Birmingham Workers Compensation Lawyer

Though workers’ compensation benefits are to be paid without regard to fault, they do not pay out automatically. There are requirements that injured workers must meet before they are entitled to receive benefits. Receipt of benefits can be delayed or denied when issues arise concerning how an injury occurred and what harm the injury actually caused.

Employers Are Not Required to Provide Workers’ Compensation Benefits

Not all employers are required to provide workers’ compensation benefits to employees in Alabama. The workers’ compensation laws do not apply to the following employers – though an excluded employer may elect to have the workers’ compensation laws apply.

• Employers of less than 5 employees (other than in the residential construction business)
• Employers of domestic employees
• Employers of farm laborers
• Municipalities with populations of less than 2,000

Though not required to provide benefits, excluded employers may still decide to opt into workers’ compensation because the system limits an employer’s liability for damages. Workers’ compensation is the exclusive remedy for employees unless an employer has engaged in ‘wilful misconduct’.  Employers who do not elect to participate in the workers’ compensation system may be subject to personal injury lawsuits and exposure to larger damage awards.

Collecting Workers’ Compensation and Suing Your Employer

For employers who are required to provide workers’ compensation benefits and those who elect into the system, the compensation authorized by the laws is usually the only remedy available to injured workers. That is, unless an employee is injured due to the willful misconduct of the employer.

Willful misconduct by an employer is conduct with knowledge of the ensuing risk of danger to employees. The inquiry focuses on what an employer did or did not do and what they knew about the subsequent risk of injury or death to workers. Injured employees alleging willful misconduct by an employer have the right to file a lawsuit and recover damages not paid by workers’ compensation.

Employers may not offer employee mistakes or the fact that employees continued to work in dangerous conditions as defenses to their liability.

Not all employers are required to provide workers’ compensation benefits to employees in Alabama. The workers’ compensation laws do not apply to the following employers – though an excluded employer may elect to have the workers’ compensation laws apply.

• Employers of less than 5 employees (other than in the residential construction business)
• Employers of domestic employees
• Employers of farm laborers
• Municipalities with populations of less than 2,000

Though not required to provide benefits, excluded employers may still decide to opt into workers’ compensation because the system limits an employer’s liability for damages. Workers’ compensation is the exclusive remedy for employees unless an employer has engaged in ‘wilful misconduct’.  Employers who do not elect to participate in the workers’ compensation system may be subject to personal injury lawsuits and exposure to larger damage awards.

When Employers are Not Responsible for Worker Injuries

Employee mistakes are not usually reasons to deny workers’ compensation benefits. But some employee conduct can fall outside the parameters of employer responsibility making resulting injuries the responsibility of the worker.

Alabama law says employers are not responsible for the injuries employees experience on the job in any of the following circumstances:

• The injury was caused by the willful misconduct of the employee.
• The employee intended to hurt himself.
• The employee willfully failed or refused to use the appropriate safety gear provided by the employer.
• The employee was impaired by drugs or alcohol at the time of the injury.
• The employee falsely and knowingly misrepresented his mental or physical condition at the time of employment and the injury aggravates a pre-existing condition.

What an employee did and why they did it can create issues employers may try to use to deny workers’ compensation claims.

Employee Eligibility to Receive Workers’ Compensation Benefits

To be entitled to workers’ compensation benefits, employees must work for employers that are covered by the applicable laws. Both full and part-time employees are eligible to receive benefits.

The right to collect workers’ compensation benefits extends to an employee who is injured or killed in an accident ‘arising out of and in the course of’ their employment and not caused by their willful misconduct.

Whether or not an employee was acting within the scope of employment at the time of the injury is an issue that is foundational to receiving workers’ compensation benefits. The statutes give some guidance, and Alabama case law further clarifies at what point employment stops.

When an Employee is Acting within the Scope of Employment

Employees are acting within the scope of employment when they are ‘engaged in or about the premises where their services are being performed or where their service requires their presence … ‘.

Alabama courts interpreting the statute have said that employment includes a reasonable period of time before and after an employee’s actual shift while the employee is on the premises of the employer preparing to start work or finishing up and preparing to leave. Workers’ compensation insurance also may apply to an employee who has quit her job and is in the process of leaving the employer’s premises when the injury occurs.

Workplace Injuries that can be Compensated

Injuries occurring in the workplace must begin as physical injuries in order to qualify for workers’ compensation benefits. Mental injuries not resulting from physical injuries are not compensated.

Workplace injuries must arise out of a sudden, unexpected occurrence or event with a connection to a worker’s employment. A worker that suffers a heart attack at work and whose job is data entry is not likely eligible to receive workers’ compensation benefits. An employee who suffers a heart attack and whose job is physically demanding may be able to make a claim even though the employee also possessed additional risk factors for heart attack.

How Pre-existing Conditions Affect Workers’ Compensation Claims

An injured worker’s pre-existing condition might limit the duration of workers’ compensation benefits but won’t usually be a reason to deny compensation. Alabama courts have held that when a workplace injury aggravates or causes further damage to a pre-existing injury or illness, the resulting disability qualifies for workers’ compensation even if the injury would have had a lesser impact on a person without the pre-existing condition.

But an employer will not be liable for the continued disability of a worker when the worker’s pre-existing condition is now the only reason for the disability. A worker with a pre-existing condition who claims permanent disability after a work injury will need to show that the work injury actually caused a permanent worsening of the pre-existing condition to qualify for permanent disability benefits.

Benefits Payable under Workers’ Compensation Laws

The benefits payable by workers’ compensation (other than medical expenses) are subject to weekly amount limitations as well as the total time of payment limitations. There is a three-day waiting period before disability benefits become payable. However, if the disability period extends beyond 21 days, compensation for the first three days of disability can be collected.

There are four types of disability that may be compensated according to Alabama law:

• Temporary partial disability
• Temporary total disability
• Permanent partial disability
• Permanent total disability

Workers’ compensation also provides benefits to the surviving dependents of a deceased worker as well as reasonable burial expenses.

How Long Workers’ Compensation Benefits are Paid

Workers’ compensation benefits are payable for a period of time specified in weeks for the particular injury or disability suffered by the employee.

Compensation for temporary partial disabilities is payable for a maximum of 300 weeks. Payment duration for permanent partial disabilities is based on the nature of the disability. Payments for the loss of a thumb will last 62 weeks. Loss of hearing in one ear is compensated for 53 weeks, while the loss of hearing in both ears receives compensation for 163 weeks.

Third-Party Liability for Employee Injuries

There may be times when an employee is injured while working, but someone other than an employer is responsible for the injuries. Third-party liability arises when the accident is caused by someone outside the employment relationship or by the willful misconduct of another employee.

A worker injured by a third party may be entitled to collect workers’ compensation benefits and also file a lawsuit for personal injury against the third party.

What to do if Your Workers’ Compensation Claim is Denied

Employers have a number of reasons they can use to deny employee claims for workers’ compensation. Challenging an employee’s conduct at the time of the injury or whether an injury is work-related can lead to denials of claims. Benefits can also be denied after a claim has been accepted.

Workers facing claim or benefit denials basically have two options in Alabama. If only medical benefits are being denied, a worker may appeal the denial to the Alabama Department of Industrial Relations (DIR). A mediator is appointed to hear evidence from both sides and make a binding decision regarding medical treatment.

If an employee’s entire workers’ compensation claim is denied a lawsuit usually must be filed to oppose the denial. A lawsuit must be filed within a specific time period – usually within 2 years after the work injury.

Attorney Fees in Workers’ Compensation Cases

Attorney fees in workers’ compensation cases are typically calculated as a percentage of the amount awarded to an injured claimant. In many types of injury cases, the fee percentage is agreed to between the law firm and the client and can be as high as 40%. But in workers’ compensation matters, many states have limited the fees attorneys can collect. In Alabama, lawyers are limited to 15% of the compensation paid.

Where to Get Help Enforcing Workers’ Compensation Rights in Alabama

While the goal of the Alabama Legislature is to ensure that employees who are injured while working are compensated for their injuries, it can still be difficult for injured workers to successfully navigate the workers’ compensation system and receive all of the benefits they are entitled to.

Working with an experienced workers’ compensation lawyer who knows how to identify and address potential issues that can cause a claim or benefits to be denied can help injured employees obtain benefits more quickly and avoid unnecessary conflicts delaying the receipt of benefits.

Client satisfaction is a priority at the Birmingham-Hoover metropolitan law firm of Oros & Associates. We are dedicated to helping injured workers obtain the maximum workers’ compensation benefits available by law. Contact Oros & Associates for a free consultation.