What Workers’ Compensation Does Not Cover

The law is specific about what injuries and illnesses are not covered by workers’ compensation, including injuries, whether mental or physical, due to stress, excitement, or fright; an injury caused by an employee because of their personal dislike for another person’s handicap, national origin, age, religion, sex, race or color; and pain and suffering for any injury. Additionally, workers’ compensation does not cover injuries caused by an employee’s intentional actions meant to kill another person or themselves, or injuries caused because the employee was under the influence of drugs, alcohol, or other mind-altering substances.

Petitioning for Benefits

An employee has up to two years from the date of the accident that caused the injury to file a petition for benefits. However, it is always best to apply for benefits as soon as possible. In some cases, the employee is eligible for benefits, but the employee and the employer have differing views of what constitutes necessary care. In cases such as this, the employee might file a petition for benefits with the Division of Administrative Hearings to get increased benefits.

Negligence

In most cases, filing a workers’ compensation claim is straightforward—you need only apply for benefits, without the need to prove negligence (although when a workers’ comp attorney files your claim for you, you’re more likely to recover the full amount of compensation you deserve and less likely to suffer delays and wrongful denials).

Contractors and Subcontractors

The law requires subcontractors to carry workers’ compensation insurance for their employees. The law also requires contractors to determine whether any subcontractor they hire carries workers’ compensation insurance. If a subcontractor does not have workers’ compensation insurance or is not required to carry it and the subcontractor’s employee is injured, the contractor must pay workers’ compensation benefits. If a contractor has to pay benefits because a subcontractor did not have or maintain insurance but was required to do so, the contractor may recover any amounts paid on the subcontractor’s behalf from the subcontractor. A subcontractor might show proof of workers’ compensation insurance by providing the contractor with a printout from the Division of Workers’ Compensation showing the subcontractor’s information, a copy of the subcontractor’s workers’ compensation insurance policy, or a certificate of liability insurance from the carrier or producer that confirms that the subcontractor has workers’ compensation insurance in place.

Independent Contractors

While some employers may hire independent contractors, construction companies may not avoid paying workers’ compensation by hiring independent contractors. Other employers who wish to hire people as independent contractors must follow the rules for determining whether the hired person is an employee or an independent contractor. An experienced workers’ compensation attorney who practices tort law understands the elements of negligence and how those elements apply to your specific situation.