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Workers' Compensation Benefits Explained

Workers' compensation insurance is a type of insurance purchased by employers for the coverage of employment-related injuries and illnesses. FindLaw's Workers' Compensation Basics has more resources in addition to this article's answers to frequently asked questions about workman's compensation.

What Is Workers' Compensation?

Workers' compensation insurance, often called "workers comp," is a state-mandated program consisting of payments required by law to be made to an employee who is injured or disabled in connection with work. The federal government does offer its own workers' compensation insurance for federal employees, but every individual state has its own workers' compensation insurance program.

Be sure to check your own state's workers' compensation benefits laws by referring to the appropriate office in your state on the State Workers' Compensation official page of the U.S. Department of Labor website.

In most situations, injured employees receive workers' compensation insurance, no matter who was at fault for the injury. These workers comp benefits act as a type of insurance. Benefits preclude the employee from suing their employer for the injuries covered.

What Accidents Are Not Covered by Workers' Comp?

Workers' compensation insurance is designed to cover work injuries. The range of injuries and situations covered is broad, but there are limits. States can impose drug and alcohol testing on the injured employee and can deny the employee workers' compensation benefits if such tests show the employee was under the influence at the time of the injury. Compensation may also be denied if the injuries:

  • Were self-inflicted
  • Occurred because the employee broke the law
  • Did not occur while on the job

What Types of Expenses Does Workers' Compensation Insurance Cover?

Although the payments are usually modest, workers' compensation insurance covers

  • Medical care from the injury or illness
  • Replacement income
  • Costs for retraining
  • Compensation for any permanent injuries
  • Benefits to survivors of workers who are killed on the job

But remember that if a person collects workers' compensation benefits, they cannot sue the employer. And workers' compensation benefits do NOT cover pain and suffering.

Wage replacement is usually 2/3rds of the worker's average wage, but there is a fixed maximum amount that the benefits will not go over. That may seem modest, but note that these benefits are not taxed. So, as long as the employee was making a fair wage, they should have no major problems.

The eligibility for wage replacement begins immediately after a few days of work are missed because of a particular injury or illness. You may have to be taken off work by doctors approved by the worker's comp system or your employer. Those doctors may also decide when you can return to work either light duty or full duty.

Does Workers' Compensation Cover Long-term and Permanent Injuries?

Yes. Workers' compensation insurance is not limited to just incidental accidents. It also covers problems and illnesses that are developed over a long period of time of doing the same injurious activity. For example, carpal tunnel syndrome or back problems from repetitious movement. Some workers are exposed to injurious chemicals or substances over time and the effects may not be known for years.

See also What Types of Injuries are Compensable Under Workers' Compensation?

Who Is Covered by Workers' Compensation?

Most types of employees are covered by workers' compensation insurance. That said, states commonly exclude some workers from coverage, such as:

  • Independent contractors
  • Business owners
  • Volunteers
  • Employees of private homes
  • Farmworkers and farmhands
  • Maritime employees
  • Railroad employees
  • Casual workers

Because employees of the federal government are covered under the federal workers' compensation insurance program, they are not covered by state workers' comp. Some states do not enforce the workers' compensation program on employers with fewer than 3 to 5 employees working for them. This varies from state to state.

Can I Sue My Employer for a Work Injury?

Workers compensation was created as an alternative to filing a personal injury lawsuit. In some states, however, you may still be able to sue your employer for any reckless or intentional action of your employer that caused your injury. Other states may allow a wrongful death lawsuit if an injury results in the employee's death. In general, if you choose to do this, you will waive your right to workers' compensation.

If you are successful, the court may award a broad range of damages, such as punitive damages, medical expenses, lost wages, pain and suffering, and mental anguish.

Can My Employer Fire Me for Filing a Workers' Compensation Claim?

No. Most states prohibit this by law. If an employer does retaliate against an employee for filing a workers' compensation claim, the employer should be reported immediately to the local workers' compensation office.

Learn About Your Benefits From an Experienced Workers' Comp Attorney

Accidents occurring on the job should be covered by workers' compensation insurance. If you've been injured on the job and your employer disputes your workers' comp claim, you likely need legal help. An experienced workers' compensation lawyer can provide peace of mind for your claim.

You Don’t Have To Solve This on Your Own – Get a Lawyer’s Help

Meeting with a lawyer can help you understand your options and how to best protect your rights. Visit our attorney directory to find a lawyer near you who can help.

Or contact an attorney near you:

Next Steps

Contact a qualified workers' compensation attorney to make sure your rights are protected.

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