Workers' Compensation Basics

By Jade Yeban, J.D. | Legally reviewed by Katrina Wilson, Esq. | Last reviewed August 23, 2023

Employees injured on the job are eligible to collect workers' compensation benefits. The claims process is intended to be straightforward, but there are specific guidelines for determining whether a particular injury or illness qualifies for compensation. Specific procedures must be followed in order to file a proper claim.

This section provides resources to help you understand the basics of workers' compensation law. This section also serves to help you begin the claim process. Learn from articles discussing work-related injuries and your rights as an injured worker. You will also find information to help you decide whether hiring an attorney to represent you would be a good idea.

Workers' Compensation - Basic Info

Workers' compensation, or workers' comp, is insurance coverage. This coverage benefits workers who experience a work injury. It also covers employees who develop an occupational disease. It is a job-related insurance program that operates under state law.

Workers' comp is a deal between workers and their employees. Workers' comp insurance steps in if a worker gets hurt on the job or becomes sick because of their work. An insurance company usually provides this insurance, also called an insurance carrier.

When a worker is injured or falls ill due to work, they can file a workers' comp claim. This claim, if accepted, allows them to receive benefits that help cover the cost of medical treatment. This can include doctor visits and physical therapy. It also helps cover part of their lost wages if they need to take time off work.

It is essential to know that workers' comp coverage usually only applies to employees. Workers' comp does not apply to independent contractors. If an independent contractor is injured while working, they may not be covered.

The Purpose of Workers' Compensation

Workers' compensation is meant to provide employees with an efficient way to receive money for work-related injuries. It is usually irrelevant who was at fault for causing the injury. If the employee was injured while on the job, they can file a claim for workers' compensation benefits. However, there are a few exceptions.

Because an injured worker and their family can experience sudden hardship caused by the unexpected loss of income, workers' compensation benefits are intended to provide injured workers with a way to pay bills and medical costs during recovery. The system involves a trade-off: injured workers receive payments quickly, but these payments are capped. An employer is protected from lawsuits but must provide benefits to injured workers even if the employer is not at fault.

The Process of Filing a Workers' Compensation Claim: At a Glance

The process starts with reporting the workplace injury to the employer. The employer, or a co-worker, can then contact the insurance carrier to start the claim. Sometimes the employer might be self-insured, which means they'll handle the workers' comp benefits themselves.

If a worker has a job injury, it is essential for them to get medical treatment. Medical benefits from workers' comp insurance can cover these medical bills. This coverage can be a lifeline, whether a personal injury like a broken bone, an injury from a car accident while on the job, or even a disease from exposure to harmful substances at work.

The rules for workers' comp differ among the states. They are governed by each state's workers' compensation act. In many places, the state agency that oversees this system is the Division of Workers' Compensation (DWC). This is usually a part of the Department of Labor.

Set Payment Amounts

It is essential to remember that workers' compensation benefits are typically capped by law. The payment amount decreases over time as the employee heals and begins to resume job duties.

Types of Injuries

Common injuries include someone hurting their back in a fall or from lifting heavy objects, burns or respiratory ailments related to the use of chemicals, and injuries from traffic accidents. Workers who suffer injury from repetitive motions (for example, a wrist injury caused by typing) can usually file for workers' compensation, and some stress-related injuries may be covered.

Remember that workers' compensation insurance generally covers all injuries incurred during job duties. This includes injuries that occur at an off-site location. For example, this can also include business travel. However, injuries caused by employee misconduct, injuries outside the scope of work, and injuries caused by "acts of God" are not covered.

Benefits

Workers' compensation benefits pay costs associated with medical care, lost wages, and retraining if the injury forces the employee to seek a new position or line of work. Workers' compensation payments do not account for any pain and suffering the injured employee might experience.

Workers' comp benefits might include disability benefits if they cannot work due to injury or disease. These benefits can be for:

Temporary disability
Permanent disability
Total disability
Death benefits (for dependents if the worker passes away due to a work-related injury)

The amount of these benefits often depends on the worker's average weekly wage before their injury.

Workers' Compensation vs. Civil Lawsuit

Suppose the injury is caused by the employer's purposeful disregard for employee safety. In that case, the injured worker can usually file a lawsuit instead of proceeding with a workers' compensation claim.

If the employee is successful in the lawsuit, they might recover more money than through a workers' compensation claim. They may be able to seek attorney's fees and punitive damages as well.

How an Attorney Can Help

Although workers' compensation laws are meant to provide injured workers with fast relief, the claim process can be complicated and involve time-sensitive deadlines and a lot of paperwork. If you have been injured at work and want to file a claim as soon as possible, an attorney can help.

Remember, each case is unique. Not all injury cases will be treated similarly under the workers' compensation system. Understanding these basics can help you navigate what can be a complex process. If you need help, do not hesitate to contact a workers' compensation attorney for guidance. They will use their expertise to explain your options and help you choose your best path forward.

Learn About Workers' Compensation Basics

Workers' Comp In-Depth

A comprehensive overview of workers' compensation insurance and what it covers. Learn about workers’ compensation laws, the scope of coverage, the types of injuries covered, and how to file a claim.
Workers' Comp: Employers' Responsibilities

Employers in most states are required to provide their employees with workers’ compensation insurance. Failure to do so can result in fines, civil liability, and even criminal prosecution in certain circumstances.
Workers' Comp Benefits Explained

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What Types of Injuries are Compensable?

Only injuries that are connected in some way to an employment requirement or condition are compensable by workers’ compensation insurance. This section details how insurers define "work-related injury" for the purposes of determining coverage.
Can I Sue My Employer Instead?

In some rare circumstances, as in the case of intentional torts, an employee can sue his or her employer rather than pursue workers’ compensation benefits. In this section, you’ll learn when you can, and cannot, sue your employer for a work-related injury.
Workers' Comp and Returning to Work

In most states, an injured worker is entitled to benefits for medical care, temporary or permanent disability, and vocational rehabilitation. Depending on the amount of the employee’s wages, however, benefits may be stopped once the employee returns to work.