Regardless of how a safe job site looks, accidents always happen. A truck driver can dislocate his shoulder when carrying a heavy load, or a nurse could hurt their back when lifting patients.
It’s not uncommon to see a construction worker injured or killed by falling materials. Realistically speaking, every workplace puts employees at risk to some extent.
That is why workers’ compensation coverage exists. The insurance is designed to protect the rights of employees injured at work.
So, what is workers’ compensation, and how does it work? Read on to learn more about it.
What Is Workers’ Compensation Insurance?
At some point, many new entrepreneurs ask, “what is workers’ compensation?”
Workers’ compensation, also called workman’s compensation, is an insurance policy that protects business people and their employees.
Through workers’ comp, a worker who gets injured on the job can receive benefits to cover their expenses, including medical costs and lost wages. The policy can also pay the dependents of an employee who dies due to work-related injuries or accidents.
Similarly, employers benefit from having workers’ comp coverage as they don’t have to cover costs of employee injuries out of pocket. Apart from this, the coverage protects the employer from potential lawsuits taken by the employee.
Some companies are exempt from obtaining workers’ comp insurance depending on individual state requirements. Texas, for example, is the only state where coverage is optional, except for a few sectors where it is required.
How Does Workers’ Compensation Work?
How workers’ comp works will vary depending on your state of residence. However, the general steps to take when making a claim are universal across states.
Step 1: You’re Injured at Work
Generally, workers’ comp benefits apply to employees injured when performing their delegated duties. Injuries that occur at the workplace but beyond the working hours are not covered.
Another thing, not all injuries occurring at the workplace are covered either. Exceptions include:
- Injuries from accidents caused by an employee under the influence
- Injuries resulting from willful misconduct or negligence
- Intentionally self-inflicted injuries
Workplace injuries do not exclusively result from accidents or other one-off incidents. Some work-related injuries result from repetitive motion stress, which can lead to pains and injuries that merit workers’ compensation benefits.
Step 2: Seek Medical Treatment
When injured at work, you must undergo a medical evaluation and treatment as soon as possible. Your doctor will document how, when, and where you were hurt so that you can pursue compensation.
You may also need rehabilitative care to help with your recovery. Make sure to record all the injuries and treatments received as they will help in your case.
Step 3: Report the Injury to your Employer
The next step is to inform your employer- usually through your supervisor or human resource manager about the injury. Your reporting the injury should mark the start of the claims process.
Most employers advise workers to report injuries as soon as possible. If you fail to report the injury on time, you can lose out on workers’ comp benefits.
Your employer should follow up with the insurance firm to address the claim. Here, the insurance company will issue you the first report of injury form.
You must review it, checking for errors, omissions, or incomplete information.
Step 4: The Insurer Investigates the Claim
After filing the claim, the insurance firm will investigate it to decide whether to approve or deny it. The process includes interviews with the employer and employee and a review of relevant documents.
If the claim is denied and you feel the decision is unfair, you can file an appeal with your state workers’ comp agency. The case will be reviewed either by the agency or by a judge.
At this point, you may need to hire an experienced workers’ comp attorney to advocate for you.
Step 5: Workers’ Comp Benefits are Paid
If the insurance company approves your claim, you will start receiving payments to cover your medical bills and lost income.
The workers’ comp insurance can cover several things, including:
- Medical bills- The healthcare provider sends bills directly to the worker’s comp insurer, which will pay them.
- Disability benefits- Covers part of the employee’s lost wages and are paid directly to the employee.
- Rehabilitation benefits- Helps the employee recover from the injuries over time.
- Death benefits- If an employee dies on the job, workers’ comp covers their funeral expenses and pays some benefits to their dependents.
In most states, workers’ comp pays two-thirds of the injured worker’s weekly wages. There may be limits to the total amount though depending on your state.
Why Does Worker’s Compensation Exist?
Employers have a legal obligation to ensure their workplaces are safe for workers. Regardless, accidents still happen. And when they do, workers’ comp insurance provides coverage.
So then, what is the purpose of workers’ compensation? According to the Insurance Information Institute, workers’ comp serves two purposes.
The first is to ensure injured, or ill employees recover compensation for job-related injuries and illnesses. The second purpose is to protect employers from lawsuits of workers injured when working.
A remarkable thing about workers’ comp is that it is a no-fault program. That means a qualifying employee is entitled to the benefits regardless of who was responsible for the injury, so long as it was work-related.
In more practical terms, workers’ comp eliminates the need for time-consuming and costly lawsuits. You don’t need to sue your employer to get compensation; you are not allowed to do so.
Instead, you rely purely on the workers’ comp program to get compensation for your injuries. Compare this to personal injury suits where outcomes are uncertain, and the process can take up to years to settle fully.
Plus, state laws forbid employers from striking back against employees who bring workers’ comp claims. If they do, workers’ comp coverage offers you additional protection.
What Does Worker’s Compensation Do for Me?
What workers’ comp does for you is that it reimburses you for all medical costs and part of damages associated with your work-related injury.
Understanding the worker’s compensation payment structure can help you plan well for your future. So, what is workers’ compensation payment? These are benefits that you receive when injured on the job. In most states, you get two-thirds of your average weekly wages.
Here are the payments that you can expect to get.
Medical Benefits
Workers’ comp pays for medical treatment for a work-related injury, as long as your doctor recommends it.
Temporary Income Benefits
You can collect temporary income benefits if you miss work when recovering from your injury. But temporary income benefits don’t kick in until after the first week of missed work.
The benefits will then last until your doctor says that you have achieved maximum medical improvement, you return to your normal job at the same wages, or you receive temporary income benefits for 104 weeks.
Some states allow an extension of the 104-week limit if you have spinal surgery 12 weeks before the deadline.
Supplemental Income Benefits
You may run out of your impairment income reimbursement before being fully healed. In that case, you may qualify for supplemental income but only if:
- You had a permanent impairment rating of 15% and above
- You still cannot resume working or earning 80% of your former salary
- Your impairment income benefits were not paid as a lump sum
- You are undergoing vocational rehabilitation
You can receive supplemental income benefits for up to 401 weeks if you qualify.
Disability Benefits
Some work injuries are severe enough to cause temporary or permanent disability. Workers’ comp can offer lifetime income benefits for permanent disability.
Some impairments that warrant lifetime income benefits are:
- Amputation of either hands or feet
- A spinal injury that led to permanent paralysis
- Complete blindness
- A traumatic brain injury that resulted in severe mental impairment
- Third-degree burns that cover 40% of the body and require a skin graft
Lifetime income payments are usually 75% of your pre-injury average weekly wage.
Other Workers’ Comp Benefits
You can receive other payments on top of compensation for medical treatment and part of your wage loss. Depending on your state, you may be eligible for:
- Medical travel expenses- You may receive reimbursement if you travel more than 30 miles from your home for treatment. This is especially true if there is no treatment available within your locality.
- Vocational rehabilitation- Your disability may limit a return to your normal job. Your doctor may also have referred you to a vocational rehabilitation program after reaching maximum medical improvement.
- Death benefits- Some employees die as a result of work-related injuries. Their spouses, children, or other eligible family members can receive death benefits for a specific period. These benefits are often 75% of the deceased employee’s pre-injury wage.
What If My Workers’ Compensation Claim is Denied?
Workers’ comp is indeed well regulated, and the outcomes are guaranteed. Unfortunately, sometimes insurance companies deny rightful claims, and the injured worker does not receive the benefits to which they are entitled.
There are various reasons why this happens. It can be because the injured employee missed the deadline for informing the employer or that the employer failed to file a claim on your behalf.
Another reason that causes issues is if your claim is disputed. Disputes usually surround the circumstances of the accident, for instance, saying it did not happen at the workplace or that your illness was not work-related.
The good thing is that a denied workers’ comp claim is not the end of the road. You can appeal the decision through your state workers’ comp agency.
But you must gather evidence to support your claim, including witness statements and the doctor’s records.
Hiring an experienced workers’ comp lawyer would be your best bet at gathering enough evidence to support your claim.
Hire a Workers’ Compensation Attorney Today
Were you injured in a work-related accident? Does the insurance company deny your claim?
You need an experienced attorney to help you appeal the denial and receive payment for your injuries.
At Legal Giant, our workers’ compensation attorneys can fight on your behalf to get your rightful compensation. Contact us today to schedule a free evaluation of your case.
