some jurisdictions, if the employee violated a safety regulation, benefits could be denied under certain circumstances.
Workers’ compensation covers lost wages up to a maximum depending on the average wage of the insured worker. The minimum and maximum benefits differ from state to state. It also compensates for medical care, medications, vocational rehabilitation, and transportation for medically-related visits. Unlike recovery available in negligence claims such as auto accidents, there is no compensation for pain and suffering in workers’ compensation cases. The system is set up to take care of the financial and medical needs of the insured person. In the event of an injury that results in death, dependents may receive benefits, which are governed by the laws of the jurisdiction.
A worker is entitled to receive timely benefits after a disabling injury. One purpose of workers’ compensation laws is to provide quick payment, so that injured workers have income to cover necessary living expenses. Unfortunately, insurance companies and self-insured employers are not always interested in paying required benefits and in some instances they find reasons not to pay. Failure to pay benefits puts the injured worker and his/her family in an extremely difficult position which can result in a financial crisis.
When benefits and medical care are denied or delayed, the claimant should take action to pressure the employer/insurance company to pay what is required. A hearing before the Workers’ Compensation Commission (Maryland and Virginia) or Department of Employment Services (District of Columbia) is often necessary to have these benefits ordered.