Workers’ Compensation Benefits Explained

You may find below some brief explanation of workers’ compensation insurance.

What is workers’ compensation or workman’s compensation?

Workers comp is the shorter term referring to workers’ compensation insurance. Workers comp is a program that is mandated by the state, providing for payments to an employee who has been injured or disabled because of their work. The federal government offers no workers’ compensation insurance for federal employees, but these employees may still be able to get benefits under the state’s laws on workers comp.

In most instances, the employee who has been injured while performing their work may be entitled to a workers’ compensation regardless of who was at fault. Workers comp prevents an employee to file a lawsuit against their employer for their injuries covered by the workers comp.

In most situations, injured employees receive workers’ compensation insurance, no matter who was at fault for the injury. Because these workers comp benefits act as a type of insurance, they preclude the employee from suing his or her employer for the injuries covered.

See also Workers’ Comp FAQ.

What types of incidents are and are not covered by workers’ compensation insurance?

Although workers comp has such a broad coverage, there are still limits to that. States may require alcohol and drug testing on an injured employee after the injury, and if found positive, may result in the denial of the worker’s compensation benefits. Some may also deny benefits for self-inflicted injuries; if the employee was violating a law or company policy; or when the injury occurred at the time when the employee was not on the job.

What types of expenses does workers’ compensation insurance cover?

The following are some expenses that may be covered by workers’ compensation insurance:

  • Medical care from the injury or illness
  • Compensation for any permanent injuries
  • Replacement income
  • Costs for retraining
  • Benefits to survivors of workers who are killed on the job

It is worth noting that once a person collects workers’ compensation benefits, they may not be allowed to file a lawsuit against the employer. Workers comp also do not include pain and suffering.

The lost wages benefit is usually equal to about two-thirds of the injured worker’s average wage, although a maximum amount may be set. These benefits, although significantly lower than the worker’s original wages, are tax-free. Wage loss benefits eligibility starts from after a few days of work missed because of the injury or illness suffered.

Does workers’ compensation insurance cover long-term and permanent injuries?

Yes, it does. Workers’ comp does not only include accidents, but also physical illness and problems that may have developed for a certain period because of the performance of the same tasks. Some examples may be back problems because of lifting and stressful movements, or carpal tunnel syndrome for repetitive movements of the wrist.

If the injury is lifetime and cause an employee’s permanent disability to perform the same work and tasks they did prior to the injury,  then they may be entitled to long-term benefits or larger lump-sum benefits.

Permanent work disability benefits and eligibility for such benefits may sometimes be complicated and take a while to process, that is why is best to contact your local workers’ compensation office as soon as possible after an injury.

In addition to workers comp, a permanently disabled person may be entitled to receive social security benefits. However, social security benefits are at times harder to claim.

What is the Workers’ Compensations Act?

This is an act that includes the state laws requiring employers to avail of insurance for employees; it also establishes employer liability for injuries sustained by employees while on the job.

Who is covered by workers’ compensation insurance?

Most employees are covered by workers comp, except the following in certain states:

  • Independent contractors
  • Casual workers
  • Business owners
  • Volunteers
  • Railroad employees
  • Employees of private homes
  • Maritime employees
  • Farmers and farmhands

Federal employees may not be covered by the states’ workers’ compensation programs because they are covered by the federal workers’ compensation system. There are also states that do not require a worker’s compensation insurance for employers with 2 to 5 employees and may vary from state to state, so check your state’s laws on workers’ compensation insurance.

If I’m injured on the job, but not actually at my workplace, am I still covered by workers’ compensation insurance?

Probably; depending on the situation. If you are injured while performing a task that is within the scope of your job requirements, then you will be covered by workers comp. One example may be those that travel to deliver their products and were hurt during the travel.

Can I use my own doctor for work injuries covered under workers’ compensation?

That depends on your state and depending on whether or not you have already stated this wish before your injury. However, the usual practice is to refer you to a doctor whom the employer will pay. Remember that this doctor may be on the employer’s side. They will be the ones who will fill up the medical report which will be used to know what your compensation would be. These doctors may minimize the seriousness of an injured employee’s condition or even state that it has been a pre-existing condition in order to gain favor from your employer with the hopes of increasing the likelihood that their services would be used again by your employer.

Can I see my own doctor if I’ve already been treated by an insurance company doctor?

The laws regarding this matter may be complex and could vary from state to state. You can tell the insurance company that you would prefer to be checked by another doctor and request a new one. However, there is some waiting period involved. If your injury is serious enough, certain states may allow you to get a second opinion. There are also states that allow the injured worker to consult their own doctor after 90 days of being checked by the insurance company’s doctor. If you have a serious injury, get the best doctor to look into your case who specializes in whatever injury you suffered. Do not worry about the cost because the workers’ compensation insurance would cover the doctor’s fees.

Who pays for workers’ compensation insurance coverage?

The employers pay for workers comp coverage. Employers are required by the state’s laws to avail of insurance for their employees. Small businesses with 3-5 employees may no longer be required, but larger companies are. The really big companies may even be allowed to self-insure or act as their own workers’ compensation insurance companies. These companies will shoulder all that is required and covered in an ordinary workers comp.

Can I sue my employer for a work injury?

Yes, if you waive your rights to receive workers’ compensation benefits. You can file a lawsuit against your employer for their reckless or intentional acts that led to your injury. Successful lawsuits may mean that the employee will be awarded for medical expenses, punitive damages, pain and suffering, lost wages, and mental anguish.

Can my employer fire me for or tell me not to file a workers’ compensation claim?

No. This is not allowed in some states. If the employer fires the employee of retaliates in whatever way because of the employee’s workers’ compensation claim, then the employee should immediately report this employer to the local workers’ compensation office.

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