Workers' Compensation Benefits

Last updated November 21, 2024

From construction work to nursing, many jobs across the country have a high risk of injury for employees. Workers’ compensation laws protect injured workers from financial losses caused by getting injured or contracting illnesses on the job.

Workers’ compensation laws, rules, and procedures differ by state. When you need help with your worker’s comp case, find an experienced worker’s compensation lawyer in your state to protect your rights.

How Does Workers’ Compensation Work?

Employers in many states must provide workers’ compensation coverage to employees. Some states exempt employers with less than a certain number of employees. The employer pays for workers’ compensation insurance directly. Employers are generally prohibited from requiring their employees to pay for the cost of coverage.

Employers can purchase worker’s compensation insurance through different providers. In some states, such as New York, companies can purchase workers’ compensation insurance through a state fund. Approved companies can also be self-insured.

Cash benefits get paid out when a worker files a valid claim and is eligible for wage benefits and payment for medical expenses. Eligibility and the process for filing for workers’ comp benefits vary by state.

What Does Workers’ Compensation Cover?

Workers’ compensation benefits typically cover medical treatment and a percentage of wage replacement if you cannot work because of a work-related injury or occupational disease. There may be a limited time for you to receive medical benefits. Medical bill payments can continue if you require more comprehensive medical care.

Average weekly wage loss benefits can cover a specific time, or they may be extended to cover vocational rehabilitation or training for a new job. Workers’ comp coverage, claim requirements, and filing time limits vary by state.

What Doesn’t Workers’ Compensation Cover?

Among other things, workers’ compensation typically does not cover the following:

  • Injuries sustained off company time or premises
  • Injuries or illness arising from drug or alcohol consumption on company time or premises
  • Intentional injuries
  • Pain and suffering arising from the work-related illness or injury

Certain types of workers may not fall under workers’ compensation law in a given state, including:

  • Farmers
  • Maritime workers
  • Independent contractors
  • Business owners
  • Volunteers
  • Undocumented workers

Why Your Workers’ Comp Claim Might Be Denied

Depending on where you live and your line of work, a workers’ comp claim must pass certain tests. Some of the more common reasons why your claim might be denied include:

  • If you were under the influence of drugs or alcohol at the time of the accidents
  • Whether you violated company safety policies and procedures
  • If you were a covered employee of the company at the time of the incident
  • If your injury or illness occurred on the job or in the course of employment

Employers also must provide proper safety training, equipment, and information. Your duty to follow and use this training is sometimes considered a key element in whether a claim is accepted or denied.

If your workers’ compensation claim is rejected, it is possible to file an appeal. Depending on your state, there are likely multiple appeal rounds. The appeals process varies by state, as does the time limit for filing an appeal.

Can You Sue Your Employer?

The workers’ compensation program is a no-fault system. The benefit of this system is that you can get benefits even if your employer was not negligent. However, this generally means that you cannot also file a personal injury lawsuit against your employer.

If you accept workers’ compensation, benefits do not cover damages for pain and suffering. However, if your employer intentionally or recklessly caused your injuries, you may be able to file a personal injury lawsuit.

You can also sue an employer for improperly denying benefits. Some employers or insurance companies may improperly deny your work injury claim. If your employer is challenging your claim, you can talk to a workers’ compensation lawyer who can advocate for you to get the benefits you are owed.

What Other Benefits Are Available After a Workplace Injury?

After exhausting your workers’ compensation benefits, you may be eligible for additional benefits. If you cannot find a job, you may qualify for unemployment insurance benefits.

Workers’ comp provides benefits for a temporary total disability or a permanent partial disability. If your injury or illness qualifies, you may be able to secure short-term or long-term disability benefits. These may be work-provided disability benefits or Social Security Disability benefits.

To qualify for total disability benefits, you have to meet the requirements for Social Security disability. If your loved one was killed in a workplace accident, as a dependent, you may be able to receive death benefits.

Get Advice From an Experienced Workers’ Compensation Lawyer

Making the wrong decisions in a workers’ compensation case could mean having your claim denied. It could potentially expose you to criminal charges of workers’ comp fraud, although this is rare.

An experienced workers’ compensation lawyer can address your particular legal needs. Your lawyer can explain the law and represent you in court, and they can guide you through the appeals process to make sure you have the right evidence. Take the first step now and contact a local workers’ compensation lawyer for legal advice.

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