Workers Compensation: What to Know

If you are injured or fall sick as a result of a workplace accident or unsafe conditions, you may be entitled to compensation. Every state has its own laws and regulations surrounding workers’ compensation, but all 50 states have a program in place to protect injured or sick workers.

Businesses purchase workers’ compensation insurance, and some programs are state-funded. It covers the cost of lost income, medical bills and rehabilitation costs to employees who are unable to work due to their injury. Workers’ compensation can also pay death benefits to family members who lost a relative due to a work-related injury or illness. 

When to File

Every state has its own qualifying criteria and regulations, so you must investigate your local government’s website to determine whether you are eligible to file. Workers’ compensation is usually available to those who:

  • Have been injured due to work-related duties
  • Fell ill due to poor working conditions
  • Lost a family member as a result of a work-related incident

Workers’ compensation is not given to those who self-inflicted injury at their workplace or who were under the influence of drugs or alcohol at the time of their injury. Employees must be on duty and on the premises at the time of their injury; off-site injuries unrelated to work responsibilities do not qualify for compensation.

Qualifying Injuries and Accidents

There are a variety of injuries that can occur in the workplace, but not all of them are eligible for workers’ compensation. Generally, any injury or illness that results at work qualifies for a claim, but the nature of that injury and its relevance to work duties must be evaluated.

Examples of workers’ compensation injuries include:

  • Broken bones, fractures or sprains from falls
  • Cuts or wounds from slipping on stairs or a wet floor
  • Being injured by a driver on-site
  • Losing a finger or experiencing bodily trauma from work machinery

Established independent contractors (freelancers) are not entitled to worker’s compensation regardless of how long they have worked with a company. Only employees with a W-2 can file for compensation, but some lawyers may be able to help contractors seek compensation through other channels. 

How to File Workers’ Compensation Claim

To file a claim, you must first receive any necessary treatment from your primary care doctor or an emergency facility. Inform the physician that this is a work-related injury. Keep documentation of your visit as well as copies of any medical bills. You must contact your employer and report your injury. Failure to give notice within 30 days can result in disqualification for workers’ compensation, so you should make it a priority to reach out and inform your employer as soon as possible.

The employer should then provide you with the necessary paperwork. It is generally the responsibility of the business to handle and submit all relevant paperwork for employee compensation. This includes any additional documentation such as invoices and doctor’s notes. 

What to Expect After Filing for Workers’ Compensation

Once paperwork has been submitted, the company’s worker compensation insurer will examine the claim. They will determine whether an employee is eligible based on a variety of criteria including the cost of treatment(s), supplemental income and any other benefits.

If the claim is approved, the employer and employee can discuss payment options. Employees can either receive a lump-sum of money or a structured settlement of routine payments. 

What to Know About the Process

Once a claim has been accepted, the employee will receive money for the agreed-upon duration. They must inform both their employer and the insurance company when they have recuperated and intend to return to work.

If you are unable to return to work as a result of your injury or illness, the workers’ compensation policy may continue to issue disability benefits. Individuals who receive workers’ compensation for a family member’s death within one year after they die. Compensation will vary by state, the relationship to the deceased and the salary of the deceased prior to their passing.

In the event a workers’ compensation claim is denied, the employee may request another review from the insurance company, or the employer may appeal the decision. They can also seek counsel from a workers’ compensation lawyer.

About the Author: Hannah Moses is a contributing writer for Ratto Law Firm. She resides in Memphis, TN, where she is a digital marketing specialist that loves concerts in the city, southern eats, and being close to her alma mater, Ole Miss.

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