Compensation for Slip and Fall Work Accident Claims

Slip and falls are one of the most common types of work related accidents. According to the National Safety Council (NSC), slip and fall injuries account for over 20 percent of all workplace injuries. That translates into more than one million workers’ compensation claims filed each year.

The majority of slip and fall injuries result in relatively minor “soft tissue” injuries. These include sprained tendons, ligaments and muscles, minor contusions and abrasions, small gashes, and minor burns. A large number of slip and falls however, result in much more serious injuries, referred to as “hard injuries.” These include head trauma, disk herniations, fractures, amputations, deep gashes, and third or fourth degree burns.

With few exceptions, employers are bound by Occupational Safety and Health Administration (OSHA) regulations. These regulations mandate safety measures in the workplace. An employer who violates OSHA requirements may incur substantial fines and, in extreme cases, imprisonment.

The most common causes of falls at work are:

  • Spilled liquids
  • Cracked, torn or uneven flooring
  • Inadequate or non-existent warning signs
  • Poor lighting
  • Holes in the floor
  • Broken or uneven stairs
  • Exposed cables
  • Abrupt, unexpected elevator stops

Compensation for Slip and Fall Workplace Accidents

Employees injured in workplace accidents have a right to workers’ compensation benefits. Eligibility does not require proof of the employer’s negligence; the injury alone is sufficient to file a workers’ comp claim. Benefits normally include payment of medical and therapy bills, out-of-pocket expenses (for medications, crutches, etc.), and approximately two-thirds of wages lost during treatment and recovery.

To begin a work accident claim, you have to file a “first report of injury” form (DWC-1) with your employer. You must enter specific information about the date, time and cause of your slip and fall accident on the form. If your injuries are serious enough to require immediate hospitalization, you may complete the DWC-1 form once you’re stabilized.

Your employer will give you a list of company-approved physicians. The workers’ comp insurance company pays these physicians. (Despite potential conflicts of interest, in most cases you have no choice.) You choose one of these physicians as your “primary treating physician.”

Your primary physician evaluates you and, if necessary, refers you to a specialist. These can include orthopedists, podiatrists, chiropractors, and other doctors whose practices concentrate in the area of your injury.

If you believe your physician isn’t acting in good faith, or that your injury is more serious than he reports, you may request a second opinion from another company-approved physician. You can see your own physician, but there’s no guarantee you’ll be reimbursed by workers’ comp. You may be personally responsible for any fees your private doctor charges.

Your workers’ comp physician determines when you’ve reached a level of MMI (maximum medical improvement). At that time, she’ll give you a return to work form, noting whether or not you’re cleared to return to work.

Depending on the seriousness of your injury, your doctor may diagnose:

  • Temporary partial disability – you can resume your former job duties after a period of recovery.
  • Permanent partial disability – you may be able to return to work, but not at your former job. (Your employer may give you a different position that accommodates your disability, or you may have to seek employment elsewhere if such a position isn’t available.)
  • Permanent total disability – you won’t be able to return to your former job or do any other type of work.

Determining Fault in a Slip and Fall Accident

An employee who contributed to the cause of his workplace injury is entitled to workers’ compensation benefits. Just as it isn’t necessary to prove the employer was negligent, workers’ comp laws do not bar the employee from coverage if the slip and fall accident is entirely his fault.

There are a few exceptions. If actions that result in an injury are intentional (actions that have a high probability of causing injury, or exhibit a wanton disregard of probable consequences), a work accident claim may be denied. While each case is unique, questions of coverage denial normally arise in fraud cases, or when a worker purposely does something he knows is unsafe.

Example: Waiter disregards Wet Floor sign

Alex worked as a server at a local restaurant. His duties included taking customers’ orders, transferring them to the kitchen, and serving food to the customers. Alex was working his way through college and used his tip money to pay his expenses. He knew that he could increase his tips by serving more customers, so he worked as fast as possible.

The restaurant was very busy one evening when another server unintentionally dropped a tray, spilling water and soda on the floor. The supervisor had a kitchen worker promptly mop up the spill, but the area was still slick. The supervisor also placed several “Caution” signs in the area. Workers had been instructed during training never to walk through an area where a Wet Floor sign was posted.

The slick area blocked Alex’s quickest path to his designated serving area. He had to walk entirely around the restaurant to get to his tables. Alex decided getting to his customers was more important than the risk the slick area posed. Ignoring the signs and his training, Alex hurried through the slick area, fell and broke his right leg.

Despite disregarding his training, the signs, and his common sense, Alex was still entitled to full workers’ compensation benefits. His actions did not rise to a level necessary to deny him coverage. Alex’s intention was to get to his customers, not to slip and fall. Alex didn’t believe he would slip, or he wouldn’t have disregarded the signs and walked through the area.

If Alex’s intention was to disregard the signs knowing he would be injured, or if he deliberately took advantage of the spill and purposely slipped and fell so he could collect benefits, his work accident claim would likely be denied.

Third-party Actions

Most workplace slip and fall accidents limit an injured employee’s benefits to workers’ compensation. This includes payment of medical bills, out-of-pocket expenses, and a portion of lost wages. Workers’ comp benefits do not include payment for pain and suffering. An injury resulting in a disability may entitle the employee to a separate cash settlement award.

There are some cases where a slip and fall at work may result in a “third-party” personal injury claim or lawsuit (against parties other than an employer). These cases entitle an injured worker to payment of medical bills and out-of-pocket expenses, the full amount of lost wages, AND an amount for pain and suffering.

To have a legitimate third-party injury claim, proof must exist that a party other than the employer was negligent, and the other party’s negligence is responsible for the injury.

Example: Fall off a ladder

Henry worked for a construction company as a roofer. His job duties took him from one building site to another, and he worked with several private sub-contractors on each site. While Henry was climbing a ladder to a roof, an employee for a lumber company backed his truck up to the site. He struck Henry’s ladder, causing him to fall more than thirty feet to the ground. Henry sustained a broken femur and fractured clavicle.

Henry collected workers’ comp but also filed a third-party lawsuit against the lumber company. His lawsuit alleged that the company driver’s negligence was the direct and proximate cause of his injuries. Henry won his lawsuit and was compensated for all his damages, including his pain and suffering.

Reimbursing Workers’ Compensation

Workers’ compensation laws permit insurance companies to recover benefit payments when the same worker receives a settlement in a third-party civil action (claim or lawsuit).

If you receive workers’ comp benefits and are also awarded a settlement in a third-party lawsuit, you’ll probably have to reimburse workers’ comp for the majority of what they paid. Because workers’ comp benefits don’t include pain and suffering, any money you receive in your third-party action representing your pain and suffering should be yours to keep.

The Role of Attorneys

An attorney is usually not necessary in a minor workers’ comp or third-party claim for soft tissue injuries. If there’s no question of liability, there are little, if any negotiations. Payment for medical bills, out-of-pocket expenses, and a portion of lost wages is standard.

If your work accident results in a serious injury however, you should consult with an attorney. Attorneys have leverage and expertise in navigating the legal system. They can subpoena records, take depositions, and file a lawsuit if necessary. Most personal injury attorneys don’t charge for an initial consultation, and they can provide valuable information to maximize your claim.

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