Eligibility Requirements For Workers Comp
The eligibility requirements for workers comp are fairly straightforward. While they vary slightly from state to state , the basic eligibility criteria are:
- You qualify as an employee
- Your employer provides workers comp coverage
- You suffered your back injury on the job
- You met the requirements to file a workers comp claim on time
If you meet these basic requirements, then you should generally be eligible for workers comp, and a local attorney may be able to help you obtain a back injury settlement.
How Long Will It Take For My Back Pain To Go Away
Back pain can take a few weeks or can take a few months to heal and start to go away. For some people, back pain can be permanent and chronic. You should NOT WAIT for it to go away before taking action. By then, you will have failed to mitigate your damages, meaning the insurance company can blame you for not getting better, and argue that you should have gone to a doctor sooner.
It sounds like a terrible argument, but it is not. It is the law, and the insurance company will win if you use a wait and see approach to getting medical treatment after your accident.
Alternatives To Workers Compensation
The alternative to a workers comp claim is to sue a third party who may have contributed to your injury. The first thing to know is that a third-party claim is in addition to your workers comp claim, not instead of it. Of course, if your employer did not provide workers compensation coverage, then the employer may face a lawsuit.
Third-party claims can arise, for example, when a car strikes an employee during work and the driver has no affiliation with the employer. Similarly, when poorly made or maintained equipment injures you, you may have a claim against the manufacturer of the machinery or the company that maintained it. On occasion, a work-related injury will occur on property that does not belong to the employer. If the condition of the property contributed to the injury, then the property owner may be liable for damages as well.
Third-party claims offer an advantage to the employee, as they are not subject to the limitations on recovery found in workers compensation statutes and coverage.
These damages can include:
- The emotional impact of any resulting disability
- Loss of companionship or affection
- Loss of enjoyment of life
- Loss of sexual function
- Worsening of prior injures
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About Backaches Stemming From Working On The Job
Most employees who develop backaches get some medical treatment and quickly return to work. Others find their symptoms dont go away and have trouble performing the requirements of their jobs.
Most backaches starts from lifting, pulling, or pushing items. It is common for employees to report immediate symptoms while bending or twisting. Common diagnoses include lumbar back strain, herniated disc, annular tear, fractured vertebrae, and pinched nerve.
Employees who develop nerve problems can have symptoms that travel down their bodies resulting in pain, numbness, and tingling in their lower extremities. Treatment includes prescription medications, physical therapy, injections, and surgery. Common surgical procedures are laminectomy, discectomy, and lumbar fusion. Some people who undergo back surgery will require lifetime medical care and permanent work restrictions.
What’s The Likely Outcome Of A Workers Comp Case Involving A Back Injury
Workers who filed claims for a back injury were very likely to receive at least some compensation through workers comp. According to our survey, 74% of workers with back injuries received compensation, either through a voluntary settlement or through an award by a judge after a workers compensation hearing. Only 26% of workers with back injuries did not receive a settlement or award.
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Bulging Or Herniated Discs
When spinal discs become damaged, the fluid inside them can begin to leak and in some cases the discs may burst. A bulging disc occurs when the outer cartilage is weakened, causing the inner cartilage to bulge out. When you have a herniated disc, the inner cartilage pushes through the outer layer. This can put pressure on nearby nerves, causing pain.
If My Back Injury At Work Is Denied Coverage What Do I Do
Denial of benefits is common, especially with workersâ compensation settlement back and spine injuries. Injured people end up filing a workersâ comp lawsuit back injury claim when the employer or its insurance company try to say that something else caused the back or spinal pain other than an injury at work.
For example, the denial letter might state that an older worker is simply feeling the effects of aging and that is why he or she has chronic back or spinal pain. If the employer knows the worker has an old injury from a car accident, sports, or another cause, the insurance company will likely try to pin the current pain on that instead of work duties. Even when admitting that the injury is current, the insurance provider may try to argue that it happened outside of work and therefore does not warrant wage loss benefits.
We understand that it is extremely frustrating and discouraging to receive a denial when you feel legitimately entitled to benefits as an injured worker. The good news is that you have a right to retain a back injury attorney for legal representation and that you pay no legal fees upfront. Our New York spinal cord injury lawyers earn a fee only if we are successful in winning your case.
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Factors That Affect Lower Back Injury Settlement Amounts
No two back injury cases are the same. There will often be variations in terms of circumstance and nature of the injury. These differences will ultimately affect the compensation amount. For instance, a worker with a mild strain will likely receive less money than one with severely herniated discs.
Common factors that affect the compensation amount for lower back injury cases include:
Insurance Companies Do Not Want To Pay
One thing to remember as you work on dealing with your injuries is that no matter the pain you feel you are in, or the amount you feel you may be entitled to, insurance companies to not want to pay out on these injuries.
Because of this, you must be crafty in your positioning. Most people not represented by a lawyer end up giving too much information, and the wrong information, and it compromises the value of their back injury settlement amount. The key is to give the adjuster only those things that will help your claim, then working past their objections with substantive evidence.
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Common Causes Of Workplace Back Injuries
Back injuries in the workplace can occur through a variety of different events.
Some of the most common causes of workplace back injuries include:
- Improper technique when lifting heavy objects,
- Sudden movements,
- Working too fast, and
- Repetitive motions that strain the back.
Improper lifting technique commonly results in workplace back injuries. Lifting heavy objects without properly engaging the leg muscles places undue strain on the spinal cord. This often leads to back injuries such as herniated discs. Herniated disc settlements for workers comp may involve large payments to cover the full extent of rehabilitation and medical treatment.
Did Work Cause Your Back Injury
Your back is the foundation structure of your musculoskeletal system, and a focal point of just about all motility your body can experience. Your flexibility and range of motion depend on the strength of your back, the condition of your tendons and ligaments, and on the bony structures of your spinal column that protect your spinal cord, the communication conduit for your nervous system.
A back injury is seldom minor. Something as simple as a pinched nerve or a pulled muscle can cause months or more of chronic pain and limited range of motion. More serious back injuries, like herniated disks, or vertebral fractures, or spinal cord damage, can leave you incapacitated for days, weeks, or even an entire lifetime.
There are numerous types of back injuries suffered on the job. These injuries are often caused by manual labor, heavy lifting, and repetitive motions. They occur frequently and sometimes without warning. As such, insurance companies are often suspicious of injured workers that claim back injuries, especially when those injuries involve soft tissue damage that can be difficult to diagnose.
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Can You Get Workers Compensation For A Back Injury
Yes, if the back injury is a result of a job-related activity. For instance, if your job requires lifting heavy materials daily and you strained your back, you may qualify for workers comp. If your job responsibilities involve climbing a ladder to access job materials and you fall and hurt your back, you may be eligible for workers compensation. If your job requires you to sit at a desk for long periods and you develop persistent lower back pain, you may qualify as well. If you are a nursing assistant who regularly must lift patients in and out of a hospital bed or of a wheelchair and you injure your back, you may be eligible for workers compensation.
Some injuries, however, do not qualify for workers comp, including those suffered during horseplay at work. Even though you experienced the injury on the job site, hurting yourself as a result of horseplay with co-workers does not qualify, in most cases. If you hurt your back while you are off the job, even if it causes you to miss time at work, you are not eligible for workers compensation. You need to be able to show your back injury was a result of a work-related activity to collect workers compensation benefits.
To receive workers compensation benefits, you need to show how your work activity caused low back pain. You will likely need the support of your physician to prove the diagnosis is from work activity or an injury, and to prove that your back injury makes it difficult or impossible to perform your job.
Judge’s Review Of The Settlement
In most states, a workers’ comp judge will have to review your settlement before it becomes official. This will take place at an informal conference. If you’re not represented by a lawyer, the judge may attempt to make sure the settlement is fair to you. But without knowing your medical history, the judge is limited in helping you.
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A Payment Of Medical Care
In the state of California, workers compensation law requires claims administrators to approve and pay for all medical care that is reasonably required to cure or relieve the effects of an injured workers injury. In some cases, the claims administrator may dispute the need for medical care or a medical procedure.
If that happens in your case, you may be evaluated by a qualified medical evaluator . If the dispute is not resolved, your case may go to trial on the issue of whether the recommended treatment or procedure is medically necessary and reasonably related to your work injury.
How The Worker Was Injured
Amanda had worked at the local bar and grill for ten years as a part-time waitress and hostess.
One day as her shift was coming to an end, her supervisor asked for help carrying several large boxes that had just arrived from their food distributor. As she lifted a box off the truck, she pulled a muscle in her back and dropped the box. She could instantly feel the pull from her lower back to her neck.
Amanda worked in a compulsory workers compensation state, meaning that an employer is required to carry workers compensation insurance.
Because Amandas injury occurred on the job and in the scope of her employment, it was covered by workers compensation insurance.
On-the-job injuries are covered regardless of fault, so long as the employee was not injured in the commission of a crime.
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Filing A Workers Compensation Claim For Lower Back Strain
Lower back strains occur when overexertion or repetitive movement causes damage to the tendons and muscles in the lower back. This is one of the most common back injuries and can lead to intense lower back pain, lower back spasms, and an inability to maintain proper posture.
You can suffer lower back strain during work from various activities, including lifting heavy objects, twisting the body during work activities, and exerting pressure on the lower back by bending over for long periods. Work activities can cause repetitious damage to the lower back muscles and tendons, leading to long-term, chronic lower back strain.
Workers Compensation Claims Handlers: The Human Factor
All claim handlers must comply with their states workers compensation laws and guidelines. They reimburse healthcare for reasonable medical bills. They pay injured workers wages based on pre-determined rates. The Social Security Program Operations Manual contains a chart listing of compensation wage payment rates for every state.
Compensation claim handlers often rely on your physicians judgment when deciding compensation, disability, and permanency. If they question a medical diagnosis, you must undergo an independent medical exam by their chosen doctor.
After a single examination, IME doctors determine your disability status by answering these and other questions.
- Is the back injury work-related?
- Is the treatment necessary?
- Does the injury prevent the worker from doing their job?
- Can the injured worker perform any work?
- Have they reached maximum medical improvement?
- Is their back injury a pre-existing condition?
Back Injuries Suspicions
When claim representatives handle back injury claims, their decisions often reflect a degree of doubt. Whether a person sustains injuries in a car accident, a fall, or a workplace mishap, mistrust often affects a back injury claims outcome. The doubt is not as profound when you have a serious, visible, or easily detectable injury. When a disability involves muscles and other soft tissues, physicians must take your word that you are experiencing pain. Claim representatives do not always accept what you say.
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How Long Do Settlements Take
Short answer: It varies greatly. The Martindale-Nolo survey of readers turned up an average of 15.7 months to resolve a case, and less than 20% of cases are resolved in less than six months. Obviously, those who try to negotiate a better workers comp settlement may hire legal assistance to negotiate the best terms for a settlement or to bring a hearing if there is a disputed issued. This can be time consuming. However, a shorter time frame is not always better. Those actions that lengthen the process can also bring higher settlements.
Once an agreement is reached, it can take four-to-eight weeks for money to arrive while settlement contracts are drafted, signed and approved.
What If My Employer Or My Employers Insurer Wants To Settle My Claim
In some instances where workers suffer one or more injuries while on the job, an employers insurer will make a full and final offer to settle the case in a lump sum . This may happen even after the insurance company pays certain benefits. In many instances, accepting a full and final settlement offer in a work injury case will close the case out.
This means that the injured worker cannot go back and seek medical treatment coverage, even if a condition worsens. Therefore, before accepting a full and final offer, make sure that your condition stabilizes and that you do not have any additional treatment plans. This is because you will usually not have the right to reopen the claim at any point in the future.
In most instances, full and final settlements in back injury cases come in a lump sum. Out of the successful lump sum settlement, an attorney will take their fees along with any other open balances or expenses. The remainder will be for the accident victim. In addition, injured workers do not typically have to pay state or federal income taxes on earnings from a workers compensation or personal injury claim.
As part of a full and final settlement offer in a workers compensation case, there may also be an agreement to waive any lien in the companion third-party personal injury case. This is especially common in work injury cases where a person injures his or her back in a motor vehicle collision that happened while on the job.
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Minute Free Consultation Withlos Angeles Back Injury Lawyers
Car accident claims involving back injuries are difficult to settle favorably if the injuries are lower back strains or sprains. These are injuries that insurance companies are notorious for lowballing. The adjuster will lowball you to the moon without a lawyer to defend your claim.
Even with back disc injuries, insurance companies will almost always try and argue your injury is pre-existing. We always advise people who call us to NOT sign a medical release for the insurance adjuster to try and prove them wrong. That will do nothing to help and has a high risk of backfiring and hurting your settlement payout.
With years spent fighting insurance companies on these issues, we are prepared to cut through the bad offers and fight to get you a fair settlement for your back injury. We offer a 30 minute free consultation to everyone hurt in a car accident. , , or message us using the contact form below, 24/7, for your free consultation.
File A Claim With The Pennsylvania Bureau Of Workers Compensation
Your next step is to file a claim with the Bureau of Workers Compensation. Your employer must first file a First Report of Injury with the bureau to begin the process. They have seven days after you report an injury to file the report. Your employer should also immediately notify their insurance carrier about your injury. The insurance carrier has 21 days to decide whether they will affirm or deny your benefits.
If you inform your employer of your injury within the first 21 days, you are eligible to receive benefits from the date you were injured. If you report the injury after the initial 21-day period, but before the end of the 120-day statute of limitations for reporting an injury, you may receive benefits starting on the date you reported the injury. That is another good reason you should immediately notify your employer about your injury.
Once you have suffered a work-related injury and notified your employer or have become aware of an injury because of a medical report, you have three years to file a workers compensation claim from the date of your injury in most cases. In some very rare circumstances, the time may be extended if you did not know that your medical condition was work related. If you do not file a claim within the three-year window, you will not be eligible to receive workers compensation.
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