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On behalf of Koszdin, Fields & Sherry posted in Medical Benefits on Friday, March 31, 2017.

What do you do when you get injured on the job? Employers are required by law to take out a workers’ compensation insurance, which provides payments to take care of medical bills in case of a workplace injury. Despite this, the system is not usually friendly to injured workers. Employers and insurance firms often refuse injured workers their medical benefits. Further, an injured worker cannot choose where to go to receive medical care; instead, they are required to select a designated health professional from the medical provider network.

In case of disputes regarding medical benefits, a worker cannot sue their employer since workers’ comp is a type of insurance cover. It should be noted that the insurance does not cover cases where it is proven that the worker was intoxicated or otherwise incapacitated at the time of injury. It is also not applicable if the injury was self-inflicted, or if the worker was in contravention of the company’s policy at the time of injury. Though modest, the insurance payments usually cover:

  • The cost of medical care
  • Compensation for permanently disabling injuries
  • The cost of retraining
  • Compensation to the surviving family in case a worker dies while on the job

Workers compensation insurance also pays out the medical bills in cases where the worker has issues resulting from long-term, repetitive activity such as back problems or carpal tunnel. The insurance covers most categories of workers except volunteers, farmers, farmhands, independent contractors, casual workers, railroad and maritime employees, business owners, and workers at private homes. Federal employees are covered by a different program.

While you cannot sue for denied workers’ comp, you can sue your employer for any intentional oversight or reckless action that contributes to a workplace injury. If the suit is successful, you may be awarded punitive damages, cost of medical care expenses, pain and suffering, or lost wages. However, such litigation will preclude you from the right to receive workers’ comp. Further, it is prohibited for employers to fire, or otherwise intimidates, a worker for filing a claim for workers’ comp in a majority of states.

If you require legal assistance to appeal against withheld medical benefits or sue for workplace injury, contact an experienced compensation litigator for advice on the way forward.

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