When Workers' Compensation does its job, the worker is fairly compensated for his injury and allowed to recover fully. When the worker is healed, the employer gets their worker back at full strength and everybody "wins".
Like any system however, Workers' Compensation doesn't always provide the desired result for all parties. Sometimes, a worker is hurt and files a claim, but the insurer refuses to pay the claim. This can result in bad feelings between employee and employer and can result in an injured worker not receiving fair compensation for an injury.
The process: how Workers' Compensation works
The process is straightforward on the surface. When a worker suffers an injury, they go to the doctor and ask for a First Medical Certificate and a Workers' Compensation Claim Form. Both are then given to the employer, who forwards them to the insurance carrier.
In many cases, the claim goes through, the worker is fairly compensated and the worker returns to work when fully healed. The worker is fairly compensated and the employer gets a fully-healed employee back on the job when the worker is pronounced fit to return to work.
However the insurer doesn't always pay the claim. They have the option to dispute the claim and not pay it. If the insurance carrier disputes the claim, the worker has the option of going before the Conciliation and Arbitration Services (CAS) for what is called an "independent review".
Sometimes they find in favour of the worker and sometimes they find in favour of the insurance carrier. For an injured worker whose claim has been denied, this can be problematic. The worker is injured and unable to work, but told that he or she won't be compensated and has to go back to work before fully healed.
How injured workers can protect themselves
Angus Castley, Partner at Bradford Legal, a personal injury law firm, said hiring a lawyer is the most beneficial option if the insurance company disputes the claim.
"Workers' Compensation is a great way to ensure that workers are fairly compensated and allowed to fully heal, but it doesn't always work for the injured worker," Castley said.
"Unfortunately, while both the employer and employee benefit when the insurance carrier fairly compensates the employee, the insurance carrier loses money every time they compensate the employee.
"While we would never accuse a carrier of impropriety, one can easily see how it would appear that there is a natural bias built into the process that leaves room for inadequate compensation and an inappropriate outcome for the injured employee.
"The injured worker needs an advocate to look after his or her interests. That is why we always recommend hiring a lawyer when injured to ensure that the process works fairly and that he or she is fairly compensated and allowed to heal fully before returning to work.
"Workers' Compensation is a great resource for an injured worker, but someone has to ensure that the worker is treated fairly."
