Working offshore or in the maritime industry poses unique challenges and risks that are unlike any other industry. The nature of the job often requires strenuous physical effort, and workers operate in unpredictable environments that can include severe weather conditions and high-sea turbulence. The use of heavy machinery and equipment on decks slippery with seawater increases the risk of accidents. It is unfortunately common for workers to face injuries and, sometimes, even fatal incidents.
When an injury does occur, you may feel overwhelmed by the complex process of filing a maritime claim to cover your lost wages, medical expenses, and other related costs. The law is intricate, with various federal laws and acts in place to protect maritime workers, but there’s a crucial question that many injured maritime employees grapple with: “Can my maritime claim be denied if I was injured at work?”
Here at Abraham Watkins, we are ready to help answer your questions and begin the process of representing you in your case. We believe that everyone deserves access to high-quality legal representation without an upfront cost which is why we offer a free consultation and work on a no-win no-fee basis.
Call 713-535-9319 to discuss your case with a dedicated Houston maritime attorney.
Understanding Maritime Law and Workers’ Compensation
The maritime industry is governed by an intricate web of legal guidelines designed to protect the rights and well-being of its workers. Central to this network is workers’ compensation – a system established to provide medical treatment, disability benefits, and other resources to workers who are injured on the job.
In many industries, workers’ compensation is relatively straightforward, but for maritime workers, the situation is significantly more complex. Maritime work often takes place outside traditional territorial boundaries and thus falls under federal rather than state jurisdiction. Several federal laws have been enacted to offer protection and provide workers’ compensation benefits to maritime employees under federal jurisdiction.
The Jones Act
One of these key pieces of legislation is the Jones Act. Officially known as the Merchant Marine Act of 1920, the Jones Act allows injured maritime workers to file a claim against their employers if their injury was caused by employer negligence. This negligence can include unsafe working conditions or inadequate training. Crucially, the burden of proof is on the worker to demonstrate employer negligence, and this often requires the guidance of a personal injury lawyer.
The Longshore and Harbor Workers’ Compensation Act
The Longshore and Harbor Workers’ Compensation Act (LHWCA) is another federal law that provides compensation for medical expenses and lost wages to maritime workers injured on navigable waters of the United States or in adjoining areas used for loading, unloading, repairing, or building certain types of vessels. This Act covers workers not covered by the Jones Act, including longshore workers, harbor workers, ship maintenance specialists, shipbuilders, and ship-breakers.
Maintenance and Cure
An important aspect of the workers’ compensation system in the maritime industry is the concept of “maintenance and cure.” If a worker is injured or falls ill while in service of a ship, the employer is obligated to pay for the worker’s medical treatment (“cure”) and provide a daily living stipend (“maintenance”) until the worker reaches maximum medical improvement. This obligation applies regardless of who was at fault for the injury or illness.
Filing a Maritime Claim
It’s crucial to understand, however, that while these laws and guidelines are designed to protect workers, navigating them can be a complex process. Often, a maritime claim’s success will depend on the specific circumstances of the injury, the worker’s employment status, and where exactly the injury occurred. Furthermore, dealing with insurance carriers, who might challenge a claim to minimize your payout, can add another layer of complexity to the process.
While the concept of workers’ compensation is not unique to the maritime industry, it is important to understand that maritime workers are subject to a different set of regulations under federal law. Therefore, state-level workers’ compensation programs that apply to most land-based occupations don’t usually extend to maritime workers. Instead, several federal laws, such as the Jones Act and the Longshore and Harbor Workers’ Compensation Act (LHWCA) fill this gap, providing injured maritime employees with a means to seek compensation for work-related injuries.
Unlike the Jones Act, which covers seamen, the LHWCA specifically extends workers’ compensation coverage to other maritime workers not covered by the Jones Act. These employees often include dockers, harbor workers, shipbuilders, shipbreakers, and other workers engaged in maritime employment on or near the navigable waters of the United States.
The LHWCA provides compensation for medical care and vocational rehabilitation services to these workers injured while performing their duties. It also covers compensation for disabilities, both temporary and permanent, partial or total. Additionally, in unfortunate instances of workplace fatalities, the LHWCA provides death benefits to surviving spouses and other eligible survivors.
Navigating the distinctions and specifics of these federal laws requires knowledge and experience. As a maritime worker, knowing your rights and understanding these laws is essential. However, this doesn’t replace the value of an experienced Houston personal injury lawyer when dealing with complex legal matters or in the face of a denied claim.
Types of Workers’ Compensation Benefits
Maritime workers who suffer injuries or contract occupational diseases while on the job are entitled to a range of benefits under federal workers’ compensation laws. These benefits are designed to provide support to injured workers and help them cope with the financial, physical, and emotional impacts of their injuries.
Here are the main types of workers’ compensation benefits:
- Medical Treatment – Following a work-related injury or illness, maritime workers are entitled to receive the necessary medical treatment to recover. This medical treatment includes emergency treatment, ongoing medical care, surgeries, medication, and rehabilitation services. The employer or insurance carrier is typically responsible for covering these medical expenses, which should be provided until the worker reaches maximum medical improvement.
- Vocational Rehabilitation Services – If a work-related injury or illness affects a maritime worker’s ability to return to their former job, they may be eligible for vocational rehabilitation services. These can include assessment of job skills, job training, job-search assistance, and even education in some cases.
- Temporary Disability Benefits – Temporary disability benefits are designed to replace a portion of lost wages during the time the worker is recovering and unable to work.
- Permanent Disability Benefits – These benefits come into play if the injury or illness results in a long-term or permanent inability to work. These can be for permanent partial disability (where the worker can still do some work) or permanent total disability (where the worker can’t return to any kind of gainful employment).
- Death Benefits – In the tragic event that a maritime worker dies due to a work-related injury or illness, their dependents are entitled to death benefits. These benefits typically include weekly compensation based on the employee’s average annual earnings and may also include payment towards funeral expenses.
Understanding the types of benefits available is essential for maritime workers. However, gaining access to these benefits is often not straightforward. An experienced personal injury attorney can help you through this complex process and fight for the full range of benefits you could be entitled to.
Process of Filing a Workers’ Compensation Claim
The immediate aftermath of a work-related injury or the diagnosis of an occupational disease can be stressful and confusing. Knowing the steps to take can help ensure that your rights are protected.
Notify Your Employer Immediately
The first step after sustaining an injury at work is to report the incident to your employer as soon as possible. This should be done in writing, detailing the circumstances of the accident, the nature of the injury, and any other relevant details. For occupational diseases, the employer should be informed as soon as the worker becomes aware of the diagnosis. A delay in reporting can jeopardize your claim.
Seek Medical Attention
After notifying your employer, the next critical step is to seek immediate medical attention. Even if the injury seems minor, it’s important to get a thorough medical checkup. Some injuries may not show immediate symptoms but can lead to complications later on. Additionally, medical reports from such checkups will serve as crucial evidence when filing your workers’ compensation claim.
File a Claim
The process of filing a workers’ compensation claim involves submitting a formal document to your employer or insurance carrier, explaining in detail the incident, the injuries sustained, and the medical treatment required. It’s crucial to note that each state has its own procedures for filing claims and also has its own statute of limitations, which is the timeframe within which a claim must be filed.
For federal maritime workers covered under the Harbor Workers Compensation Act, the claim form LS-203 should be filed with the U.S. Department of Labor.
Follow Through With Medical Treatment
Continue with all necessary medical treatments prescribed by your healthcare provider and maintain records of all treatments and medical expenses. Remember that the goal of workers’ compensation is to help you recover from your injury and return to work, so following the prescribed treatment plan is crucial.
Maintain a thorough record of everything related to the incident and your claim. This record includes copies of your notification to your employer, medical records, claim forms, correspondence with your employer or insurance company, and any other relevant documents.
Role of the Claims Administrator
After a workers’ compensation claim has been filed, it comes under the purview of a claims administrator. This individual, who may be an employee of the insurance carrier or a third-party administrator, is responsible for reviewing the claim and determining whether it is valid.
The claims administrator examines the circumstances surrounding the incident, the injuries claimed, and the medical reports submitted. They also ensure that all procedures and protocols have been correctly followed in the claim process. A significant part of their job is to identify any discrepancies or potential issues that could affect the claim’s validity.
Role of the Administrative Law Judge
If there’s a dispute regarding the claim, the case may be heard before an Administrative Law Judge (ALJ). The ALJ conducts a formal hearing to review the evidence presented by both the injured worker and the employer’s insurance carrier. They have the power to make legal decisions on the claim, including the eligibility and extent of benefits.
It’s important to have legal counsel represent you in these hearings, as the proceedings can be intricate and require a detailed understanding of maritime and workers’ compensation laws.
The Three-Day Waiting Period
After reporting a work-related injury or occupational disease, there is generally a three-day waiting period before compensation benefits are paid out for time lost from work. If the injury or illness causes the worker to miss more than a few days of work, the benefits may be retroactively paid from the date of the injury.
This waiting period varies based on federal and state laws and the specific circumstances of each case. It’s critical to understand this waiting period to manage expectations about when benefit payments might commence.
The Difference Between Personal Injury Claims VS. Workers’ Compensation Claims for Injured Offshore Workers
Unlike workers’ compensation claims, personal injury claims are based on the concept of negligence. If you can prove that your injuries resulted from someone else’s negligence, you could file a personal injury claim to seek compensation for your damages. This process is markedly different from filing a workers’ compensation claim, which doesn’t require the injured worker to prove anyone’s fault.
Why Personal Injury Claims May Be Important for Injured Offshore Workers
Personal injury claims can be significant for offshore workers due to the potential for more substantial compensation. In a workers’ compensation claim, benefits are typically limited to medical expenses and a percentage of the injured worker’s lost wages. On the other hand, a personal injury claim allows for the recovery of all lost wages, medical expenses, pain and suffering, and other damages.
Filing a Personal Injury Claim
To file a personal injury claim, you typically need to prove that your employer, or another party, acted negligently and that this negligence directly led to your injury. This often requires the guidance of an experienced offshore injury lawyer to gather evidence, build a strong case, and represent your interests.
The Jones Act and Personal Injury Claims
For seamen injured on the job, the Jones Act is a federal law that allows them to file a personal injury claim against their employer. The Jones Act can be complex and requires careful navigation, which can be done by an experienced Houston maritime attorney.
While workers’ compensation serves as a vital safety net for injured workers, it may not provide full compensation for all the damages suffered. For injured offshore workers, a personal injury claim may result in a more accurate reflection of the true financial, physical, and emotional costs of their work-related injury. Understanding the differences between these two types of claims and when each is appropriate is crucial in ensuring that injured offshore workers receive the compensation they deserve.
Reasons Why a Maritime Workers’ Compensation Claim Might Be Denied
Navigating the complex world of maritime workers’ compensation can be a daunting task. It can be even more intimidating when you have to face the possibility of a denied claim. Understanding the reasons behind denied workers’ compensation claims can provide you with the necessary knowledge to tackle potential pitfalls.
Reason One – Failure to Report the Injury or Illness
One primary reason for claim denial is the failure to report the injury or illness promptly. The process of claiming workers’ compensation benefits commences with notifying the employer about the injury. Depending on the jurisdiction, an injured employee might have to report the injury within a specific timeframe, usually a few days to a week after the incident or the diagnosis of an occupational disease. Failing to meet this deadline could potentially result in a denied claim.
Reason Two – Discrepancy Between Medical Reports and the Claim
Another common reason is the discrepancy between medical reports and the claim. For instance, if the medical reports do not support the severity of the injury as claimed or indicate that the injury is not work-related, the claim might be denied. It is crucial to ensure that all medical reports, from emergency treatment to ongoing medical assistance, align with the claim filed.
Reason Three – The Injury Occurred Outside The Scope of Employment
Additionally, insurance carriers often scrutinize the circumstances surrounding the injury. If the injury occurred while the employee was violating company policy or engaging in irresponsible behavior such as intoxication, the claim could be denied. Employers and insurance companies might also dispute claims if the injury happened outside the scope of employment or during a non-work-related activity.
Reason Four – Suspicion of Fraud
Employers may also deny a claim if they suspect fraudulent activity. Workers’ compensation fraud is a serious offense, and suspicion of fraud, whether through fabricated injuries, exaggerated symptoms, or false statements about the ability to work, can result in claim denial and potential legal repercussions.
Reason Five – Inadequate Documentation
Inadequate or incomplete documentation often leads to claim denial. Detailed documentation, including medical reports, injury reports, and wage statements, is pivotal for a successful claim. Any discrepancy or lack of transparency can raise doubts, leading to potential claim denial.
Reason Six – Time Runs Out
Another critical legal factor in workers’ compensation claims is the statute of limitations; this is a law that sets the maximum period within which legal action can be initiated after an injury or illness. If you do not file a claim within this time frame, you may lose your right to claim workers’ compensation benefits altogether.
The statute of limitations varies from state to state and can range from one to three years from the date of injury or illness. In some cases, the clock starts ticking from the moment the employee becomes aware of their injury or illness. Understanding this limit is crucial in ensuring a timely and successful claim.
Reason Seven – Not Seeking Legal Counsel
Not seeking legal counsel for your maritime claim can increase the likelihood of a denied claim. Without the guidance of an experienced lawyer, you may face challenges in understanding complex legal procedures, gathering sufficient evidence, and adhering to strict deadlines.
Skilled insurance companies representing maritime employers can take advantage of your lack of legal representation during negotiations. By not seeking legal counsel, you risk missing out on the experience and advocacy needed to effectively present your case.
What to Do if Your Workers’ Compensation Claim Is Denied
Experiencing a workplace injury is a daunting ordeal, but having your workers’ compensation claim denied can intensify the stress and confusion. In such challenging times, it’s essential to understand the steps to take in response to a denial.
Review The Reasons for the Denial
The first step upon receiving a denial is to review the reasons carefully. Denial letters should explain why the insurance carrier or employer chose not to approve the claim. Your next steps will depend upon the reason for denying your claim.
If the denial results from a lack of medical evidence or a misinterpretation of the facts, gathering additional information or clarifying existing evidence can be beneficial. This process could involve obtaining more detailed medical reports or gathering witness testimonies to prove that the injury occurred at work.
In some cases, the denial may be due to procedural errors, such as missed deadlines or incomplete paperwork. While it’s critical to meet all reporting and filing deadlines, some jurisdictions may allow for exceptions if a valid reason for the delay is provided. If procedural errors are the cause of denial, consulting with an experienced Houston maritime attorney can help determine potential courses of action.
File an Appeal
After examining the denial letter and addressing any discrepancies, the next step is usually to file an appeal. This process varies depending on the jurisdiction, but generally, it involves submitting a request for a hearing or review.
Prepare for the Hearing
Preparing for the hearing is a crucial step in the appeal process. The hearing typically involves presenting the case before an administrative law Judge, who will review the evidence and make a decision. You or your Houston maritime attorney will present evidence supporting your claim, including medical records, witness testimonies, and any other relevant documents. Your employer or insurance carrier will also have the opportunity to present their case.
Hire Legal Representation
Legal representation can significantly influence the outcome of the hearing. A personal injury lawyer with expertise in maritime and workers’ compensation law can guide an injured worker through the complex appeal process. They can help gather and present evidence, cross-examine the opposing side’s witnesses and make compelling legal arguments.
While some injured workers may hesitate to engage legal counsel due to cost concerns, it’s important to note that Abraham Watkins works on a contingency fee basis. This type of fee structure means that we only get paid if your case is successful.
The appeal process can be lengthy and complex, requiring thorough preparation and persistence. However, a denied workers’ compensation claim is not the end of the road. With the right guidance and determination, it’s possible to navigate this challenging process and secure the benefits needed to aid recovery and financial stability. After all, every injured worker deserves fair compensation for their injuries and the peace of mind to focus on their recovery.
Effects a Denied Claim May Have on Your Life
A denial of a workers’ compensation claim can significantly impact an injured maritime worker’s access to various benefits. Understanding these implications is critical in formulating an action plan to appeal the denial.
Suffering Lost Wages
Workers’ compensation is designed to provide a portion of your lost wages while you are unable to work. This income replacement is crucial for many workers and their families who rely on these funds to cover their daily living expenses. A denial of a claim can disrupt this income stream, leaving you to grapple with financial hardship on top of your physical injuries.
Suffering Medical Expenses
Medical expenses form a large part of the benefits provided under workers’ compensation. These may include costs associated with hospital stays, surgeries, medications, physical therapy, and other treatments related to work-related injury or occupational disease.
If your claim is denied, the responsibility for these significant medical costs may fall onto you and your family. Without compensation benefits, managing these expenses can be an overwhelming burden, particularly if you do not have comprehensive health insurance.
Missing Out on Disability Benefits
When an injured worker’s compensation claim is denied, the implications are far-reaching and can be particularly profound when it comes to disability benefits. Disability benefits under workers’ compensation can be classified into temporary and permanent and further into total and partial disability.
These benefits are calculated based on the employee’s average annual earnings and the extent of their disability. They are designed to support workers who have lost some or all of their earning capacity due to a work-related injury or illness. A denial of a claim can mean a loss of these benefits, making it challenging for you to support yourself and your dependents.
To understand this, let’s delve into the four major categories of disability benefits – Permanent Total Disability (PTD), Permanent Partial Disability (PPD), Temporary Total Disability (TTD), and Temporary Partial Disability (TPD).
- Permanent Total Disability (PTD) – PTD is designated when your work-related injury or illness results in a complete inability to work for the rest of your life. Compensation for PTD is intended to cover your lost wages for your remaining lifespan. If your claim is denied, this can significantly jeopardize your financial future. Without PTD benefits, you may face substantial economic hardship.
- Permanent Partial Disability (PPD) – You are considered to have a PPD when you sustain a permanent injury but can still perform some work, albeit not at the same capacity as before the injury. PPD benefits aim to compensate you for your reduced earning capacity. A denial of a compensation claim means you might not receive these benefits, making it harder for you to adapt to a lower-paying job or altered work circumstances.
- Temporary Total Disability (TTD) – TTD refers to a condition where you are completely unable to work for a temporary period due to a work-related injury or illness. TTD benefits are intended to replace lost wages during this recovery period. A denied claim can create significant financial strain if you are unable to work and at the same time lack the financial support of TTD benefits.
- Temporary Partial Disability (TPD) – TPD occurs when you can return to limited or light-duty work while recovering from an injury or illness. TPD benefits compensate for the wage difference between your earnings before the injury and your reduced wages during recovery. If a claim for TPD benefits is denied, you may struggle to cover your living expenses with reduced income.
In all these scenarios, denial of a workers’ compensation claim can mean a significant financial burden, further complicating your recovery process. This underlines the importance of understanding your rights and navigating the claims process correctly or seeking experienced legal assistance when a claim is denied.
Returning to Work Could Be More Challenging
In some cases, a work-related injury or disease might prevent you from returning to your former job. In such instances, workers’ compensation offers vocational rehabilitation services, which can include assessment, counseling, training, and job placement assistance. These services aim to help you return to employment. A claim denial can cut off access to these services, making your return to the workforce more challenging.
You May Still be Able to Claim Unemployment Insurance
In some situations, you may be eligible for unemployment insurance if you are unable to return to work and your workers’ compensation claim is denied. However, the eligibility criteria for unemployment insurance are different and can be complex to navigate. It is also important to note that unemployment benefits are typically lower than workers’ compensation benefits and may not provide the same level of financial support.
Choose the Maritime Lawyer Houston Offshore Workers Trust!
Protecting your rights as an injured maritime worker is an essential aspect of ensuring you receive the compensation and benefits you deserve. It’s crucial to be aware of potential strategies to safeguard your rights and to understand the tactics that your employer or insurance company might employ.
The first line of defense is being knowledgeable about your situation. Familiarize yourself with the maritime laws applicable to your situation and the benefits you’re entitled to receive under these laws. Having this knowledge will arm you against any misleading information or underhanded tactics that your employer or insurance company may attempt.
Next, meticulously document all medical treatment received due to your work-related injury or illness. These records should include details of every medical visit, the type of treatment administered, and any prescribed medications. Also, keep a personal journal documenting how your injury impacts your daily life. This can serve as valuable evidence if your claim is denied and you need to appeal or file a lawsuit.
Just as crucial as documenting your medical treatment is seeking the necessary medical attention immediately after an injury and throughout the recovery process. Do not let concerns about costs prevent you from obtaining the treatment you need. Under workers’ compensation laws, your employer’s insurance carrier is responsible for covering your medical expenses, and this includes emergency treatment and ongoing medical care. Delaying or avoiding medical treatment can not only harm your health but can also negatively affect your compensation claim.
While navigating the complexities of your claim, it’s important to understand the role of various entities like the federal government, private employers, and insurance carriers. Each of these entities has a part to play in the processing and approval of your claim. The federal government, through bodies such as the Department of Labor, oversees the overall workers’ compensation framework and ensures employers comply with laws.
On the other hand, private employers are responsible for providing safe working conditions and carrying workers’ compensation insurance. They are obligated to process your workers’ compensation claim and ensure you receive your benefits. Insurance carriers are responsible for paying out benefits on approved claims, but it’s important to note that they are also often looking for ways to minimize their payouts. Knowing the roles and responsibilities of each entity will help you identify when they are not fulfilling their duties, and you can take appropriate action.
Lastly, it’s vital to understand your average annual earnings and its relation to your benefit payments. Workers’ compensation benefits are often calculated based on a percentage of your average weekly wage, up to a maximum limit set by law. Therefore, knowing your average annual earnings is essential to ensure you receive the correct amount of benefits. If you believe the calculated benefits do not accurately reflect your average earnings, don’t hesitate to challenge the figures provided by your employer or their insurance company.
Can my employer or insurance company deny my claim even if my injury occurred at work?
Yes, it is possible for your employer or their insurance company to deny your workers’ compensation claim even if the injury occurred at work. Reasons for denial can vary widely and may include disputes over whether the injury was work-related, whether the required paperwork was correctly completed and submitted on time, or whether appropriate medical treatment was sought. It is crucial to consult with a knowledgeable maritime lawyer if your claim is denied.
What are my options if my claim for medical benefits is denied?
If your claim for medical benefits is denied, you have several options. You can request a hearing or mediation through your state’s workers’ compensation board, file an appeal, or in some cases, file a lawsuit against your employer or the insurance company. In all cases, it is recommended that you seek the advice of an experienced Houston maritime attorney who can guide you through the process and help you choose the best course of action.
How can I prevent my workers’ compensation claim from being denied?
While there are no guarantees, you can increase the likelihood of your claim being accepted by promptly reporting the injury to your employer, seeking immediate medical treatment, thoroughly documenting your injury and its impact on your life, and complying with all procedural requirements when filing your claim. It can also be beneficial to seek legal counsel to ensure that all processes are correctly followed.
Can I sue my employer if my workers’ compensation claim is denied?
The answer to this depends on the specifics of your situation. Generally, workers’ compensation is considered an “exclusive remedy,” meaning that in most cases, you cannot sue your employer for a work-related injury. However, there are exceptions to this rule. If your employer intentionally caused your injury, or if your employer does not have workers’ compensation insurance as required by law, you may be able to file a lawsuit. Consult with a Houston personal injury attorney to understand the best course of action for your case.
Abraham Watkins – Houston Personal Injury Attorneys With an Impeccable Record of Success
Navigating the complex landscape of maritime law and workers’ compensation claims can be an overwhelming experience for injured maritime workers, mainly when a claim is denied. However, it’s crucial to remember that you are not alone in this journey.
At the law firm of Abraham Watkins, we have been tirelessly serving maritime workers for over seven decades. Our rich history, which makes us one of the longest-serving law firms in our state, bears testimony to our relentless dedication and steadfast commitment. We understand the unique risks and complexities faced by maritime workers and take pride in safeguarding their rights.
Recognizing the financial challenges these workers often encounter, we offer our legal services on a contingency fee basis; this means our clients are not burdened with any upfront costs. Instead, our fees are paid only after we successfully resolve their case, whether through a court victory or a favorable settlement. Our goal is to alleviate financial stress and ensure that justice is accessible to all maritime workers we represent.
We’re here to help you protect your rights, secure your benefits, and obtain the justice you deserve. We have the knowledge, experience, and tenacity to challenge insurance carriers, employers, and the federal government on your behalf, ensuring that your voice is heard.
For a free consultation or any further questions, don’t hesitate to contact us.
Call us at 713-535-9319.
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