Northern Virginia Personal Injury Lawyer Blog : Northern Virginia Injury Lawyer & Attorney : Brien Roche Law Firm : Medical Malpractice, Product Liability, Car Accidents : Washington DC, North Virginia, Maryland

Workers’ compensation claims can be complicated when an individual has suffered an injury while employed with one company and then goes to work for another company and later reinjures him- or herself. Which employer is going to be responsible for that compensation?

Some states have set up what is referred to as a second injury fund. In these states, that second injury will be partially paid out of that second injury fund and then also partially paid by the second company. That second injury fund is a fund of money that is created by contributions from all of the different insurance companies that underwrite workers’ compensation insurance coverage in that jurisdiction.

A similar type of fund that may exist is the uninsured employer’s fund. An employer who has not taken out workers’ compensation coverage and who therefore cannot pay the benefits called for under the workers’ compensation act may still be covered in the sense that the employee may make a claim against the uninsured employer’s fund. To the extent that any payments are made out of that fund, the fund administrator or the attorney general of that state will typically make a claim against the uninsured employer in order to recover such payments.

 

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If an employee is injured on the job as a result of the fault of some third person, then that employee may have a basis for a claim (sometimes referred to as a third party claim) against that other individual or company. For instance, suppose you are working on a construction job and you are employed by the general contractor. If, while performing those duties, an employee of a plumbing sub-contractor drops a pipe that strikes you on the head, you may be entitled to the benefits called for under the act. In addition to being compensated under the workers’ compensation act, you may also have a basis for a claim against the plumbing sub-contractor whose employee dropped the pipe on you. In some states, on a construction job such as this, all contractors may be immune from suit by any other employee on that construction job. In other states, the employee may sue any other responsible contractor on the job.

If the injured employee in that circumstance does recover money from the third party who caused the injury, then the employer of that injured worker (or more likely the employer’s insurance carrier) is entitled to recover all or part of the monies paid to the worker under the workers’ compensation act. This is a principle known as subrogation. Subrogation literally means that one party is subrogated or steps into the shoes of another party and acquires their rights.

Under most workers’ compensation acts, once the employee makes a claim for and receives benefits, then to the extent that the employee has any right of recovery against a third party, the employer or its insurance carrier acquires that right of recovery to the extent of wage and income benefits it paid to the employee. The purpose of allowing subrogation in this instance is to hold down the cost of workers’ compensation insurance coverage and further to prevent the employee from receiving a double recovery on the wages and medical benefits received.

If the employee receives compensation under the workers’ compensation act and is further compensated for the same injuries as a result of the third party civil claim, that constitutes a double recovery to the employee. After paying back amounts paid to him for wage and medical benefits under the workers’ compensation act, the employee is entitled to keep any excess damages awarded by a jury or received in settlement.
 

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There also is a good bit of controversy regarding the provision of medical treatment to injured workers. Typically, the medical treatment is controlled by the employer or the employer’s insurance carrier. This means that the employee receives treatment from doctors who have been chosen by the insurance carrier or the employer. These doctors obviously know who is paying their bill and they know that the insurance carrier and the employer expect this employee to return to work at some point in time so that their financial exposure in paying wage benefits is limited. Although these doctors generally provide quality medical care for the injured employee, they have a somewhat mixed loyalty. They know that the employer and the insurance company want this employee to return to work, but they also know that it is not necessarily always in the employee’s interest to return to work too quickly or even to return to that form of work at all.
 

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The law relating to workers’ compensation coverage can become extremely complex when dealing with issues of occupational disease. The run-of-the-mill, on-the-job injury in which an employee falls and breaks an ankle does not involve a great deal of controversy. However, the claim of the employee who over a period of time develops, for example, carpal tunnel syndrome as a result of typing at the keyboard, is harder to classify as being a result of the employment. Different states have dealt with that issue in a variety of ways. Some states provide coverage for these types of repetitive stress injuries or exposure injuries; other states do not.

Another area of significant controversy in regard to workers’ compensation claims is compensation for emotional injuries. In some states, an employee who suffers, for example, a nervous breakdown because of emotional stress on the job may be entitled to the whole range of benefits under the workers’ compensation system. Other states have denied those types of benefits on the theory that the relationship between employment and emotional injury is simply too tenuous and therefore the employer should not be made to bear the burden of the expense associated with that type of injury.
 

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There has been a good deal of controversy over the extent to which workers’ compensation laws should provide benefits to injured employees. Many states put a cap on the amount of wage benefits that the employee can receive. In some jurisdictions the employee can receive no more than five hundred weeks of wage benefits, which is the equivalent of approximately ten years of benefits. This is to the advantage of the employer in that it puts a limitation on the employer’s or the insurer’s liability.

However, it may be a detriment to the employee if the employee is permanently disabled and cannot return to any form of work. If in fact the employee is permanently and totally disabled, then he or she may be able to extend those benefits under state law. However, proving that a worker is both permanently and totally disabled is not an easy task. As such, in many states employees are left in a situation in which they cannot return to their former employment, yet at the end of the allowable time their wage benefits are terminated.
 

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