Does Every Injury that Occurs at Work Create a Valid Workers Compensation Claim?

The simple answer to that question is: No, not in Utah. The Workers Compensation system controls injuries that occur at work. That means that an employee cannot bring a personal injury claim against his employer for an injury sustained at work. That is a disadvantage to Utah employees. The advantage of the system is that in order to prevail under the Workers Compensation system, an employee does not need to prove that the employer was negligent in order to recover. In a standard personal injury case, an injured victim could not recover anything unless he or she could prove that the employer was negligent in some way.

So, does that mean that if you get hurt at work you have a winning case no matter what? No. Your injury must be able to survive what is called “The Allen Test.” The Allen Test dictates which work related injuries are compensable under Utah Law, and which ones are not. The test comes from the landmark case, Allen v. Industrial Commission. That case was decided by the Supreme Court of Utah in 1986. The case was about an employee who injured his back while lifting crates of milk onto the shelves at a grocery store. This case is extremely important to Utah Workers Compensation law because the Justices wrote a lengthy opinion which detailed the entire history of how Utah Courts have determined which work-related injuries are compensable, and then they re-defined what the uniform law on that issue should be in all cases going forward. Since the case, the rule has been as follows:

In order for a work-related injury to be compensable the following two elements must be met:

1. The injury must have happened by accident. That means that either the cause of the injury must be unexpected, or the result must be unexpected. The majority of work-related injuries satisfy this first prong of the test because most employees do not hurt themselves on purpose. Even internal failure injuries, like heart-attacks, are unintended.

2. Element 2 is divided into two sub-parts. These sub-elements are really the crux of the issue. There must be a causal connection between the injury and the worker’s employment duties. The key question is, whether by a preponderance of the evidence, there is a sufficient causal connection between the injury and the working conditions. This question is answered by a 2 part analysis:

 2.A – Legal Causation: When an employee has a preexisting medical condition which contributes to the injury, an unusual or extraordinary exertion is required for the legal causation prong to be met. The test is whether that exertion is unusual or extraordinary when compared with everyday activities that nonemployees perform. For example: taking out the trash, walking around the block, lifting a small child, carrying travel bags, etc. On the other hand, when there is no reason to believe that there is a preexisting condition, ordinary exertion is sufficient to satisfy legal cause. This part of the analysis can be tricky because sometimes it can be difficult to know whether or not there was any preexisting injury. When an internal failure injury coincidently occurs while at work, there is reason to suspect that there may have been a preexisting injury. When there is a preexisting injury, an extraordinary exertion must be shown. For that reason, legal causation can serve as a defense to many injuries that occur in the workplace. This standard of extraordinary exertion is the defensive offset intended to counter-balance the fact that people who live with preexisting injuries are more likely to be injured whether they are at work or not.

2.B. – Medical Causation: The second required prong of the causation element is met by  showing that the exertion required by the job, led to the resulting injury. This is done through medical records or doctor’s opinions. This prong is easy to understand, if your doctor says that your injury was caused by whatever happened to you at work, this element is satisfied. Preexisting injuries are only relevant to medical causation to give the doctors a baseline by which they may judge the injury. If the work accident did not light up, or aggravate the preexisting condition at all, then there is no work injury.

In summary, proving that your injury claim is compensable through the Utah Workers Compensation system can be a difficult task. Make sure you schedule at least a free initial consultation with an experienced Utah Work Comp Injury Lawyer before you inadvertently create obstacles for your own recovery.

When someone gets hurt at work, Utah State Statute outlines formulas that tell us exactly what amount of money the injured worker is entitled to recover. As long as the right numbers are put into the equation, the right numbers will come out. However, there may be a disagreement as to whether or not a particular claimant qualifies for a given type of claim at all. If you have questions about whether or not you are being offered a fair amount for any claim after being injured at work, contact a work injury attorney right away.

5 Types of Workers’ Compensation Damages

1. Medical Expenses – these are the most obvious damages an injured worker is entitled to, so long as a Doctor states that the injury is work related, and injured worker is entitled to recover the full amount of any medical bills incurred. The injured worker is not even responsible for co-pays. Bills must be submitted within a year in order to have a valid claim to be compensated for them.

2. Temporary Total Disability (TTD) – An injured worker is entitled to collect temporary total disability when a doctor’s written record states that because of the injuries, the worker is unable to perform the duties necessary at that particular place of employment. If that is the case, the injured worker should receive 2/3 of their average weekly wage at the time of the injury. This amount has both a floor and a ceiling. It can’t be more than the state average weekly wage (just under $800.00), and it can’t be less than $45 per week + $5 per week for each dependent in the injured person’s household. Those hurt on the job are entitled to receive this benefit until they have recovered enough to return to work, or for 12 years, whichever is less.

3. Temporary Partial Disability (TPD) – This is for injured workers who have returned to work, but are still missing some time. This benefit is calculated in the same way as TTD. The difference is that this amount only considers the difference in average weekly wage from before and after the accident. For example, if an employee was working 40 hours before the injury, but now their doctor says they can only work 20 hours per week during their first month back, the amount that the injured worker would be entitled to is 2/3 of the difference between what the employee was making before and after the injury. The same roof and ceilings apply as well.

4. Permanent Partial Disability (PPD) – This compensation is for people who are left with some form of permanent impairment from the injury, but who are still able to work and hold down a job. Once maximum medical improvement has been reached, a doctor will do a wide variety of tests and will assign an impairment rating using AMA Guidelines. This number will be a percentage out of 100 which the patient is impaired. A large impairment, such as losing a hand, would be about a 50% impairment, a small impairment, such as an injured pinky finger, would be about a 1% impairment. The amount of compensation takes that percentage and multiplies it by 312 (the maximum number of weeks). This gives a number of weeks, losing a hand would be around 160. Then, that number of weeks is multiplied by the same number the other equations used. Two-thirds of the employee’s average weekly wage at the time of the injury. If a worker was earning well over the average weekly wage, the ceiling changes to only two-thirds of the state average weekly wage. Therefore, losing a hand would be worth around $80,000.00 (160 X 500.00).

5. Permanent Total Disability (PTD) – These damages are only available to injured workers who are hurt so badly that they are unable to return to any job reasonably available to them. This includes jobs they have held in the past, and other positions that they are qualified to hold. If a case qualifies as a perm total, based on the doctor’s written evaluations, the damages are substantial. They would be entitled to 2/3 of their average weekly wage at the time of the injury or 85% of the average weekly wage, whichever is less, for the entire first 312 weeks. After those 12 years, they are entitled to 36% of their average weekly wage for the rest of their entire lives. These damages can be shut off at any point if the victim recovers and is able to return to work, or if the employer pays to have the victim trained and qualified for a new vocation. Sometimes a full and final settlement of all potential future damages is the wisest decision.

The basic summary contained in this article is not enough to properly represent yourself against an insurance carrier. For more information, call 435-673-9990 to speak to a work injury lawyer in Southern Utah.