Fortunately, Alex’s wife, who was there with him at the time, had the sense to call me first. This includes both emergency treatment and an ongoing treatment plan until you are restored to pre-injury status, or as close to it as you can be. Your doctor will insure that your treatment stays on track, and the evaluations will strengthen your claim against the insurance company. Sometimes, doctors aggressively refuse to bill insurance, threatening to withhold or terminate treatment unless the patient and his or her lawyer agree in writing that the doctor’s bills will be paid in full, regardless of insurance coverage.Read More
Compensation for Work Related Injury or Illness
In order to avail the benefits provided by workers’ compensation, you are required to prove that the injury or illness is related to your work. Rephrased in legal jargon, the unfortunate event must be “arising out of employment and occurring during the course of employment,” commonly abbreviated as AOE/COE. Know the rules that dictate whether or not an employee’s injury or illness is work-related and covered by the workers’ compensation.
If, however, fooling around or breaking rules in the workplace is excused by the employer, or is a commonly accepted behavior in the workplace, the courts consider injuries sustained during such times as work-related injuries and workers’ compensation benefits can be availed.
Illnesses and diseases that develop because of constant strain on the worker are covered by the workers’ comp. Diseases related to work as well as psychological or physical illnesses resulting due to long-term exposure to stress and strain are all covered by the workers’ comp. However, in such instances, there is a difficulty in attempting to prove whether the illness is work-related or not. Different states have different rules for such situations. For more information, you are required to check out the employees’ rights booklet provided by your employer that lists down the injuries and illnesses that are covered by workers’ compensation.
Some exceptions exist. For example, injuries sustained while the worker was drunk or under the influence of illegal drugs are not covered by the workers’ comp. The coverage is not provided if the injured worker was:
- Hurting himself or others intentionally
- Breaking work-related rules intentionally
- Perpetrating a serious crime, or
- Fooling around in the workplace, aka horseplay
Seek a lawyer
Many times a worker's injury or illness may be of a dubious origin, a gray area when it comes to understand worker's comp coverage. In these special circumstances, it is always worth seeking a lawyer’s expertise. The lawyer may be able to tell you whether or not you qualify for the benefits. As a lawyer is aware of your state laws he may be the best counsel in such matters.
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