Workers’ Compensation for Employees: FAQ

Workers’ compensation protects employees who suffer job‑related injuries or illnesses by covering medical care, lost wages, and other benefits. Because the rules vary by state and the claims process can be complex, it’s understandable that injured employees have questions about the workers’ comp system.

This FAQ answers questions about workers’ compensation. Learn about eligibility, exemptions, what to expect during the claims process, and more. An attorney near you can also answer your questions and offer legal advice tailored to your situation.

• What are workers’ compensation benefits?
• Am I eligible for workers’ comp?
• What are my employer’s responsibilities on workers’ comp?
• What if my employer doesn’t have workers’ comp insurance?
• Do small businesses need to carry workers’ comp insurance?
• How much will I get in benefits?
• Can I see my own doctor?
• Can I get workers’ compensation and Social Security disability?
• What if I can do some work, but not my regular job?
• What if I’m a part-time worker?
• What happens if my claim gets denied?
• How long do I have to file a claim?
• What are death benefits?
• Do I need a lawyer to file a workers’ comp claim?
• Confused by the workers’ compensation process? An attorney can help

What Do Workers’ Compensation Benefits Cover?

Workers’ compensation benefits are a type of insurance that provides help to employees who have a work-related injury or occupational disease. These benefits can cover:

• Medical expenses and medical care
• Lost wages
• 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 with a job-related injury or illness. This can happen suddenly, such as falling off a ladder. It can also occur gradually over time, like hearing loss from prolonged exposure to loud noises at work. It’s essential to give written notice to your employer about your injury as soon as possible.

In almost all states, your employer must carry workers’ compensation insurance unless they are self-insured. Some workers, like independent contractors or seasonal workers, may not be eligible.

What Are My Employer’s Responsibilities for Workers’ Comp?

On top of providing workers’ compensation coverage, in most states, employers must perform some, if not all, of the following duties:

• Post a notice of compliance with workers’ compensation laws in an obvious place at each job site.

• Provide immediate emergency medical treatment for injured employees who sustain on-the-job injuries.

• 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.

• Complete a report of injury about the workplace injury. The employer must mail it to the nearest workers’ compensation board office. At the same time, they must also send 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.

• Make a written report of every accident resulting in personal injury that causes a loss of time from regular duties beyond the working day or shift when the accident occurred. 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.

• Follow all requests for further information about injured workers. These requests will come from the workers’ compensation board or the insurance company. Examples of what the employer might need 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 to determine the employee’s work status following the injury.

Workers’ compensation system rules vary by state. Talk to an attorney to learn more about eligibility and exemptions in your state.

What If My Employer Doesn’t Have Workers’ Comp Insurance?

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

Injured workers file a claim with the insurance company or self-insuring employer after a work-related accident. The insurance company or self-insuring employer pays medical and disability benefits according to a state-approved formula. Unless exempt, employers without a workers’ compensation insurance policy are subject to fines, criminal prosecution, and civil liability.

Do Small Businesses Need To Carry Workers’ Comp Insurance?

Generally speaking, yes. In many states, small businesses do need to carry workers’ compensation insurance. This helps them if an employee gets hurt at work. The rules can vary based on the size and type of the business, so it’s essential to know your local laws.

In most states, sole proprietors and partnerships aren’t required to purchase workers’ compensation unless and until they have employees who aren’t owners. Most states will allow sole proprietors and partners to cover themselves for workers comp if they choose to. Some states don’t require employees to be covered if they are paid solely on commission.

Many states exempt employers with only a few employees from mandatory coverage laws. The threshold number of employees that triggers mandatory insurance is either three, four, or five, depending on the state.

How Much Will I Get in Workers’ Comp Benefits?

The amount you get in benefits usually depends on your average weekly wage before the date of injury. 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 (TTD), 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 employer’s workers’ compensation insurance adjuster chooses the health care provider. 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 your injury prevents you from performing your usual job duties, you may still qualify for light-duty work. Light-duty work means tasks that are less physically demanding or modified to fit your medical restrictions.

Employers must respect any restrictions outlined by your health care provider. For example, if your doctor says you cannot lift more than 10 pounds, your employer cannot assign you tasks that require heavy lifting. If your assignment violates your restrictions, you should notify your employer and consider seeking legal advice.

If your light-duty job pays less than your regular position, workers’ compensation may cover part of the difference.

What if I’m a Part-Time Worker?

Part-time workers can still receive workers’ comp benefits. The amount depends on your wages, which are likely lower than those of a full-time worker, so it may be less.

What Happens if My Claim Gets Denied?

If your workers’ compensation claim is denied, you’re not necessarily out of options. Denials are fairly common, and most states allow you to appeal the decision. If this occurs, getting expert legal help can make a significant difference in whether you ultimately receive benefits.

Common reasons for workers’ compensation claim denials include:

• You missed the time limit (statute of limitations) for reporting the injury or filing the claim.
• You have insufficient medical evidence linking your condition to your job.
• You were classified as an independent contractor instead of an employee.
• The workers’ compensation insurance carrier believes your injury was not work-related.

How Long Do I Have To File a Claim?

There is a time limit for filing a claim, known as a statute of limitations. This limit varies by state for different types of injuries. Report your injury and state your claim immediately.

Waiting too long can result in losing your right to benefits, even if your injury is severe. If you’re unsure about your state’s deadline, consult a workers’ comp lawyer right away to avoid missing your window for benefits.

What Are Death Benefits?

In some cases, the injury or illness 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 help 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’ Comp Claim?

You can file a claim on your own. The process can be difficult. An expert lawyer 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 usually a portion 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. For example, if you don’t get reimbursed for your impairment, you should speak to an attorney about your legal options.

Because state law is relevant, your legal advisor should be licensed in the state where you work. FindLaw’s directory of workers’ compensation attorneys can get you started. Select your state or city to review ratings and contact information for local experts. Then, reach out for help getting reimbursement for your lost wages and medical bills.