Workers' Compensation Benefits

Last updated January 20, 2025

Workers’ compensation laws protect employees with workplace injuries or illnesses. The benefits, eligibility, and process for workers’ comp varies by state. It’s hard to know where to start if you have never dealt with workplace injury claims.

This provides an overview of workers’ compensation benefits and how to apply them. Find an experienced worker’s compensation lawyer in your state to help you through the workers’ comp process.

How Does Workers’ Compensation Work?

Most employers must provide workers’ compensation coverage to their employees. The employer pays for workers’ compensation insurance to cover workplace injury claims. Employers can purchase insurance coverage through insurance carriers or state funds or get approval as self-insured.

Workers’ comp is a no-fault insurance program. You can get benefits even if your employer wasn’t responsible for the accident. However, you only have limited compensation options. You get partial wage benefits and medical care. You are generally not eligible for pain and suffering or punitive damages.

After a work-related accident, you must notify your employer and file a claim with the state division of workers’ compensation. Your employer has to cover all related medical expenses. After a waiting period, your employer has to pay disability benefits until you can return to work. Eligibility and the process for filing for workers’ comp benefits vary by state.

What Are Workers’ Compensation Benefits?

Workers’ compensation benefits typically cover medical treatment and wage loss benefits if you can’t work because of a work-related injury. Workers’ comp also covers occupational diseases from exposure or repetitive stress. For a permanent disability, workers comp can also cover vocational rehabilitation. If a worker dies in a workplace injury, their dependents can get death benefits.

Medical benefits continue as long as necessary to treat the injured employee. Temporary total disability benefits continue until the employee can return to full-time work. If workers can do light duty or part-time work, they can often get partial disability benefits.

Wage benefits are based on your average weekly wages. Generally, benefit payments are about two-thirds of your average pay. Benefits can cover a specific time. Sometimes, you can get an extension to cover vocational rehab or retraining for a new job. Workers’ comp coverage, claim requirements, and filing time limits vary by state law.

Who Is Eligible for Workers’ Compensation Benefits?

Not all workers or injuries qualify for workers’ comp benefits. Generally, workers’ compensation does not cover:

  • Injuries sustained outside the workplace
  • Injuries involving drug or alcohol use on the job
  • Intentional injuries

Certain types of workers may not fall under workers’ compensation laws. Exempt workers can include:

  • Farmer workers
  • Maritime workers
  • Independent contractors
  • Volunteers

Some workers have benefits under other workers’ compensation programs, and federal employees have a separate federal workers’ compensation program for work-related injuries.

How Can You Apply for Workers’ Compensation Benefits?

Before applying for benefits, you must report the accident to your employer. After reporting the accident and getting medical attention, you can file a workers’ comp claim. File for benefits with your state workers’ compensation board. Include information about the accident, date of injury, medical provider information, and contact information.

You may have to work together with your employer, doctor, and state agency to complete the application process. You can also contact an attorney to help you with the workers’ compensation injury claim.

Why Did the Insurance Companies Deny Your Workers’ Comp Claim?

The workers’ comp insurance carrier can deny your claim if they think your injuries don’t qualify. Common reasons to deny a workers’ comp claim include:

  • You didn’t report the accident in time
  • You didn’t file a workers’ comp claim within the deadline
  • The injury is not a job-related injury
  • You didn’t follow your healthcare providers’ medical advice
  • You refused to return to work
  • A pre-existing condition caused the impairment
  • Independent medical providers find you are able to return to work

If you get a denial letter, you can request a hearing with your workers’ comp state agency. You can also request reconsideration to have the agency review your claim. If the hearing finds you are not eligible, you can file an appeal. The appeals process varies by state. There is a limited time to file an appeal.

What Other Benefits Are Available After a Workplace Injury?

After exhausting your workers’ compensation benefits, other government benefits are available to help. Long-term benefits can include state benefits and Social Security Disability benefits.

To qualify for total disability benefits, you have to meet the requirements for Social Security disability. However, Social Security Disability Insurance (SSDI) benefits are often lower than your workers’ comp benefits. There is also a maximum monthly benefit under SSDI.

How Can a Workers’ Compensation Lawyer Help?

Making the wrong decisions in a workers’ compensation case could mean having your claim denied. It is more difficult to appeal a denied claim than to get it right the first time. An experienced workers’ compensation lawyer can explain the process to speed up your claim benefits.

Your attorney can represent you in court and guide you through the appeals process. Your attorney can also negotiate a settlement to get compensation. Contact a local workers’ compensation lawyer for legal advice.

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