This article is part of a larger series on Workers' Compensation Insurance.
When you have a work-related injury covered by workers’ compensation, you typically cannot file a lawsuit against your employer. Workers’ comp laws in every state include an exclusive remedy provision that protects employers from employee lawsuits as long as their business has a valid policy in place. However, there are situations that override this protection and can result in workers’ compensation lawsuits.
What Is an Exclusive Remedy?
Exclusive remedy is the provision in workers’ compensation laws that says that injured workers cannot sue their employers for a work-related injury as long as they receive workers’ compensation benefits. When an employee collects these benefits, they essentially agree to the exclusive remedy provided by state law.
Why Is Workers’ Compensation an Exclusive Remedy?
In the history of workers’ comp, this idea of an exclusive remedy and no-fault insurance is part of what’s known as the “grand bargain.” Employers promise to create safe workplaces and cover injuries and partial lost wages while injured workers give up their right to sue.
To make this possible, workers’ compensation insurance is a no-fault coverage. This means workers do not have to show that their employers were at fault to receive benefits. Workers can be responsible for an accident that causes their own injury and still have their medical bills covered and collect disability payments.
When Can You Sue for a Workplace Injury?
There are exceptions to the exclusive remedy clause for injured workers. Because workers’ compensation laws vary from state to state, so do the situations where workers’ comp lawsuits are allowed. Some states are more lenient when it comes to exceptions than others. If in doubt, consult with a workers’ compensation attorney to determine your rights within your state laws.
Your Employer Doesn’t Have Workers’ Comp Insurance
The first example of a situation where many states allow you to seek compensation for your injuries is when your employer does not have a workers’ compensation policy in force. When this happens, you can sue your employer for your medical expenses, lost wages and, in many states, pain and suffering.
Keep in mind that while most states require all employers with only one employee to have a valid insurance policy in force, there are exceptions. For example, workers’ compensation is optional in most situations in Texas. Other states, such as Alabama, only require insurance once a business has five employees. Moreover, almost every state has exceptions to its workers’ comp requirements and let certain employers opt out of coverage. In many of these cases, employers may still be held financially responsible for their employees’ injuries, and their injured employees usually have the right to sue for damages.
Tip: Some states have funds set up to pay medical bills and lost wages for employees whose employers do not carry the workers’ compensation insurance that they’re mandated legally to have. Contact your state workers’ compensation board for more information.
Your Employer Intentionally Harmed You
Exclusive remedy may be waived if you believe that your injuries were induced intentionally like your employer punching you in the face. If this or something similar occurs, then you may be able to file a civil lawsuit for an intentional tort.
Some of the most common intentional torts include:
- False imprisonment
- Intentional infliction of emotional distress
- Invasion of privacy
Civil torts are not limited to physical injuries so that employees can sue for nonphysical injuries like emotional abuse.
You Were Injured by a Third Party
You may claim workers’ compensation benefits and file a civil lawsuit if you were injured on the job by a third party. One example of this is a delivery driver who is hit by another automobile and hurt. Because the driver was hurt while working, he can file for workers’ compensation, but he can also sue the individual who caused the accident.
While the injured delivery driver has rights to both workers’ comp benefits and civil damages, he may have to return a portion of his benefits to either his employer or his employer’s insurance company. Another option for the insurance company, which has the right to make sure the responsible party pays, is to join the driver’s civil suit to recover the benefits it paid. Either way, getting benefits through workers’ comp ensures faster payments than waiting for a decision in court.
Your Employer Has Dual Capacity
Dual capacity is when an employer has a relationship with a worker outside of the employer-employee relationship like being the manufacturer of goods the employee consumes or the provider of a service the employee uses. If this secondary injury is the source of an employee’s injury, then the employee may be able to sue his employer.
Let’s say, for example, that an employer produces air fresheners using a toxic chemical, and chronic exposure to the chemical leads to an employee’s respiratory illness. That employee may file a workers’ compensation claim for medical costs and lost wages but can also file a personal injury suit against the air freshener manufacturer, who may also be his boss, for civil damages.
Your Employer Concealed the Source of Your Injuries
Some states permit workers to sue employers who conceal workplace risks from employees or the extent of a worker’s injury from the state or their insurer. Florida, for one, allows workers’ compensation lawsuits when an employee was not made aware of a hazard but can show their employer knowledge of the potential for injury or death and concealed that information.
One typical example of this is working with a hazardous substance. If a business owner fails to tell employees about the risk or doesn’t mention it after a worker falls ill from exposure, the injured workers can sue.
Your Employer’s Actions Were Grossly Negligent
Business owners in a few states may face workers’ comp lawsuits if their behavior is grossly negligent and leads to an employee’s death. While definitions of gross negligence vary by state, it generally involves a person being aware of the severity of the risk but choosing to act conscious indifference to the others’ safety and welfare.
Texas is one example that allows beneficiaries to sue for gross negligence. However, an employee in Texas may also be able to sue if they can show the accident that caused their injury was “substantially certain to occur.” This is a much higher standard to hit because the injured worker must prove their employer’s actions would almost definitely cause harm.
Under most circumstances, employees cannot sue employers for work-related injuries––these injuries are paid for by workers’ compensation insurance benefits. If you feel that your employer intentionally harmed you or concealed injury risks, you could be eligible to open a lawsuit. Of course, everything is contingent on the state you live in. Talking to an attorney in your state could help you best understand what your rights are.