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Workers' Compensation Benefits: FAQ

Workers' compensation is something that most employees have through their job. It would help to learn more about the process for claiming workers' comp or what happens after you are injured on the job. Once a workplace injury does occur, navigating the requirements of workers' compensation benefits can be confusing.

The following provides brief answers to frequently asked questions (FAQs) about workers' comp benefits and when a worker might want to contact an attorney. Workers' compensation laws are different in every state. If you want answers to your specific workers' compensation questions, contact an experienced workers' compensation lawyer in your state for further information.

What Is Workers' Compensation?

Workers' compensation insurance, also called workers' comp, is a state-run program of benefits made to an employee who is injured or disabled while on the job. The federal government offers a separate workers' compensation program for federal employees. Every state has its own specific workers' compensation insurance program and division of workers' compensation.

Depending on the state, an employer can pay for workers' comp insurance premiums through a private company, through a state program, or be approved as a self-insured employer. Worker eligibility, the period to first report of injury, the payment of compensation, and weekly benefits may all depend on state law. Talk to a workers' comp attorney for more information about workers' compensation in your state.

In most cases, injured employees receive workers' compensation coverage regardless of who was at fault for the work-related injury. As a trade-off, these state workers' compensation acts don't allow most employees to sue their employer for injuries in a personal injury lawsuit. However, there are exceptions where an employer intentionally or recklessly caused the workers' injuries.

What Kinds of Benefits Does Workers' Comp Provide?

Workers' compensation benefits include paying for medical treatment and wage benefits. An injured worker will have their medical expenses covered for any medical care related to the workplace injury. Workers' comp will also provide wage benefits to workers when they cannot work because of their injuries. Other benefits may include occupational therapy or vocational job retraining to help get the employee back to work.

Will Workers' Compensation Benefits Be Equal To My Wages?

Generally, no. Most jurisdictions will compensate an injured employee for lost wages due to injury at about two-thirds of the employee's average weekly wages. There may also be a minimum amount of work injury compensation that must be paid per week and a maximum amount of compensation, regardless of the employee's salary.

How Much Time Do I Have to File a Claim?

Workers have a limited time from the date of injury to notify their employer of the injury and file a claim for workers' compensation wage and medical benefits. The timeline for reporting a job-related injury depends on the state, with different timelines for reporting to the employer and filing a claim. In many states, the worker must report the accident "as soon as possible." Timelines can range from as little as 72 hours in Wyoming to report an injury 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 or occupational disease. A medical provider will make a physical examination and may also assess permanent injury impairment. The medical examination healthcare provider is just for the IME, and you can continue receiving medical care from your treating physician. If you fail to attend the IME, your workers' comp claim could be denied.

My Family Member Was Killed at Work. Am I Entitled To Workers' Comp Benefits?

Generally, workers' compensation laws allow death benefits to be paid to dependents. Depending on the state, workers' compensation benefits can be made for a set period, up to a maximum benefit amount, or indefinitely. For example, in Connecticut, there is no time limit for death benefits for the spouse but can be stopped if the spouse gets remarried or dies.

In some states, workers' compensation statutes will allow beneficiaries other than dependents to collect death benefits when an employee has died from a workplace injury. For example, in New York, benefits are paid to the spouse and children. If no dependents exist, death benefits can be given to surviving parents.

What if an Employee Is Injured After Not Following Instructions?

Generally, if an employee has failed to follow the rules or guidelines established by their employer, the injury will still be protected by workers' compensation insurance coverage. However, if the employee's conduct is a serious and intentional violation of rules or guidelines established for workplace safety, the workers' compensation insurance carrier may try to deny the claim. Injuries that happen when the worker is under the influence of alcohol or drugs may also be denied.

What Happens if a Workers' Comp Claim Is Denied?

After receiving a notice of denial from an employer or the employer's insurance company, employees may be able to file an appeal to protect their benefit rights. 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.

For example, in Wyoming, the worker only has 15 days after the date the written notice of the final determination is mailed to request a hearing. Make sure you talk to an attorney or file an appeal in time, or you may lose your rights to receive workers' comp benefits and reimbursement for medical bills.

When Can I Return to Work?

If you return to work, you must notify the workers' compensation department immediately. 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 your 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 cannot return to full-time employment.