Workers' Compensation Benefits: FAQ

Workers’ compensation is something that most employees have through their jobs. Most workers don’t know much about the process for claiming workers’ comp. Workers only need to find out what happens after a workplace injury. Navigating the requirements of workers’ compensation claims can be confusing.

This article answers frequently asked questions (FAQs) about workers’ comp benefits. Workers’ compensation laws are different in every state. If you want answers to your specific questions, contact an experienced workers’ compensation lawyer in your state.

What Is Workers’ Compensation?

Workers’ compensation insurance provides benefits to employees who have a work-related injury or disability. Every state has its own workers’ compensation insurance program. Individual workers’ compensation divisions and boards run state programs.

An employer can pay for workers’ comp insurance premiums through a private company, state program, or as a self-insured employer. Worker eligibility, reporting deadlines, and weekly benefits all depend on state law.

Generally, injured employees get workers’ compensation coverage regardless of fault. As a trade-off, workers’ compensation acts don’t allow most employees to sue their employers in a personal injury lawsuit. However, there are exceptions when an employer intentionally or recklessly causes workers’ injuries.

States take workers’ compensation fraud claims seriously. Mistakes or misrepresentations in a workers’ comp claim can expose you to criminal charges.

What Kinds of Benefits Does Workers’ Comp Provide?

Workers’ compensation benefits include paying for medical treatment and wage benefits. You will have your medical expenses covered for any medical care related to the workplace injury. Workers’ comp will also provide wage benefits when you can’t work because of your injuries. Other benefits may include vocational rehabilitation services or retraining to get back to work.

Who Is Eligible for Workers’ Compensation Benefits?

State workers’ compensation laws cover most employees. This includes full and part-time workers and seasonal employees. The federal government offers a separate workers’ compensation program for federal employees.

Independent contractors are generally excluded from workers’ comp benefits. Some employers wrongly classify workers as contractors to avoid giving them benefits and workers’ comp. A lawyer can challenge the employer’s classification to help you get benefits and medical care.

Will Workers’ Compensation Benefits Be Equal to My Wages?

In most jurisdictions, lost wages benefits are about 60% to two-thirds of your average weekly wages. In some states, there is a minimum amount of work injury compensation. States have a maximum amount of compensation no matter how much you make in salary.

How Much Time Do I Have to File a Claim?

You have a limited time from the date of injury to notify your employer. There’s also a time limit to file a claim for workers’ compensation wage and medical benefits.

The timeline for reporting a job-related injury depends on your state. There are different timelines for reporting to the employer and filing a claim. In many states, you must report the accident as soon as possible. Timelines can range from as few as 72 hours to report an injury in Wyoming and up to 180 days to report an injury in Utah.

What Is an Independent Medical Examination?

Your employer can request an independent medical examination (IME) to evaluate your injury. A medical provider will make a physical examination and assess permanent injury impairment. The medical examination healthcare provider is just for the IME.

You can continue receiving medical care from your treating physician. If you fail to attend the IME, your employer can deny the workers’ comp claim.

My Family Member Died at Work. Am I Entitled to Workers’ Comp Benefits?

Generally, workers’ compensation laws provide death benefits for dependents. Depending on the state, workers’ compensation benefits can be for a set period, up to a maximum benefit amount, or indefinitely. Talk to a workers’ comp lawyer to find out about death benefits in your state.

What if an Employee Gets Injured After Not Following Instructions?

Coverage depends on the individual situation. Generally, failing to follow guidelines still gives employees protection under workers’ comp. However, the insurance carrier may try to deny the claim if your conduct was a serious workplace safety violation. Intentional actions causing injury are also generally excluded.

Insurance will also deny injuries that happen when you’re under the influence of alcohol or drugs.

What Happens if the State Denies My Workers’ Comp Claim?

After receiving a notice of denial from your employer or your employer’s insurance company, you may be able to file an appeal. If your state denies your appeal, you can request a hearing to present your appeal. However, there is a limited time to file an appeal with your state’s workers’ compensation board.

When Can I Return To Work?

If you return to work, you must notify the workers’ compensation department. This includes part-time, temporary work, or work as an independent contractor. If your doctor says you can return to light duty or modified work, you must also notify workers’ comp. As soon as you return to work or can return to work, any temporary total disability benefits will end. You may still be eligible for temporary partial disability benefits if you can’t return to full-time employment.

When Should I Call a Workers’ Compensation Lawyer?

You may not need a lawyer for a simple workers’ comp claim. However, serious workers’ compensation cases can be more expensive for the insurance company, and they may look for a way to deny your claim. An experienced workers’ compensation lawyer can help you with complex benefits claims or appeals. Most workers’ comp lawyers offer a free initial consultation, so you don’t have to pay anything upfront. Consult with a workers’ comp attorney to find out about your legal options.