Workers' Compensation: Questions and Answers
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.
Workers file a claim with the insurance company or self-insuring employer when they get injured. The insurance company or self-insuring employer pays medical and disability benefits according to a state-approved formula. Unless they fall within limited and exempt categories, employers without workers' compensation insurance are subject to fines, criminal prosecution, and civil liability.
This article provides the most frequently asked questions (FAQs) about workers' comp benefits. We'll answer the following in FindLaw's workers' compensation FAQs.
- What are workers' compensation benefits?
- Am I eligible for workers' comp?
- What are my employer's responsibilities on workers' comp?
- 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
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, medical care, lost wages, and even vocational rehabilitation if you need to learn a new type of work because of your injury.
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 something that happens 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.
In almost all states, 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.
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.
The workers' compensation system might be different depending on the state. You should check with an attorney about the laws of your state.
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, a permanent disability, or a partial disability.
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 doctor. Check the laws in your state or ask a workers' compensation attorney for more guidance.
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.
If you can do light-duty work, you can still get some benefits, especially if your employer doesn't have any light-duty work for you to do.
Part-time workers can still get workers' comp benefits. The amount depends on your wages, which are likely lower than a full-time worker's, so it might be less.
If your claim gets denied, you can appeal. Many people get help from an attorney. Many injury lawyers only charge a fee if they win your case.
There is a time limit to file a claim called a "statute of limitations." This limit is different in each state for different types of injuries. Report your injury and state your claim immediately.
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.
You can file a claim on your own. The process can be difficult. 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 usually a portion of the benefits you get.
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.
To understand where you stand and your next moves, speak with a workers' compensation lawyer near you.
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Contact a qualified workers' compensation attorney to make sure your rights are protected.