Workers’ Compensation Law FAQs

You cannot get benefits for non-economic forms of harm, such as pain and suffering or lost enjoyment of life, through the workers’ compensation system. If a third party caused or contributed to your injury, you may be able to recover non-economic damages through a personal injury lawsuit against them. Workers’ compensation often does provide coverage for psychological conditions that arose from a job-related accident, however, such as PTSD or chronic depression.

Yes, workers’ compensation programs in most states provide reimbursement for expenses incurred in traveling for doctor’s appointments or treatments that are reasonable and necessary. The specific rules vary depending on the state. For example, some states provide reimbursement only for mileage over a certain distance or only in situations in which comparable treatment was not available closer to the worker’s location.

Workers’ compensation often provides benefits for permanent scarring, although the rules vary among the states. Benefits may depend in part on the location and extent of the scars, as well as whether they affect your employability or earning capacity. Scarring may form part of an injured worker’s permanent disability rating and increase their disability benefits. Or the workers’ compensation system may account for it with a separate one-time payment.

One of the requirements of workers’ compensation is that the injury must have been work-related. This generally means that the employee must have been performing an activity for the benefit of their employer when they were injured. Workers’ compensation does not cover most injuries during lunch breaks or the commute to work. However, if an event outside the office is a mandatory part of the job, an injury likely will be covered. If the event was not technically mandatory, an injury still may be covered if attendance was virtually mandatory under the circumstances or if the employer gave employees incentives to attend.

This will depend in part on when you report the injury. You should report an injury as soon as possible to start the claims process. The insurer must decide whether to approve or deny your claim within a reasonable period, and some states provide a fixed deadline within which the insurer must reach a decision. (It may be able to ask for an extension if needed.) This deadline is often about 30 days after the claim is filed. If the insurer fails to comply with the deadline, your claim may be considered automatically approved, or the insurer may be on the hook for penalties. To be on the safe side, though, you should contact the insurer if you do not get a decision on your claim within a reasonable time.

You cannot be fired (or otherwise treated adversely by your employer) because you filed a workers’ compensation claim. This would form the basis of a wrongful termination lawsuit against your employer. However, filing a workers’ compensation claim does not protect you from being fired for another reason that is non-discriminatory and otherwise legal. If your employer is planning layoffs, moreover, you generally are not exempt from being laid off and are not entitled to special treatment because of your disability.

Most states do not require an employer to reinstate an injured employee or hold their position open while they are on injury-related leave. A few states do provide a right to reinstatement as long as the injured worker returns within a certain period of time. Other states may provide a hiring preference to former employees who were injured on the job, placing them ahead of non-employee applicants for the position. Employees have additional protections under certain federal laws, such as the Americans with Disabilities Act and the Family and Medical Leave Act.

In states other than Texas, most ordinary employers are required to carry workers’ compensation insurance. If your employer has violated the law, you generally can bring a third-party personal injury claim against it. This is because the employer has waived its protection against personal injury liability by failing to get workers’ compensation coverage. (You may be able to get more compensation through this type of claim than through the workers’ compensation system.) Another alternative is to seek benefits through the state workers’ compensation fund or temporary disability insurance program. Many states have created these programs to help employees facing this situation.

You may face serious obstacles to getting benefits if you do not report your injury as required. Insurers tend to be suspicious of injuries that are not reported promptly, and state laws provide only limited exceptions for workers who miss the deadline. However, you still may be able to get benefits if your supervisor witnessed the injury or otherwise was aware of it. You also may be able to work around missing the deadline if you were physically unable to provide notice to the employer, such as if you were in a coma and did not have anyone else who could provide notice for you. Workers’ compensation programs will be more likely to permit an exception if the employer did not suffer any harm because of the late reporting.

Your options will depend on the wording of the settlement. If the settlement represented a full and final release of all of your claims, you may not be able to get more benefits unless you can argue that the change in your condition is a new injury. If you did not sign a full and final release, however, you may be able to reopen your claim. You would need to present medical evidence on the worsening of your condition, as well as meeting procedural rules for reopening a claim.

You may need a workers’ compensation lawyer if you are dealing with a permanent disability or a complicated condition. Retaining an attorney also may be critical if your claim has been denied or if your employer has signaled that they are skeptical of it. In other words, whenever a claim is contested or a significant amount of money is at stake, professional representation can make a huge difference. By contrast, you may not need to hire an attorney if you suffer a straightforward injury, you expect to return to work after a short time, and your employer promptly accepts responsibility for payments.

You probably will not be able to get a free workers’ compensation lawyer, but you should not worry about paying attorney fees up front. Most workers’ compensation lawyers handle their cases on a contingency fee basis. This means that they receive a limited percentage of the benefits that the worker recovers. (However, you also may be responsible for reimbursing your lawyer for certain additional court costs, which you can discuss before signing your representation agreement.)

While you have a right to receive communications from your attorney about the status of your claim, you should be aware that you may not get an immediate response. Workers’ compensation lawyers tend to be very busy, and they may not prioritize responding to a claimant if their case has gone through no new developments since their last communication. You can consider asking assistants and paralegals who are working with the lawyer about the status of your case, or you can ask to see the file for your case. This should give you a sense of what the lawyer has done on your behalf. If these steps do not get results, you may want to consider finding a new lawyer.