In the U.S., lawyers have always fought for employee rights in the workplace. Before there was a workers’ compensation program, lawyers supported workers by challenging employers to provide much needed benefits, such as medical care and lost wages, when on-the-job injuries and illnesses occurred.
Once the workers’ compensation system was instituted, lawyers broadened their focus to include the insurance companies that provided workers’ comp coverage to the employers. Today, attorneys help injured workers by fighting to try to ensure that employers and their insurance companies always live up their workers’ compensation responsibilities.
A Brief Background of Workers’ Compensation
The American workers’ compensation system evolved in response to a rising number of industrial accidents and the resulting court battles between employers and employees. Prior to the workers’ compensation system being put into place, most injured workers could only seek compensation for their harms and losses through lawsuits.
But the courtroom was not an affordable avenue for many laborers (too bad they couldn’t take advantage of our contingency fee arrangement2 at the time), and injured employees who chose this route could be denied compensation if their employers could prove any of the following three conditions:
- Contributory negligence – if the worker was responsible, in any way, for the injury
For example, if an employer pointed to evidence that showed that an injured worker was not wearing a hardhat when a beam fell off a platform and hit him in the head, resulting in serious brain injury and a concussion, the injured employee could be denied compensation.
- Assumption of risk – if the injury resulted from an ordinary risk of employment of which the workers should have been aware
For example, a worker who lost a leg when a forklift toppled over and pinned him down could be denied compensation from the employer if the employer produced a signed employment contract in court and argued that the injured worker had assumed the risk.
- “Fellow Servant” rule – if a coworker caused the injury
For example, if one worker spilled toxic chemicals on another worker causing serious, debilitating burns, some courts would still rule in favor of the “blameless” employer and deny the injured worker compensation.
Lawyers fought for workers’ rights in these seemingly unwinnable cases, and in a small number of cases, the courts found in favor of the employee. But even then, employers were held liable for unpredictable amounts that may not have even been enough to cover the worker’s medical care. The system was broken, and employees were suffering.
Carolina Coal Company Mine Explosion Speeds the Passage of North Carolina’s Workers’ Compensation Act
In May of 1925, an explosion at the Deep River Coal Field in Coal Glen, NC killed 53 miners. This was one of North Carolina’s worst coal mining disasters, and the investigation report following it referenced “a general lack of knowledge and experience managing the mines.” John McQueen, President of the Carolina Mining Company, anticipated that the company would be sued by the families of the deceased and survivors and placed the corporation into receivership. In part due to the disaster, the North Carolina General Assembly passed a workers’ compensation law in 1929 with the encouragement of the Department of Labor. A good deal of the credit for the new law can be given to the lawyers at the time who kept up the legal pressure on employers and insurers to care for their injured workers.
The Workers’ Compensation Compromise
The workers’ compensation system was developed as a compromise between injured workers and attorneys on one side and employers and insurers on the other. It generally relieves employers of liability from employee lawsuits in exchange for accepting responsibility for most medical costs, retraining, and lost wages related to on-the-job injuries, regardless of fault.
After North Carolina enacted the state’s first Workers Compensation Act in 1929, South Carolina followed suit in 1935. Since then, the system has covered a massive amount of injured workers while simultaneously encouraging employers to provide safer working conditions for all.
In 2020 alone, the National Academy of Social Insurance reported that the no-fault workers’ compensation system covered approximately 135,572,000 workers and paid $58,925,000,000 in benefits.1 In the Carolinas, the breakdown is as follows:
But it’s not just employees who benefit from the arrangement. The workers’ compensation system is designed to protect both employers and employees. It generally protects employers from being sued by injured workers, and it protects eligible employees by providing benefits to those injured on the job. But, like most compromises, it’s also a balancing act that requires attorney oversight and intervention to try to prevent the balance of power from tipping in favor of employers and insurers.
If employers also benefit, where does the imbalance come from? In 49 out of 50 states (with Texas being the exception), most employers are required to purchase workers’ compensation insurance that provides benefits to eligible employees hurt on the job. The insurance companies that sell employers workers’ compensation insurance coverage are mostly for-profit businesses, and as such, are motivated to pay out as little compensation as possible. And this is where the balance can get off kilter.
Attorneys play a pivotal role by fighting to try to hold insurance companies accountable for their part of the compromise – providing benefits to eligible injured employees. Because without resistance, some insurance companies may get away with shocking treatment of injured workers in need.
Examples of Insurance Company Bad Behavior
With a focus on the bottom line, some insurance companies may fail to fulfill their responsibilities in the compromise that the workers’ compensation system is based on. Our firm has seen examples of bullying, delaying, and denying tactics that are, simply put, bad behavior. And that motivates us to fight even harder for our clients’ rights.
Here are a few examples of the types of insurance company bad behavior that we have fought to overcome1 when seeking fair benefits for our clients.*
- Pressure – One employee who suffered significant burn injuries in a work-related accident was pressured by the insurance company to return to work even though her doctors said she wasn’t ready. This was after aggressive efforts to keep her from getting prescriptions filled or even seeing a doctor.
- Threats and inconsistent payments – One client was told that if he didn’t settle his case for the amount the insurance company was offering, the insurance company would discontinue his weekly checks. By the time he called us, the insurance company hadn’t paid him in two weeks. We immediately called the adjuster, demanded that the checks be reinstated, and even got our client a second medical opinion – which revealed he needed surgery.
- No shows – Another client was rear-ended in a work truck, and the insurance company delayed in settling a hospital bill that eventually ended up in collections. After going back and forth with the insurance company, we set a workers’ comp hearing date and were angered (but not surprised) when no one from the insurance company came to the hearing. (By the way, the judge signed our order.)
How Attorneys Protect the Rights of Injured Workers
The above examples are just a few of the ways some insurance companies may try to take advantage of injured employees in order to protect their profits. Workers’ compensation attorneys deal with these situations, and many more, as they fight to try to preserve the balance inherent in the workers’ compensation compromise and make insurance companies do their jobs.
Attorneys help you level the playing field and strive to be:
- Advocates who help clients fight for the medical treatment they need to heal properly
- Protectors who guard clients’ rights as employees and seek necessary benefits
- Advisors who help clients navigate workers’ comp laws and guide them towards resolution
When eligible employees are wrongly denied workers’ comp benefits or do not receive the full compensation to which they may be entitled, attorneys can help. In extreme cases, when a worker has been killed on the job, workers’ comp lawyers can help their loved ones fight for death benefits. And if you’re still not sure why lawyers are critical in making insurance companies do their jobs, always remember this: we get paid more when you get paid more, and most insurance companies get paid more when you get paid less.2
Your Role in Preserving the Workers’ Compensation Compromise
Injured employees also play an important role in helping the workers’ compensation system operate as intended. If you were hurt at work, you can help yourself while helping the injured workers that follow behind you.
First and foremost, you should always report when you are injured at the workplace, and you should seek workers’ compensation benefits for your harms and losses. Because employees hurt on the job can’t generally sue their employers, you need to be able to rely on the system to work the way it was intended. And for the system to work correctly, as many injured workers as possible should exercise their rights.
You should also enlist the assistance of an experienced workers’ compensation attorney to help you seek benefits. It’s important to choose the right workers’ comp attorney for you – one who you trust to listen, show compassion, and fight for you. When injured workers know their rights and have a seasoned workers’ comp lawyer by their side, an insurance adjuster may very well think twice about trying to steamroll them.
It’s expected for you to act on your rights. And by doing so, you help set an example for your coworkers. You are being held to your part of the compromise (i.e. not suing your employer), and you have every right to demand that your employer’s insurance company be held responsible for its part of the bargain (i.e. providing you workers’ comp benefits when you suffer an eligible injury at work). When each party does their part, even if that takes a lawyer making the insurance party do its job, balance is restored, and justice can be served.
When Workers’ Compensation Works, Everyone Benefits
In addition to employers avoiding costly lawsuits when a worker gets injured and eligible workers receiving medical benefits and lost wages when they are injured on-the-job, workers’ compensation can also lead to an emphasis on safer work environments for everyone.
Because workers’ comp insurance premiums increase as the number and severity of claims increase, employers are incentivized to maintain safe workplace conditions – fewer accidents means lower premiums and fewer claims. Today, many insurance companies encourage employers to enforce office safety measures, such as workstation ergonomics and accident prevention plans, and to educate their workforces about workplace safety and new risks arising in the American workforce. This can be attributed, in part, to the actions of employees and lawyers holding insurance companies accountable for their end of the social contract of workers’ compensation.
If you have been injured in a work accident, contact us online or call us at 1-866-900-7078 for a free case evaluation. We are on your side and are ready to hear your story. Then, we can tell them you mean business.
*Cases or matters referenced do not represent the law firm’s entire record. These are specific examples of experiences we have had with some insurance companies, adjusters, employers, clients, or others. These stories do not necessarily represent any industry or employer as a whole. These descriptions of events are based upon the recollections of individual staff members. Client identities have been removed or changed to protect their privacy.