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Workers' Compensation FAQ

In every state except Texas, employers must buy insurance for their employees from a workers' compensation insurance carrier according to the state's workers' compensation act. In some states, larger employers with enough assets can self-insure or act as insurance companies, while smaller companies are exempt. A smaller company is typically one with fewer than three or four employees.

When workers get injured on the job, they file claims with the insurance company or self-insuring employer. The insurance company or self-insuring employer pays medical benefits and disability benefits according to a state-approved formula. Unless they fall within limited and exempt categories, employers without workers' compensation insurance can face fines, criminal prosecution, and civil liability.

This article provides the most frequently asked questions (FAQs) about workers' comp benefits. Read on to learn more about these topics on workers' compensation FAQ:

What Are Workers' Compensation Benefits?

Workers' compensation benefits are a type of insurance that gives help to employees who have a work-related injury or occupational disease. These benefits can cover medical expenses, medical care, lost wages, and even vocational rehabilitation if you need to learn a new type of work because of your injury.

Am I Eligible for Workers' Comp?

To qualify for workers' comp benefits, you must be an employee who suffered an injury or illness related to the job. This can happen all at once, like falling off a ladder, or over time, like hearing loss from loud noises at work.

It's essential to give written notice to your employer about your injury as soon as possible. Your employer must carry workers' compensation insurance unless they are self-insured. Some workers, like independent contractors or seasonal workers, might not be eligible.

For more information, visit FindLaw's Workers' Compensation Eligibility page.

What Are My Employer's Responsibilities on Workers' Comp?

In most states, employers must perform some, if not all, of the following duties:

  • They must post a notice of compliance with workers' compensation laws in an obvious place at each job site.
  • Employers must provide immediate emergency medical treatment for injured employees who sustain on-the-job injuries.
  • They must furnish further medical attention if an injured worker cannot select a medical provider or tells the employer in writing of a desire not to do so.
  • Employers must complete a report of injury about the workplace injury. They must mail it to the nearest workers' compensation board office. They should also mail a copy of the report to the employer's insurance company. An employer who refuses or neglects to make an injury report may be guilty of a misdemeanor that is punishable by a fine.
  • They must make a written report of every accident that results in personal injury and causes a loss of time from regular duties beyond the working day or shift when the accident happened. They must also make a written report for every accident resulting in personal injury that requires medical treatment beyond first aid or more than two treatments by a doctor or any other persons rendering first aid.
  • Employers must comply with all requests for further information on injured workers. These requests will come from the workers' compensation board or the insurance company. Examples of what the employer might be asked to send include the employee's earnings before and after the accident, reports of the date of the employee's return to work, or other reports that may be required to determine the employee's work status following the injury.

The workers' compensation system might be different depending on the state. You should check with an attorney about the laws of your state.

How Much Will I Get in Benefits?

The amount you get in benefits usually depends on your average weekly wage before the date of injury, the type of injury, and your specific state laws. You can get up to two-thirds of your average weekly wage in most states if you are off work. The exact amount and type of benefits can change if you have a temporary total disability, a permanent disability, or a partial disability.

Can I See My Own Doctor?

It depends on where you live. In some states, you can choose your treating physician. In other states, the worker's compensation adjuster selects the doctor. Check the laws in your state or ask a workers' compensation attorney for more guidance.

Can I Get Workers' Compensation and Social Security Disability?

Yes, you can get both. But, the amount of workers' comp benefits might reduce how much you can get from Social Security disability. If this applies to you, seek legal advice.

What if I Can Do Some Work, but Not My Regular Job?

If you can do light-duty work, you can still get some benefits. This is especially true if your employer doesn't have any light-duty work for you to do.

What if I'm a Part-Time Worker?

Part-time workers can still get workers' comp benefits. The amount might be less because it depends on your wages, which are likely lower than a full-time worker.

What Happens if My Claim Is Denied?

If the insurance company denies your claim, you can appeal. The appeal process can be complicated. Many people get help from an attorney. Many injury lawyers only charge a fee if they win your case.

How Long Do I Have to File a Claim?

There is a time limit to file a claim called a "statute of limitations." This limit can be different in each state for different types of injuries. It's essential to report your injury quickly and state your claim immediately.

What Are Death Benefits?

Unfortunately, the injury or illness sometimes results in death. Death benefits are a type of workers' compensation benefit paid to the dependents of a worker who dies because of a job-related injury or illness. These benefits can include payments to replace the worker's lost wages and to cover funeral expenses. The exact amount and eligibility depend on the laws of your state.

Do I Need a Lawyer to File a Workers' Compensation Claim?

You can file a claim on your own. The process can be complex. A workers' compensation attorney can help you understand the process, though. They can also help you gather evidence and argue for your benefits. Workers' compensation lawyers usually work on a "contingency fee" basis. That means they only get paid if they win your case. The fee is typically a part of the benefits you get.

Confused by the Workers' Compensation Process? An Attorney Can Help

Workers' compensation claims involve several parties and can get confusing for non-lawyers. If you believe your employer is not taking care of its workers' comp responsibilities, you may need to assert your rights through legal action.

To get a sense of where you stand and your next moves, it's a good idea to speak with a workers' compensation lawyer near you. A lawyer can help you with your worker's compensation case and help you get reimbursement for your life and medical bills.

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