Understanding Workers’ Compensation

Workers’ compensation — also known as workers’ comp — was created for employees that are injured or disabled at some point during their employment. Workers comp is a government-mandated system that is one of the rights, responsibilities, and obligations protected by employment law. It is a type of insurance that offers monetary compensation for injuries or disabilities that were caused or sustained in the workplace. To receive workers’ comp, you must be able to demonstrate a qualifying injury or event and submit supporting documentation as part of your application for workers’ comp payments. If you feel that you should have received workers’ comp and you didn’t, or if you feel that the workers’ comp provided does not adequately meet the needs of your injury/disability, you may have grounds to sue your employer

Employees need to be aware of what workers’ comp is, how it works, what is covered, what the process looks like, and when to get a lawyer involved. The article below is designed to cover all of the above information. 

Who Pays for Workers’ Compensation?

Although workers’ comp laws vary between states, if workers’ comp is required for your job, employers should always pay. Workers’ compensation insurance is normally withheld as a percentage of an employer’s payroll. Employers have two options for providing coverage for their employees:

  1. Insurance programs facilitated through the state;
  2. Private insurance companies.

Employees should be aware that there are certain types of workers or occupations that are not always covered by employer-provided workers’ compensation — examples may include:

  • Business owners;
  • Independent contractors;
  • Volunteers;
  • Federal employees;
  • Railroad employees;
  • Longshoremen;
  • Taxi drivers;
  • Small businesses;
  • Agricultural workers;
  • Part-time employees.

There are several reasons why workers’ comp may not be provided in certain scenarios. The Federal Employment Compensation Act (FECA) provides federal employees with workers’ compensation, so coverage is taken care of at the national level. Most states exempt any form of independent contractor work from workers’ comp. Additionally, some small companies do not have to provide workers’ comp if they only employ a certain number of employees. 

What Injuries Are Covered By Workers’ Compensation?

Not all injuries are covered by workers’ compensation. The bottom line is, the injuries that are covered by workers’ comp must be connectable in some manner to employment requirements, or specific tasks. Some broad categories of injury types that are covered by workers’ comp are:

  • Serious/catastrophic loss: Serious or catastrophic loss can be several things. This classification could be injuries such as broken bones, amputations, brain trauma, paralysis/spinal injury, burns, and scarring/disfigurement;
  • Repetitive stress/motion injury: Repetitive stress injuries arise when you perform the same movement day in and day out. This injury can occur in many places. It could occur in your back from lifting boxes or even in your wrists from typing;
  • Occupational disease: Some jobs are riskier than others, and exposure to certain elements, or not taking proper safety precautions can result in occupational disease. Some examples include heart disease, cancer, mesothelioma, silicosis, hearing loss, HIV, respiratory disease, and skin disease;
  • Joint/connective tissue injury: This type of injury could be to several areas including the foot, ankle, leg, hip, hand, arm, or shoulder. It could also result from a variety of situations — even something as simple as slipping and falling;
  • Mental health illness: The workplace can be stressful and taxing — causing numerous mental health issues. A few examples of mental health illnesses that may qualify include depression or anxiety.

Injuries That Do Not Qualify for Workers’ Comp

Not all injuries qualify for workers’ comp. What does, or does not qualify can change depending on the job code, the state you’re in, or your employer. Below are a few examples of injuries that generally do not qualify for workers’ comp:

  • Injuries that occur when commuting to or from work;
  • The injury is not reported in a timely fashion;
  • The injury does not have medical proof/documentation;
  • The injury was pre-existing;
  • Injuries that occur when attending recreational work activities (as long as they are not mandatory);
  • Injuries that occur as a result of intoxication or substance abuse;
  • Injuries that occur as a result of workplace horseplay or fighting.

Workers’ Compensation Process

There is a standard process for how workers’ comp works. It begins with getting sick or injured on the job and progresses as follows:

  • Seek medical attention: After you become injured or sick, you need to seek immediate medical attention. This is important for your health and any time-sensitive deadlines. Be sure to gather documentation, even if the injury may seem minor;
  • Notify employer: After you get the medical attention that you need, take your documentation, and talk with your employer. Talk to your employer as soon as possible. They will gather information, assess the situation, and point you in the right direction to file a report; 
  • File a report: Your employer will get you all of the necessary documentation for filing a report. This should include insurance forms, state reporting forms, organizational information on employee rights and workers’ comp benefits, and written protocol for returning to work. After you fill out the report, your employer is generally responsible for officially filing it;
  • Wait for approval: As mentioned above, workers’ compensation must be approved. The waiting time varies between scenarios, but in some cases, insurers will begin paying medical benefits while your claim approval is still pending;
  • Return to work: Be sure to look into the return-to-work protocol with your employer. Most employers will require written notice before returning to work. Depending on the severity of the injury, employees may return to work while still receiving benefits.

Workers’ Compensation Benefits

Workers’ compensation benefits can vary depending on the state and the job code/organization, but the most common type of workers’ comp that is paid by the insurer is medical treatment. With this benefit, insurers cover the medical expenses associated with your injury/sickness treatment/care. If your medical condition is serious enough, you may be able to receive one of the following workers’ comp benefits:

  • Temporary disability benefits: This type of benefit pays out some percentage of your wages for an allotted amount of time, until your medical condition is healed, or until you can perform your full duties. This may be all of your wages or just some. In order to qualify, your medical condition must interfere with your return to work long-term;
  • Permanent disability benefits: This type of benefit pays out some percentage of your wages long-term, or potentially for life. To qualify, your medical condition must permanently interfere with your day-to-day life/work.

Workers’ comp benefits can start almost immediately if there is enough evidence to prove that your injury or sickness is job-related. The sooner you file, the sooner you can receive benefits.

Special Considerations for Workers’ Comp

Workers’ comp is complex. It is not always apparent what qualifies, and what employers are held liable for. According to The Center for Construction and Research Training (CPWR), there are injury underreporting patterns within the U.S. construction industry. It can be difficult to regulate workers’ comp within physical industries like construction and many others since their work depends highly on their physical abilities. 

It is important to understand that workers’ comp is not disability insurance or unemployment insurance. These programs pay out individuals that are insured regardless of where and when the medical condition occurs — workers’ comp only compensates approved medical conditions obtained on the job. If you are trying to take advantage of workers’ comp by reporting a medical condition obtained outside the workplace, think again. This is considered insurance fraud, and insurance fraud is a felony.

Unlike many other types of benefits, workers’ compensation is typically tax-free.

When to Hire a Workers’ Comp Lawyer

As mentioned above, workers’ comp is a complicated process, and it could be worth it to hire a workers’ comp lawyer. If your injury is minor, or your employer is more than willing to work with you throughout the process, you can probably represent yourself. Below are some examples of when to hire a workers’ comp lawyer:

  • When your employer denies your claim;
  • If your benefits are not being paid in a timely fashion;
  • If the compensation does not cover all of your medical treatment or lost wages;
  • If your medical condition limits you from performing your work;
  • If your employer retaliates for filing a claim.

An experienced workers’ comp attorney in your local area will help you present the best case. They will help you understand your employment rights, gather the necessary evidence to support your case, understand short-term disability vs. long-term disability, negotiate with insurance companies, and draft a settlement agreement. If you are stuck, a workers’ comp lawyer can help guide you through any part of the process. 

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