If an employee gets injured on the job, workers' compensation is supposed to pay for his or her medical treatment.If one of your employees develops a chronic condition, he or she may file a workers' compensation claim.The insurance adjustor and the insurance company's attorneys will defend against the claim if you have workers' compensation insurance.You may be called on to testify as a witness if you help build the defense as an employer.There are some basic steps you can take to defend against a workers' compensation claim.
Step 1: You can check the names of the defendants.
You may be able to get the lawsuit dismissed if the employee has correctly named the employer and insurance company.Having a lawsuit dismissed in this way typically doesn't make it go away, the employee still has the option of filing another lawsuit in which you and your insurance company are correctly identified.If the complaint was mishandled, you can seek dismissal of the claim.Again, this sort of dismissal doesn't prevent the lawsuit from being refiled and served properly the second time around.
Step 2: Determine the court's jurisdiction.
The court that has the power to decide workers' compensation cases must be filed by the employee.The court must have both subject matter and personal jurisdiction.Personal jurisdiction relates to you as the employer and where your business is located, while subject matter jurisdiction is related to the type of case.You may be able to get the lawsuit dismissed if the employee has filed it in the wrong court.The employee can refile the lawsuit in the correct court.
Step 3: The statute of limitations can be checked.
Each state has a deadline for when an employee has to file a workers' compensation claim.The deadline is usually two or three years after the employee's injury.Workers' compensation benefits are no longer available to an employee after the statute of limitations has expired.Depending on your state's law, the statute of limitations may begin to run from the day the first report of injury is filed, or the date the employee receives his or her last medical payment from your workers' compensation insurer if the claim is initially accepted.If there is a sudden increase in disability as a result of the injury, it may be possible to avoid the statute of limitations and file a claim anyway.The employee may have been treated for the injury and returned to work, only to experience pain later on that her doctor attributes to the original injury.
Step 4: Understand your state's workers' compensation law.
If you don't have a basic understanding of the law that applies to the claim, you will not be able to defend against it.Employees have to prove their eligibility for workers' compensation benefits.The burden may be on the employer to prove certain defenses or exceptions to coverage.It's up to you to prove that the employee knew about a rule designed to protect employee health and safety and that he or she intentionally did so.What must be proven for the defense to apply will be included in your state law.You should have a basic understanding of the legal requirements and procedures for workers' compensation in your state if you want to defend against claims.Many insurance carriers and workers' compensation attorneys give detailed summaries of the law in your state that are easy to understand.
Step 5: There are allegations in the complaint.
Check the complaint's allegations to make sure all requirements have been met.There are three requirements for an employee to be eligible for workers' compensation benefits, and they must be your employee, not an independent contractor.The argument that the injury is not work related is the most important defense against workers' compensation claims.
Step 6: You should research your state's law.
Depending on the state, an injury is considered work related for the purposes of awarding workers' compensation benefits.The injury must occur while the employee is performing his or her job duties, and must fall within the scope of those duties.An example would be if you own a plant and one of your employees is charged with removing broken bottles from the line.If she gets cut by glass while removing a broken bottle, her injury would be considered to have occurred within the scope of her employment.If an employee was cut by glass while off the clock having lunch in the employee break room, you would have an argument that her injury wasn't work related.An injury isn't necessarily considered a compensable work-related injury if the employee is on the clock.The scope of employment is determined by the criteria of each state.
Step 7: Information about when the injury occurred.
If the injury did not happen on company property or when the employee was on the clock, you may be able to argue that it wasn't work related.Information about the employee's work status and a description of his or her job duties are required.Any other policies or safety rules that employees have knowledge of can be used to analyze and defend against a workers' compensation claim.Whether the injury occurred within the scope of the employee's job duties is determined by the job description.You may have a defense against the workers' compensation claim if the employee was injured as a result of violating a known policy or safety regulation.To defend against a workers' compensation claim in some states, you have to prove that the injury fell outside the employee's job description and that they knew about it.If the employee violated a health and safety rule, you may have to show that the rule was consistently enforced.Co-workers who were around when the accident occurred should be interviewed.
Step 8: The circumstances surrounding the injury should be analyzed.
The injury can't be considered work related if the employee was on the clock at the time.Some states don't consider horseplay injuries to be work related.Under certain circumstances, an employee in Pennsylvania can still be eligible for workers compensation benefits for a horseplay-related injury.Employers aren't usually liable for injuries occurring on the job if an employee is drunk or under the influence of illegal drugs.Employers can avoid liability in most states if they prove that the employee's injury was intentional.Employers can still be held responsible for suicide or attempted suicide if the act was due to work related depression.Employees aren't entitled to workers' compensation benefits if they are injured as a result of willful misconduct.If you argue this type of defense, you have to prove that the employee knew the activity was against the rules and likely to cause injury, but did it anyway.Key information can be provided by co-workers who were around the employee when the accident occurred.
Step 9: Take a look at the employee's medical records.
If the employee's injury relates to a previous injury or condition, you may be able to argue that the injury was caused by an unidentifiable cause.Idiopathic injuries include strokes, seizures, and heart attacks.If the employee misrepresented his or her physical condition when hired, you can use that information to defend against a later workers' compensation claim.An example would be if you hire an employee for a job that requires repetitive lifting of 100 pound boxes, and the employee says he is physically able to do that.The employee was not allowed to lift more than 40 pounds because of a back injury.You can use this information to defend against a workers' compensation claim if the employee re-injuries his back at work.In the reverse, the same argument works.If the employee suffers a minor injury on the job, then later does something in his spare time to make it worse, he won't be eligible for workers' compensation benefits.
Step 10: You can get a medical opinion.
You need a doctor's testimony to support your argument that the injury isn't work related.Whether doctor's testimony is required depends on why you're arguing the injury isn't work related.If you are arguing that the employee isn't entitled to workers' compensation benefits because he or she was intoxicated or under the influence of illegal drugs when the injury occurred, a medical opinion is required.In those cases, medical testimony is required to prove that intoxication was the cause of the employee's injury, and that if he hadn't been drunk, the injury would not have happened.If an employee suffers similar injuries at work and outside of work, you may need medical testimony to argue that the employee's disability is unrelated to the workplace injury.
Step 11: You should research your state's law.
States have different standards for how chronic ailments relate to employment.Injuries that fall into this category tend to be diseases or conditions that develop over time, or as a result of exposure to pollutants or toxins.There are diseases that occur in people who have continued exposure to the particles.Carpal tunnel syndrome and many back injuries are injuries that fall into this category.Since the injury doesn't result from a single incident, but rather from prolonged exposure or repetitive activities, the employee must show a correlation to his or her job.
Step 12: Information about the employee's work history can be found here.
If the employee has a history of exposure to similar risks, you may be able to argue that the injury is related to that exposure rather than the work they did for you.During the discovery period, both sides exchange information relevant to the claim.You can ask the employee to provide records related to his or her work history at this time.The employee's history at your company can be used to defend against the claim.If the employee failed to use proper protective or safety devices that would limit his or her exposure to the toxic material or diminish the effects of repetitive motion, you may be able to argue that the injury isn't related to their employment.
Step 13: You can find out about the employee's other activities.
Employees who participate in their off hours can cause chronic injuries.An example would be if an employee claimed to be entitled to workers' compensation benefits for carpal tunnel syndrome.He has played guitar for 20 years despite only working for six months.You may be able to argue that he developed carpal tunnel syndrome as a result of playing guitar, rather than working for you.If you interview friends, family, and co-workers of the employee, you can learn more about what he or she does away from work.
Step 14: You can get a medical opinion.
If you want to argue that the employee's injury isn't related to his or her employment, you have to have a doctors opinion.A doctor will claim that work activities are to blame for an employee's injury or illness.You can get an occupational therapist or other specialist to tour your workplace and review the activities the employee performed as part of his or her job duties.If the activities were likely to cause the employee's injuries, the specialist will issue a report.It is better to have a specialist observe and examine the workplace rather than just giving him or her a description of the job duties and asking for an opinion.The specialist is giving an impartial opinion of what employees do.
Step 15: It is a good idea to research your state's law.
Guidelines for receiving workers' compensation benefits are provided by your state's law.Most states require the employee to notify the workers' compensation agency.Before an employee can file a complaint in court, the agency may hold a hearing or require a settlement conference.The guidelines set by their primary care physician or any specialists they see to treat their injury must be followed by employees.If a doctor's restrictions are not complied with, eligibility for benefits could be lost.
Step 16: Determine when the employee told you about the injury.
In order to receive workers' compensation benefits, employees must notify their employers within a certain period of time.Specific policies that inform employees how and to whom to report workplace injuries should be maintained.If an injury is reported over the phone, keep a record of it.If the employee doesn't notify you of the injury in the way required by your state's workers' compensation law before the deadline, his or her claim can be denied.A third party such as the employee's spouse or doctor may communicate the notice.The notice needs to be received by a foreman, manager, or other representative of the employer.The deadline varies from state to state, but generally is within three to five months of the injury.When an employee has reason to know of an injury that could be related to their job, the clock starts to tick.Some states don't have a specific deadline for notifying the employer, just requiring that notice be given as soon as possible.In Missouri, the deadline to notify the employer of a potentially work-related injury is as short as 30 days.The state agency in charge of administering and regulating workers' compensation insurance must be notified by the employee.If this is a requirement in your state, you should have forms and other information on hand to give to employees when they notify you of a work-related injury.
Step 17: The employee's medical records should be reviewed.
You may be able to argue that the employee is not entitled to workers' compensation benefits if they missed doctor's appointments or refused to comply with recommendations.You should be aware of any restrictions the employee's doctor may have on his or her work duties.It is your responsibility to give work to the employee that is within his or her restrictions.If the employee continues to do work outside his or her restrictions, you may be able to cut off their workers' compensation benefits.Employees who refuse to cooperate with the doctors treating them, or who continually miss appointments, may be at risk of losing their workers' compensation benefits.