Case Study: Employer Disputes Workers’ Comp Claim

When the boss says you don’t qualify for workers’ comp, get a legal opinion. See how an injured mechanic fights for fair compensation.

This case study follows an injured auto mechanic who was severely injured while covering another worker’s shift. The employer refused to submit a workers’ compensation claim, forcing the injured man to seek legal counsel.

This case study is for educational purposes only. It is based on actual events, although names have been changed to protect those involved. Any resemblance to real persons or entities is purely coincidental.

We’ll cover how our victim was injured, the employer’s attempt to block workers’ compensation benefits, and the final resolution to the injured worker’s case.

Our study concludes with a list of important points about workers’ compensation claims.

How the Work Injury Occurred

Larry worked as a mechanic in a local garage for the past 20 years. He had never been injured and only took a few days off in all his years of employment. His employer treated him very well. Because of his seniority, Larry worked a weekday schedule with no weekends.

One Saturday, Larry offered to come into work to cover for young Joe, who had been called away because his wife went into labor. It was the least Larry could do for his coworker, and he was happy to do it.

While Larry was working underneath a car, the vehicle fell on him, crushing his body with the undercarriage. He screamed in pain. It took three employees to get the jacks in place to raise the vehicle off him. The equipment was working correctly, and none of his fellow employees in the garage were negligent in any way.

Paramedics stabilized Larry at the scene and transported him to the nearest hospital, where he was rushed into surgery. Larry was treated for a compound fracture in his right arm, several broken ribs, a punctured lung, and a badly sprained back.

Dispute Over Workers’ Comp Eligibility

The garage owner told Larry that workers’ compensation didn’t cover him because he was volunteering to work for Joe on the day of the accident. The employer refused to submit a claim and asked instead if he could just pay for Larry’s medical bills.

Larry didn’t think his employer was right about the workers’ comp and refused to sign an agreement after the injury.

As soon as he was able, Larry consulted an attorney, who confirmed that it was improper for his employer to interfere with a workers’ compensation claim.

Every American state and territory requires employers to provide workers’ compensation insurance. Larry’s employer was not exempt under their state’s laws.

Additionally, the fact that Larry was filling in for Joe didn’t make him ineligible for workers’ comp. He was on the job, performing his regular work duties when he was injured. Larry was legally entitled to workers’ compensation benefits, including wage replacement.

Larry had a long and slow recovery from his injuries, including six months of physical therapy to help him regain some range of motion in his arm and back. Unfortunately, Larry was left with difficulty breathing and would never recover the full use of his arm. He would never be able to work as a mechanic again.

Resolution of the Worker’s Injury Claim

Larry’s attorney not only filed a workers’ compensation claim with the workers’ comp insurance company, but his attorney also filed a complaint about the employer with the state Workers’ Compensation Commission.

The workers’ comp insurance adjuster agreed that Larry was covered, even though he was filling in for another employee.

Larry was evaluated by the workers’ compensation doctor, who determined that Larry was 80% disabled. Further, because of the injuries to Larry that occurred when he was crushed by the vehicle, he would never again work full time in any job.

Larry had reached “maximum medical improvement,” meaning his condition would never improve. It was time to negotiate a settlement.

Through his attorney, Larry was offered a permanent partial disability settlement of either $240,000 as a total lump sum or $130,000 with lifetime medical payments to close his workers’ comp insurance claim.

Additionally, the Commission ordered his employer to pay $20,000 in punitive damages (as a penalty) for refusing to submit Larry’s workers’ compensation.

Larry accepted the $240,000 lump sum settlement and was permitted to retire from the garage where he worked. With the money he received from his workers’ compensation settlement, he could live comfortably without worrying about his finances. He also applied for Social Security Disability, which paid him an additional amount each month.

Important Points About Workers’ Compensation

  • Workers’ compensation benefits cover medical and therapy costs for injury treatment, related out-of-pocket medical expenses, and a portion of lost wages.
  • Workers’ compensation does not compensate for pain and suffering.
  • Injured employees who are permanently partially disabled may be eligible for a lump sum settlement.
  • It is unlawful for an employer to prevent an injured employee from filing a workers’ compensation claim.

 

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