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Delaware Workers’ Compensation

According to the U.S. Bureau of Labor Statistics, there were 2.8 million non-fatal work injuries reported in 2019, which was unchanged from the previous year. In the same year, there were 18 fatal workplace injuries in Delaware, and a total of 5,333 fatal work injuries nationwide, which was a two percent increase from 2018. Whether it is a fatal, serious, or minor work accident, an illness or injury impacts the health and finances of the employee as well as their family. Lost wages, along with medical bills and counseling fees, all need to be accounted for after any workplace accident.

 

Who is Eligible for Workers’ Compensation?

Delaware residents have protections under the Workers’ Compensation system, which covers nearly all employees in the state and can help workers by paying a portion of lost wages, covering medical bills and more losses. Workers’ Compensation coverage begins on the date of hire, and benefits should be sent soon after a worker becomes eligible for compensation. It is vital that injured workers report an injury or illness immediately to establish a record of when coverage should begin.

Depending on the specific circumstances, Workers’ Compensation benefits might include the following:

  • Damages for a specific loss, such as the loss of a limb or physical ability.
  • Death benefits, including funeral expenses and loss of income for any dependents.
  • Lost wages, if the employee is unable to work.

Everyone but agricultural workers and independent contractors are covered under the Delaware Workers’ Compensation system, although employers can still buy into the system.

Work injuries and diseases will likely be covered under Workers’ Compensation. Workers’ Compensation benefits cover injuries and occupational illnesses that are directly related to work, which may include accidents and injuries that happen during travel for work, acquiring equipment for the job, or commuting to and from the jobsite.

Sometimes, injured workers may not file a claim because they fear retaliation from an employer, some may have even been told that they are not eligible. Some injured workers may not know what benefits the Delaware’s Workers’ Compensation system could offer for their cases or what other factors to consider when an injury occurs. It is best to consult with a lawyer when it seems unclear if coverage is available. There are workers who have been told that they do not qualify, and some employees may be wrongfully denied Workers’ Compensation coverage.

Workers’ Compensation Claim Denials

When a lawyer’s client is denied benefits for a work injury, a lawyer will create a case to show that the employee should have been covered. There are mitigating factors that could cause a denial, and there are times when the insurance report is filed incorrectly.

A denial can be a major setback. A worker who has been denied coverage might lose their job, have no job prospects, and not know how they can support themselves and their family. Therefore, a lawyer will take the denial seriously. A lawyer will communicate with everyone involved and reach out to a supervisor or the insurance company to have coverage reinstated. This is the quickest way for an employee to retain their position.

If it is necessary, a lawyer will begin negotiating with the insurance carrier and provide all the evidence needed to come to a favorable resolution. Negotiating with the insurance company is difficult because the insurance carrier likely has a team of lawyers who will protect the company’s interests. An experienced lawyer knows how to negotiate with insurance companies to avoid any further delays in coverage.

Denied coverage could also impact a worker’s earning potential. Since the employee’s earning potential has been altered, it can be difficult for them to get back to work and advance as they would have in the past. Lost earning potential may become part of a claim brought against the insurance carrier or anyone aside from the employer who may have been responsible for the accident or injury.

A dedicated lawyer is also prepared to go to court so that the insurance company can be forced to provide the coverage that is required. This is often the only way to ensure that an employee can recover and return to work. Disabled workers can receive the retroactive benefits they deserve, and grieving families may recover death benefits in some cases.

What Injuries are Covered Under the Workers’ Compensation System?

Most injuries and illnesses resulting from work are covered by Workers’ Compensation insurance. These three requirements are needed to meet the standards for coverage:

  • The injury must result from work activities.
  • The worker must be an employee.
  • The employer must have Workers’ Compensation insurance, which almost all employers in the state of Delaware are required to have.

How an employee gets the injury at work is important in qualifying for Workers’ Compensation. The following injuries are not covered by Workers’ Compensation insurance:

  • Injuries from fights or horseplay on the job.
  • Self-inflicted injuries.
  • Injuries that occurred while under the influence of drugs or alcohol.
  • Injuries from violating company workplace procedures.

Common workplace injuries include the following:

Some injuries, like a back strain from lifting a heavy item, may seem to be mild at first, but become more serious over time, impacting the ability to work and go about daily household tasks. Injuries that occur on the job that impact the employee’s ability to work and live as before should be reported to the manager as soon as possible.

What if I Have a Long-Term or Permanent Injury?

In Delaware, medical benefits for injured workers might be paid without length of time or cost limitations, so if a worker is permanently injured from an on-site injury, they are likely entitled to that medical care as long as it is needed.

For Delaware workers who lost more than three days due to injury on the job, temporary total disability benefits become payable on the fourth workday lost. If the disability extends beyond seven days, then full disability period becomes compensable and no waiting period applies.

Temporary total disability means the worker will receive slightly over 66 percent of their wages for the duration of the disability. The same is true for workers who are permanently and totally disabled.

For those with permanent partial disability, the injuries are split into two categories:

  • Scheduled Injuries: Some examples include lost fingers, toes, arms, legs, hands, and feet.
  • Non-Scheduled Injuries: Examples include the back, heart, and lungs.

For both types of permanent partial disability, the employee is entitled to slightly more than 66 percent of their wages, but with non-scheduled injuries, there is a 300-week maximum payout period with a capped amount.

What if My Injury is Caused by Faulty Equipment?

For workers who fall victim to faulty equipment on the jobsite, there is an additional possibility for compensation via a products liability lawsuit. Employers who provide Workers’ Compensation insurance may not be sued for what goes wrong on the jobsite, but the manufacturer of the faulty equipment can be sued for the damages that resulted from their defective product. In many workplace injuries, a products liability lawsuit is a solid option. Some examples where a products liability lawsuit might be pursued include:

Can I File for Workers’ Compensation for an Illness?

Workplace illnessSince illnesses that evolve over time may be harder for a worker to gauge as being the result of their job, consulting a skilled lawyer is the best way to prove that a chronic, long-term illness is the result of conditions or the environment at a workplace. As soon as an employee suspects that their illness stemmed from the workplace, they should speak to a medical provider and lawyer for help with benefits. A medical provider and lawyer will help link the illness to the workplace. Medical documents can also be used as evidence.

Additionally, working with chemicals and other dangerous substances or in an environment with poor air quality and inadequate safety protections can lead to all kinds of long-term illnesses.

What are Common Workplace Injuries and Illnesses?

Listed below are some common workplace injuries and illnesses that employees should be aware of:

Carpal Tunnel Syndrome: Ongoing, repetitive motions can cause carpal tunnel syndrome, which results in numbness and reduced function in the wrist and hand as nerves become compressed.

Cancer: Exposure to a host of hazardous materials and carcinogens in labs, factories, and construction sites can cause cancer in the body over time. Mesothelioma is an incurable lung cancer many workers suffer from due to asbestos exposure.

Computer Vision Syndrome: Workers using digital screens for long periods of time experience headaches, blurred vision, and neck and shoulder pain.

Hearing Loss: Hearing loss is a common occupational disease impacting workers in the United States, and it severely impacts a person’s quality of life.

Poisoning: Chemical accidents can lead to the ingestion or absorption of hazardous substances, including lead, mercury, carbon monoxide, gases, and other chemicals into the body, which causes toxicity and a host of potentially fatal symptoms.

Respiratory Diseases: Breathing in fumes, vapors, gases, and dust causes several serious and potentially life-threatening conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and bronchitis.

Radiation Sickness: This is a serious and often fatal condition resulting from acute or chronic exposure to large amounts of radiation. Symptoms and prognosis vary and depend upon the level of exposure, but signs may include vomiting, headaches, and rapid heartbeat.

What if a Workplace Accident Causes a Fatality?

Workers’ Compensation insurance offers death benefits as well, payable to the loved ones of the worker who died on the job. These benefits, often provided to the spouses and children of the deceased, are paid out through the same system that provides medical coverage to injured workers.

In some cases, negligent parties may be cited in a wrongful death lawsuit, which requires proving that the accident was caused by the party’s negligence. It must also be proven that the accident directly caused the worker’s death and that surviving family members depended on that worker. The loved ones of a deceased worker should consult a lawyer to file a claim against the at-fault party. A lawyer can help with evidence for a wrongful death case.

When Should I File for Workers’ Compensation?

Time is of the essence when filing a Workers’ Compensation claim in the state of Delaware. Injured employees in Delaware need to report a workplace injury within 10 days to management.

In addition, it is important that the injured or sick worker informs the employer in writing. The information sent to the employer should include the following:

  • Date and time of the injury.
  • Where it occurred.
  • How it occurred.
  • Request of medical attention for the injury.

According to Workplace Fairness, workers in Delaware might not qualify for benefits if they do not inform their employer and keep a written record to help prove that they followed the state’s process. Insurance providers agree that the written notification to employers is a crucial step in getting the Workers’ Compensation insurance process started. Employers are not required to begin providing Workers’ Compensation benefits without written notice of the injury.

It is also important that the employer is notified quickly because Delaware employers have to file a First Report of Occupational Injury or Disease within ten days to the Delaware Office of Workers’ Compensation and to their insurance provider. This form must be completed for all injuries, even if the injury is minor. When an employer files this form, it is not an admission of liability, but the employer could be fined for failing to file this form.

The timing requirements are designed to reduce the cost of the claim; the quicker the medical treatment begins, the better chance of a fast recovery. Accident investigations should begin promptly as well. This will link the accident to the injury. For the worker, the First Report of Occupational Injury or Disease form starts a process with the insurance carrier for coverage under Workers’ Compensation.

What are the Different Types of Workers’ Compensation Benefits?

Every worker who is covered by an eligible business can report their injuries to a supervisor who will file the claim and send the employee to a doctor who is covered by their plan. The worker should always go to the designated doctor to establish a link to the accident and injury. A doctor will also inform the worker about a treatment plan, which is important for recovery. Medical records should be kept in case complications arise.

If an employer denies liability for any injuries, a lawyer will help recover the compensation that is owed to their client. A lawyer provides comprehensive legal support for the injured worker. Employers must also have a chain of command for reporting injuries. The chain of command allows a manager or foreman to report injuries to the insurance department or Human Resources (HR) office. The insurance company should be prepared to pay for the claim, and the employee should not be allowed to return to work until they are able to do so. The employee should not feel pressured to return to work if they are not healed.

Workers’ Compensation will cover a variety of expenses. Some important types of Workers’ Compensation benefits are listed below.

Medical Coverage

Workers are entitled to medical coverage for on-the-job injuries. The coverage they receive should help them recover from their injuries. At times, these injuries can take quite a long time to heal, and the worker should be covered until the doctor has signed off that they are fully recovered.

Medical coverage can last a long time, and the coverage will likely include prescription medications that are required by the doctor. Coverage may extend past the worker’s release to return to the job. This is important because employees have the right to continue working, make money, and advance in their careers. These workers, however, may need to continue treatment so that they can thrive long after they are released for work.

Physical Therapy

Physical therapy may go above and beyond traditional treatment for injuries sustained on the job. Workers may need help refining their motor skills or using their extremities as they did in the past. If these workers are not given extensive physical therapy, they may not be able to return to work and make income.

This care might also be needed if the worker is no longer able to work. Workers who are disabled after an accident will receive the care they need until they can file a claim for permanent disability.

Counseling

Workers may experience post-traumatic stress disorder (PTSD) or other workplace mental injuries. An employer or adjuster may ask that the worker be evaluated before therapy begins to show that the employee must continue to receive treatment to function normally and even return to work.

Counseling or therapy will help workers injured on the job recover after a traumatic experience. At the same time, workers may wish to file a claim for psychological services if they witnessed a traumatic accident, injury, or death. For the business to function properly, all workers should feel comfortable going forward.

Wage Loss Benefits

Wage loss benefits pay a portion of the employee’s salary until they can come back to work. A doctor needs to sign off on the worker’s state of health, and the statement must be provided to the employer for normal work duties to resume.

If workers believe that they have not been compensated properly, a lawyer will reach out to the employer for clarification. Communications from law firms are typically taken more seriously than calls or letters from injured workers. Coming forward can be difficult or even embarrassing if the worker has not sought medical treatment sooner.

How can a Lawyer Help Me?

The Workers’ Compensation claims process can be complicated because employees may not understand how to report their injuries. Insurance companies that manage these policies want to know that workers were hurt on the job, and the claims process should include thorough details of the accident and injury.

If the accident was deemed to be outside work hours or outside the typical duties of the job, the insurance company may deny a claim for benefits. A lawyer will help their client prove that their injury happened at work. A lawyer understands how to file all the paperwork for the case, how to explain any medical care that is required, and how to handle any notice requirements as part of the claim or lawsuit.

An important part of the process is knowing how to talk to the insurance company. When the injury is reported to a supervisor, that supervisor will send the claim to the insurance carrier. Workers’ Compensation insurance could either approve care or begin asking questions.

It is advised not to give a recorded statement to the insurance company. The insurance company is responsible for determining if the injury should be compensated. Many injured workers might say something to the insurance company that could be used to deny coverage. When the insurance company denies coverage, a lawyer must investigate the case to determine the truth. The insurance company will be asked to settle so that they can provide coverage.

Wilmington Workers’ Compensation Lawyers at McCann & Wall, LLC Fight for the Rights of Injured and Sick Employees

The seasoned Wilmington Workers’ Compensation lawyers at McCann & Wall, LLC fight on the behalf of injured and sick employees. We can help you get your entitled benefits after a workplace accident, which may include compensation for medical bills, physical therapy, counseling therapy, and lost wages. Call us at 302-888-1221 or contact us online for a free consultation and more information about your case. We have an office conveniently located in Wilmington, Delaware, and we proudly serve clients throughout Dover, Newark, and Middletown.

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