A reader submitted a question about her inability to resolve a three-year-old case she filed under her state’s workers’ compensation statute. Nothing seems to be progressing and she believes that those involved are “passing the buck,” so the claim will not be paid.
Workers’ compensation laws basically exist in two forms — state systems and federal systems. The reader’s question deals with her state system. State workers’ compensation laws have been in existence in the U.S. since the late 19th and early 20th centuries.
The purpose of workers’ compensation laws is to provide employees who are injured with financial compensation if the injury “arises out of and during their course of employment”. The “win-win” characteristic of such laws is that the employer cannot be sued for negligence that might have led to the worker’s injury and the employee is able to receive compensation and other benefits without regard to the employee’s fault or conduct leading to the injury.
Although this characteristic protects the employer from being sued and provides workers’ compensation as the only recourse for employees, litigation costs, lengthy litigation and attorney fees are reduced.
Currently all states in the U.S. have some form of workers’ compensation laws, but they vary. However, one fact does not vary: They cover employees. Independent contractors, domestic workers and agricultural farm laborers, as examples, are not covered.
It’s unclear exactly how those involved in this reader’s claim are meeting their obligations. Is it the employer who is dragging its feet? Is the doctor who is treating the nurse not filing his or her medical reports on time?
It is unclear why this nurse’s case has not been handled more quickly. Obviously, all procedural and evidentiary requirements of the law must be met and this can take time, but there are “customary” steps that are included in most workers’ compensation systems.
Those steps include notifying your employer of the injury or accident, filing a claim with the state agency administering the state statute, seeking medical treatment as soon as possible, wage verification, claim determination (accept or reject), initiation of paying benefits or contesting your claim by the employer, and an appeal phase should you want to object to the denial of your claim. The time limits within which these steps vary from state to state.
It’s unclear exactly how those involved in this reader’s claim are meeting their obligations. Is it the employer who is dragging its feet? Is the doctor who is treating the nurse not filing his or her medical reports on time? Is the nurse’s workers’ compensation attorney truly representing her as he or she should?
The best solution in a situation like this is to consult with another workers’ compensation attorney and determine if the process is flawed, delayed or going at the right speed for the injury this reader experienced. If there is a problem with the nurse’s representation, she can terminate her legal relationship with the current attorney and retain the attorney with whom she consulted. Doing so will hopefully move her claim forward.
Have you experienced difficulties with a workers’ compensation claim? If so, how did you resolve them?
Nancy Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.