Can I Sue My Employer if I'm Injured at Work?

Every year, hundreds of thousands of workers suffer workplace injuries. These work-related injuries range from minor “slip and fall” injuries to permanent disability caused by industrial machinery. Workers’ compensation is a state-regulated insurance program designed to provide medical care benefits and lost wages to injured workers.

Workers’ comp is a no-fault insurance program that provides limited benefits (medical treatment and wage replacement benefits). Workers do not need to show that their workplace accident was caused by their employer’s negligence. However, injured workers cannot generally get pain and suffering or damages for emotional distress.

Workers’ comp programs vary by state. To understand your legal rights after a work injury, talk to a local workers’ compensation lawyer.

Claims for Employees Under Workers’ Compensation Coverage

Workers’ comp benefits are provided on a no-fault system. This means that the employee does not have to prove that the employer’s negligence was responsible for the employee’s injury or illness. An employee generally cannot sue an employer for an on-the-job injury covered by a workers’ compensation case.

“Under the most limited of circumstances, you can’t sue your employer for negligence after a work injury,” says T. Andrew Miller, a workers’ comp and personal injury attorney in Atlanta. “If you get hurt at work, you can summon your employer before an administrative law judge to address workers’ comp benefits and issues, but you cannot sue them for negligence. Workers’ comp is the exclusive remedy in Georgia.”

“Workers’ comp can be very confusing to navigate through,” warns Mitch Dugan, an attorney with Dugan & Associates law firm in Pittsburgh.

Filing a Workers’ Comp Claim

The most important thing to remember is that, if you have suffered a workplace injury, you need to inform your employer as soon as possible. An employer is not required to provide benefits until you notify them of your job-related injury. Depending on state law, you must give notice within a certain period from the date of the injury.

If you disagree with a workers’ compensation case decision made by your employer, you have the right to file an appeal. The first appeal is generally an administrative proceeding rather than a traditional lawsuit. A workers’ compensation judge (WCJ) will review your petition, hold a hearing, and issue a decision granting or denying the relief you seek.

“I wouldn’t recommend anyone go to any kind of court without a lawyer,” Dugan says. “Some people are under the mistaken belief that all they have to do is show up, tell their side of the story, and everything will be OK. That’s clearly not the case. Workers’ compensation is a full-blown trial system, although it’s done in steps instead of a one-day, one-trial scenario.”

If you don’t like the WCJ’s ruling on your claim, you can seek further review before the Workers’ Compensation Appeal Board. Beyond that, you can appeal the case in state court.

“The insurance company is paid by the employer. They have lawyers; they know the system. You may be in over your head. Their team might run circles around you,” Dugan says. “Many people call after the fact and say, ‘I settled my case, but this and this are problems,’ but it’s too late. And in my experience, nine times out of ten, we could have gotten a better offer. Insurance companies against an unrepresented worker usually lowball them.”

Disputing a Denied Workers’ Compensation Claim

You can file a civil lawsuit if your employer illegally fails to provide workers’ compensation coverage. But if your employer simply denies your claim or terminates benefits, your remedy is typically to file a formal claim petition or appeal within the workers’ compensation administrative system, not a lawsuit in civil court.

Sometimes, the employer’s insurance company may want to deny workers’ comp benefits. If the insurance carrier denies paying medical expenses for a work environment injury, the injured worker can file an appeal. Something most laypeople don’t know about a workers’ comp claim is also the most commonly litigated, Lewis says: impairment ratings.

After a medical exam, a numerical value is assigned to the worker in accordance with the impairment. Based on that information, a date will be set when a worker has improved as much as they can and when the wage-loss benefits will end. From the day you get the impairment rating, “you then have 90 days to dispute it, or it becomes permanent,” Lewis says, adding that a second medical opinion is a common part of a dispute. “It can be a big ‘gotcha’ in the Texas system.”

Talk to a personal injury attorney about getting fair compensation for your workplace injury.

Independent Contractors and Third-Party Claims

Subcontractors and independent contractors are not employees. Most contractors do not fall under the types of claims workers’ compensation covers. Instead, these workers can file a lawsuit against a negligent employer. In a personal injury claim, the injury victims must show that the business was negligent in causing the accident to get compensation.

Workers’ compensation may limit your options for seeking damages against your employer. But what if a third party, independent of your employer, causes your injury?

“An example would be a pizza delivery guy who gets rear-ended by a random person,” Miller says. “He’d have a workers’ comp claim to cover lost wages and medical, and then a negligence or tort claim against the person that hit him. So you’ll be dealing with a workers’ comp insurance company and an auto insurance company. Because that third-party person isn’t part of the employer, they aren’t immune from a suit.”

Talk to a personal injury lawyer if you were injured on a worksite but not as an employee.

If the Employer Does Not Have Workers’ Compensation Insurance

Most states require employers to carry workers’ compensation insurance. However, some states allow employers to opt out. For example, although Texas has a workers’ compensation system, most private employers are not legally required to purchase coverage. A Texas employer is legally required to notify all of its employees (and the state) if it opts out.

“We call it being a subscriber or a non-subscriber,” says Matthew B. Lewis, a workers’ compensation lawyer at MLF Legal law firm in Dallas. “If you’re a subscriber, you have protection against lawsuits. If you don’t, and you’re going bare, you can be sued by an employee for any negligence they may have participated in causing the injury.”

If an employer has workers’ compensation, then an injured employee must seek benefits through that system for a job-related injury. You have 30 days to file a workers’ compensation claim with your employer, and one year to file it with the Division of Workers’ Compensation.

“In Texas, we have something called network claims,” Lewis explains. “If your employer subscribes to a network or doctor through their insurance, you have to go to somebody in their network. So who do you pick? They’re looking at things through the lens of insurance as opposed to someone on the side of the patients.” Having an attorney on your side can help you seek additional outside opinions in certain circumstances.

If the employer is a non-subscriber to workers’ compensation, then the employee is free to file a personal injury claim. In some cases, this can work out better for the employee. Personal injury lawsuit awards are not capped to the same extent as workers’ compensation benefits. However, an employee who sues has the burden of proving the employer was negligent. A personal injury award in civil court requires a finding of fault, unlike workers’ compensation.

Contact a Workers’ Comp Lawyer

“Workers’ comp is a minefield for injured workers,” Miller says. “It’s very technical and complicated. In order to fully protect yourself, you’ll need an advisor.” Workers’ comp attorneys work to maximize the amount you collect and receive a percentage of your settlement after you win. “We don’t get paid until you do.”

When workers’ compensation disputes arise, they can lead to lengthy and complex litigation. There are multiple potential stages of administrative and judicial review for workplace injuries. Obviously, the employers and the insurance carriers will have attorneys helping them at every stage of this process.

You want to devote your full attention to healing from your injuries, not dealing with administrative paperwork and possible litigation. If you expect any issues with your case, it is a good idea to speak with a licensed workers’ compensation attorney.