If you injure your back at work, you may be entitled to workers’ compensation benefits. These cover the cost of medical treatment needed to recover from your back injury, lost wages due to your injury, and other benefits.
In order to receive these benefits, you need to report the injury to your supervisor as soon as possible and file a workers’ compensation claim within a certain amount of time after the injury occurred.
Most common work-related back injuries
While OSHA reports that no work-related deaths are due to back injuries, these injuries can still cause significant pain and other symptoms, as well as loss of productivity.
Back injuries at work range in severity from a muscle strain or sprain to more serious problems such as fractured or out-of-place vertebrae, a herniated disc, or a compressed nerve. Some of the most common work-related back injuries include:
- Injuries to the upper back, or thoracic spine
- Injuries to the lower back, or lumbar spine
- Herniated disc
- Spinal cord injury
What should you do when you injure yourself at work?
Report the injury to your employer as soon as possible.
Or, if your symptoms developed gradually, report the injury as soon as you learn or think it was caused by your job. This helps avoid problems or delays in receiving workers’ compensation benefits, including medical care.
“All states have a notice requirement and a time frame in which you must notify someone in a supervisory capacity [about your injury],” says David Stern
, a workers’ compensation attorney in Philadelphia. “Once you have supplied proper notice, it is important you obtain the proper medical care.”
Obtain first aid or medical treatment as soon as possible. If your injury is an emergency, go to the emergency room immediately. Tell the staff at the hospital that your injury occurred while working. If possible, contact your employer to ask what other steps you should take. If you don’t need emergency treatment, see a doctor or get first aid if needed.
If your back pain does not improve after a few days of rest and over-the-counter pain medication, you should seek medical care and treatment. You should also seek medical treatment as soon as possible if you experience any of the following warning signs:
- numbness or weakness in your legs
- loss of bowel or bladder control
- nausea or vomiting
If your workers’ compensation claim is not disputed, the cost of your necessary medical care will be paid by your employer or your employer’s insurance company. However, your state may require you to seek medical care from a health care provider who is authorized by the state workers' compensation board, except in emergency situations.
In addition, “in some states, you must see a doctor from a designated list from the employer/insurance company,” says Stern. “In other states, you have the freedom to see any doctor that you choose.”
You may also be required to obtain your prescription medications from a participating pharmacy, and your diagnostic tests from a participating testing center.
Stern says if you see a doctor, you should ask them for documentation outlining what type of work if any, you are capable of doing with your injury. This information should also be provided to your employer.
File a claim with your state’s workers’ compensation board. Once you file a claim, your employer is required to provide you with medical care. To file a claim, you will need to fill out the proper paperwork and submit it to the workers’ compensation board. If you do not file this paperwork within the time frame designated by your state, you may lose your right to benefits.
What do workers’ compensation benefits cover?
Workers’ compensation benefits may vary from state to state, but generally include the following:
- Medical care to help you recover from a job-related injury
- Temporary disability benefits if you are unable to work due to your injury
- Permanent disability benefits if you don’t recover completely from your injury
- Supplemental job displacement benefits to help cover the cost of skill enhancement or job retraining, in case you don’t recover completely and can’t return to your job
- Death benefits payable to a spouse, children, or other dependents if a worker dies due to a job-related injury
What are the steps for filing a claim?
The steps for filing a workers’ compensation claim may vary somewhat by state, but generally involve the following:
- Obtain a claim form from your employer. Your employer should give you the form or mail it to you within one day of learning about your injury. If your employer does not give you the claim form, you can download it from your state workers’ compensation board website.
- Fill out the “employee” section of the claim form. Sign and date the form. Keep a copy for your records.
- Return the claim form to your employer, either in person or by mail. If you send the form by mail, use certified mail with the return receipt requested. This will provide you with a record of the date that the form was mailed and when it was received.
Your employer will fill out the “employer” section of the claim form and forward it to their insurance company. Your employer should send you a copy of the completed form. If not, request a copy for your records.
You should receive a letter from your employer’s insurance company telling you the status of your claim. If you don’t receive this within two weeks, call the insurance company to ask about the status of your claim.
Your employer or its claims administrator will notify you if your claim is accepted or denied. This generally happens within 90 days of the date you gave the claim form to your employer.
Things that may derail your claim
Stern says several things can cause your claim to be denied, such as:
- Receiving medical care from a “biased” doctor who may not have the worker’s best interests at heart.
- Social media posts that could be misinterpreted to suggest that your injury isn’t severe or that you may be trying to manipulate the system.
- Seeking legal counsel from a lawyer who does not specialize in workers’ compensation law.
- Not seeking legal counsel or other expert advice if you don’t feel comfortable with the workers’ compensation process.
- Trying to hide something about your past medical history, such as a prior back injury.
What happens if you're denied?
Workers’ compensation benefit payments in the United States totaled $61.9 billion in 2015, according to the U.S. Social Security Administration. Medical benefits accounted for over half of this. The denial rate for workers’ compensation claims for all industries increased from 5.8 percent to 6.9 percent between 2013 to 2017, according to a study by insurance brokerage and risk advisor Lockton.
Your claim may be denied if your employer’s claims administrator believes your injury should not be covered by workers’ compensation. If this happens, you can still challenge the decision.
“In all states, you have something called ‘due process’ rights,” says Stern. “What this means is that you have the ability to challenge, through the legal system, the denial of your claim.”
If you wish to challenge a denied claim, you should do it as soon as possible, because there are deadlines for when you need to file the necessary paperwork. You can contact your state workers’ compensation board to find out what paperwork is needed and what the steps are.
Each state has its own process for how challenges are handled. But Stern says this typically involves providing medical evidence and sworn testimony supporting that a workers’ compensation claim should be allowed. You may wish to seek out an attorney who is familiar with the process to help you out with this process.
“The workers’ compensation system can be a complicated process with potential pitfalls along the way,” says Stern, “and having someone who has experience dealing with these matters, will help you through this.”
Can you sue your employer?
Stern says if your employer carries workers’ compensation insurance, and the claim is approved, insurance will fully cover the cost of any work-related injury. There are no policy limits for this type of insurance.
So if your employer has this insurance, you can’t sue your employer for a work-related injury, except in very rare circumstances. This is true whether the injury is the employer’s fault, the employee’s fault, or no one’s fault.
However, if your employer doesn’t have workers’ compensation insurance, you can sue them in civil court for the cost of your medical care and other expenses related to the injury.
“However, this is usually challenging,” he says, “since most of the time, employers who do not carry workers’ compensation insurance, do not have deep pockets. So you may not be able to make an adequate recovery against them directly.”
Stern says some states, though, have uninsured employer coverage that helps compensate employees who are injured while working for an employer that doesn’t have insurance.
If you have a back injury at work, you may be eligible for workers’ compensation benefits, including covering the cost of your medical care and wages if you are unable to work.
In order to receive these benefits, you should report the injury to your supervisor as soon as possible, seek medical care or first aid if needed, and file a workers’ compensation claim.
Updated: November 18, 2020