The Workers Comp Exclusive Remedy Rule
In Most Situations, a Workers Compensation Claim is Your Only Legal Option to Receive Medical Treatment or Cash Payments After an Occupational Injury or Illness
“Is workers compensation my only option?”
“Can’t I sue my employer for putting me in a dangerous situation that led to injury or my coworker for causing the accident?”
We hear these questions from injured employees many times per week, especially when they discover that workers compensation laws do not require employers and insurers to pay for pain and suffering, cover only a percentage of wage loss, and cap how long you can receive income replacement or permanent partial disability (PPD) benefits.
Unfortunately, the courts favor keeping work injury claims in the workers compensation system. And the general rule is that you cannot prosecute a tort lawsuit based on a work-related injury or an occupational disease. This rule is known as the workers compensation exclusive remedy rule.
This article explains when the exclusive remedy rule applies, making ‘workers compensation benefits or negotiating a work injury settlement the only way to recover damages from an occupational injury.
Read on for more information.
Then, view this article to see when you can avoid the workers compensation exclusive remedy rule and sue your employer in civil court, bring an administrative charge, or file a personal injury action against a negligent third party. An exception to the exclusive remedy rule may apply.
Our workers compensation law firm has obtained millions of dollars in medical treatment, wage loss payments, and lump sum settlements for injured employees.
Call us at (804) 251-1620 or (757) 810-5614 to see if we will accept representation, evaluate all legal options, and prosecute your claim.
What is the Definition of the Exclusive Remedy Rule?
The exclusive remedy rule means that seeking benefits available under the Workers Compensation Act is your sole remedy against the employer for a workplace injury or death covered by the Act.
The rights and remedies provided by the Workers Compensation Act controlling your claim are exclusive of all other rights and remedies you may have because of a job-related accident. You cannot maintain a common law action against your immediate employer for such an injury when your employer has accepted the provisions of the Workers Compensation Act.
Why Do Many Plaintiffs’ Lawyers and Injured Employees Criticize the Exclusive Remedy Rule?
The exclusive remedy doctrine usually prevents injured workers from seeking common law damages.
And common law damages often exceed the amount of workers comp available.
Therefore, the exclusive remedy rule is criticized for decreasing the amount of compensation an employee can receive for a work injury caused by their employer’s negligence.
What is the Reasoning for the Exclusive Remedy Rule?
As one court has explained, a critical purpose of workers compensation is “to provide a swift and sure source of benefits to the injured employee or to the dependents of the deceased employee.”
While we can (and do) disagree that workers compensation remains a “swift and sure source” of medical treatment and cash payments for occupational injuries, thanks to the efforts of insurers and businesses, courts continue to use this rationale to hold “[t]he price for these secure benefits is the loss of the common-law tort action in which greater benefits might be obtained.”
A brief history lesson explains the reasoning for the exclusive remedy rule further –
Before states began establishing workers compensation systems (Virginia created its scheme in 1918), suing your employer in civil court was your only option to recover damages from a work injury.
Winning in civil court, however, was challenging for several reasons.
First, you had to prove your employer’s negligence caused the accident and injuries. Not all workplace incidents result from negligence.
Second, even if you proved your employer acted negligently, you had to overcome the common law defenses of:
- Assumption of Risk: Under this defense, the employer could argue you should have known this injury could happen when you accepted the job.
- Fellow Worker Rule: Under this defense, the employer was not liable for damages if the injury was another employee’s fault.
- Contributory Negligence: Under this defense, the employer did not owe compensation if your negligence, neglect, omission, or wrongdoing contributed to the accident and injury. Virginia is one of a handful of states that follow the contributory negligence doctrine in motor vehicle crash lawsuits and other claims.
These defenses were difficult to overcome. As a result, occupational injuries and sicknesses forced many employees and their families into poverty, straining the community.
Third, even if you succeeded in a lawsuit against your employer, months or years likely would have passed before you received money for medical treatment or disability. This delay would diminish the win. Further, prolonging medical treatment would likely cause your condition to worsen, decreasing the likelihood of returning to work.
Seeing the problems this situation caused, legislatures began enacting workers compensation laws in the early 1900s. However, to persuade employers to pay for injuries and illnesses they may not be responsible for under the common law, employees had to give up the right to sue in civil court and obtain larger verdicts.
Thus, the exclusive remedy rule was born.
Where is the Legal Support for the Exclusive Remedy Doctrine?
Most state workers compensation statutes bar employees from bringing civil lawsuits against employers for injuries arising from the employment when the employer has workers compensation insurance (or dismiss the claims when the employer files a plea in bar). And Workers Compensation Commission and court decisions interpreting these statutes continue to apply the exclusive remedy doctrine.
For example, the Virginia General Assembly codified the exclusive remedy rule in Code Section 65.2-307.
That law, entitled Employee’s rights under the Act exclude all others; exception, says in part:
A. The rights and remedies herein granted to an employee when his employer and he have accepted the provisions of this title [the Workers Compensation Act] respectively to pay and accept compensation on account of injury or death by accident shall exclude all other rights and remedies of such employee, his personal representative, parents, dependents, or next of kin, at common law or otherwise, on account of such injury, loss of service, or death.
B. If a court of the Commonwealth makes a finding in a final unappealed order based on an evidentiary hearing or a factual stipulation of the parties and participants thereto that the cause of action relating to an accident, injury, disease, or death is barred by this section, that finding shall be res judicata between those same parties and estop them and any employer, uninsured employer’s fund, guarantee fund, responsible entities, or statutory employer from arguing before the Commission that the accident, injury, disease, or death did not arise out of and in the course of such employee’s employment. If the Commission or a court on appeal from the Commission makes a finding in a final unappealed order based on an evidentiary hearing, hearing on the record, or a factual stipulation of the parties that the claims relating to an accident, injury, disease, or death did not arise out of or in the course of such employee’s employment, then that finding shall be res judicata and estop those same parties from arguing before a court of the Commonwealth that the accident is barred by the exclusivity provisions of the Act ….
C. Notwithstanding this exclusion, nothing in the Act shall bar an employer from voluntarily agreeing to pay an employee compensation above and beyond those benefits provided for in the Act. Nothing herein, however, shall be deemed to affect or alter any existing right or remedy of the employer or employee under the Act.
Similarly, Maryland has an exclusive remedy statute that applies to work injuries.
If, however, you caused the work accident or cannot prove that someone else contributed to the injury, the workers compensation exclusive remedy rule does not hurt you.
When Does the Exclusive Remedy Rule Harm Injured Employees?
The exclusive remedy doctrine penalizes employees who could prove their employer’s negligence caused the injury and resulting harm because it prevents such employees from claiming or recovering the additional damages available in personal injury lawsuits.
Does the Exclusive Remedy Doctrine Apply if I Do Not File for Workers Compensation?
Yes.
The exclusive remedy rule shields the employer from civil liability even if you refuse to file a workers compensation claim.
Further, suppose the employer has concerns that an exception to this rule may exist for your occupational injury. In that case, some states (including Virginia) allow employers to file claims on behalf of employees so the applicable workers compensation board can determine compensability.
Does the Exclusive Remedy Rule Protect Employers Who Do Not Purchase Workers Compensation Insurance Even Though They Are Required To?
No, at least in some states.
Workers compensation is compulsory in most states, meaning employers of a specific size (three or more employees regularly in service in Virginia) must meet the self-insurance requirements for their state or purchase insurance to cover their workers compensation liability.
An exception applies if your employer does not have workers compensation insurance when it should. The employer cannot use the exclusive remedy rule to prevent you from filing a civil lawsuit for occupational injuries.
However, we recommend speaking with an attorney to determine the likelihood of collecting damages from your employer through a civil action versus claiming benefits through your state’s uninsured employer fund.
Many businesses without workers compensation insurance do not have the assets to pay a court judgment, making the uninsured employer’s fund your best option. But exceptions exist.
How Far Does the Exclusive Remedy Rule Extend?
The exclusive remedy rule protects more than just immediate employers.
It also prevents you from maintaining a personal injury lawsuit against a fellow employee or supervisor whose acts or omissions caused your injury.
Further, the exclusive remedy doctrine may protect other employers or independent contractors who caused your injuries if they qualify as your statutory employer (read about this subject here; the issue often arises in construction accident lawsuits). The threshold question is whether the potential defendant engages in work that is part of your employer’s trade, business, or occupation.
If Workers Compensation is Your Sole Remedy, Hire a Lawyer to Ensure You Get Every Possible Benefit
Like it or not, workers compensation may be your exclusive remedy after a work injury.
To see if an exception applies or to prosecute your work injury claim to the fullest, call us at (804) 251-1620 or (757) 810-5614.
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