{"id":353602,"date":"2016-04-04T10:47:02","date_gmt":"2016-04-04T15:47:02","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/injury\/workers-compensation\/workers-compensation-basics.html"},"modified":"2025-12-01T13:51:00","modified_gmt":"2025-12-01T18:51:00","slug":"workers-compensation-basics","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-basics.html","title":{"rendered":"Workers&#8217; Compensation Legal Basics for Employees"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n<div class=\"fl-page-articles fl-section-main fl-section-main-full-width\"><h1 class=\"fl-no-margin-top\">Workers&#039; Compensation Legal Basics for Employees<\/h1>\n\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/jade-yeban-j-d\/\">Jade Yeban, Esq.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/katrina-wilson-esq\/\">Katrina Wilson, Esq.<\/a>\n                | Last updated\n        <time>\n                            December 01, 2025\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n\n\n<div class=\"fl-key-takeaways fl-mb30\" data-testid=\"fl-key-takeaways\">\n    <div class=\"fl-card-content\">\n        <div class=\"fl-card-body fl-card-bg-teal fl-flex fl-flex-column\">\n                            <h2 class=\"fl-card-title fl-h2 fl-no-margin\">Key Takeaways<\/h2>\n                        <p><span data-term-id=\"55270384\">Workers\u2019 compensation<\/span> provides benefits to employees injured on the job, covering medical costs and partial <span data-term-id=\"55270403\">lost wages<\/span>. Rules vary by state, with each state setting its own procedures, coverage requirements, and benefit limits. Filing a claim requires promptly reporting the injury and following state\u2011specific guidelines.<\/p>\n\n        <\/div>\n    <\/div>\n<\/div>\n\n\n<p>The <span data-term-id=\"55270384\">workers\u2019 compensation<\/span> program protects employees who are injured or become ill on the job.\u00a0It also shields employers from costly lawsuits. Because every state has its own rules and procedures, understanding how the process works is crucial for <span data-term-id=\"55270393\">injured employees<\/span> to get the benefits they\u2019re entitled to.<\/p>\n<p>This guide explains what workers should know about <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-in-depth.html\"><span data-term-id=\"55270384\">workers\u2019 compensation<\/span><\/a>. It outlines key legal basics, including:<\/p>\n<ul>\n<li>Who qualifies for compensation<\/li>\n<li>Covered injuries<\/li>\n<li>The <span data-term-id=\"55270418\">claim process<\/span><\/li>\n<li>How <span data-term-id=\"55270409\">state laws<\/span> govern <span data-term-id=\"55270384\">workers\u2019 compensation<\/span><\/li>\n<li>The <span data-term-id=\"55270401\">insurance carrier<\/span>\u2019s role in claims<\/li>\n<li>And more<\/li>\n<\/ul>\n<p>Navigating a <span data-term-id=\"55270394\">workers\u2019 comp<\/span> claim while recovering from a <span data-term-id=\"55270391\">workplace injury<\/span> can be overwhelming and frustrating. Contact a <a href=\"https:\/\/lawyers.findlaw.com\/workers-compensation-law\/\" target=\"_blank\" rel=\"noopener\"><span data-term-id=\"55270414\">workers\u2019 compensation<\/span><span data-term-id=\"55270414\"> attorney<\/span><\/a> near you for help managing your claim. While they pursue benefits, you can focus on your <span data-term-id=\"55270387\">medical care<\/span>.<\/p>\n<h2><span data-term-id=\"55270384\">Workers\u2019 Compensation<\/span> Rules Vary by State<\/h2>\n<p>Almost every state requires businesses to carry <span data-term-id=\"55270399\">workers\u2019 compensation<\/span><span data-term-id=\"55270399\"> coverage<\/span>. The <a href=\"https:\/\/www.findlaw.com\/state\/texas-law\/texas-workers-compensation-laws.html\">exception is Texas<\/a>, which\u00a0does not require private employers to have <span data-term-id=\"55270388\">workers\u2019 compensation<\/span><span data-term-id=\"55270388\"> insurance<\/span>.\u00a0<span data-term-id=\"55270395\">Workers\u2019 compensation<\/span><span data-term-id=\"55270395\"> laws<\/span> <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-laws-by-state.html\">vary by state<\/a> and are governed by each <span data-term-id=\"55270412\">state\u2019s <\/span><span data-term-id=\"55270384\">workers<\/span><span data-term-id=\"55270384\">\u2019 compensation<\/span> act.<\/p>\n<p>For example, some states don\u2019t require certain small businesses to carry <span data-term-id=\"55270394\">workers\u2019 comp<\/span> insurance. In others, it\u2019s a must. Some states also have specific rules regarding which types of injuries are covered. For example, if a car accident happens while you\u2019re working or a coworker causes a car accident, the rules about coverage could change depending on the state where you work.<\/p>\n<p>Statutes in each state establish <span data-term-id=\"55270384\">workers\u2019 compensation<\/span> rules. <a href=\"https:\/\/www.findlaw.com\/litigation\/legal-system\/federal-vs-state-courts-key-differences.html\"><span data-term-id=\"55270409\">State laws<\/span><\/a> and court decisions control the program in that state, and no two states have exactly the same laws and regulations. Each state dictates whether <span data-term-id=\"55270388\">workers\u2019 compensation<\/span><span data-term-id=\"55270388\"> insurance<\/span> is provided by state-run agencies, private <span data-term-id=\"55270413\">insurance companies<\/span>, or by the state alone.<\/p>\n<p>States also establish procedures for handling claims and resolving disputes. States also may devise strategies, such as limits on chiropractic care, to control costs.<\/p>\n<p>In many places, the <span data-term-id=\"55270406\">state agency<\/span> that oversees this system is the <span data-term-id=\"55270426\">Division of <\/span><span data-term-id=\"55270384\">Workers\u2019 Compensation<\/span> (<span data-term-id=\"55270425\">DWC<\/span>). This is usually a part of the <a href=\"https:\/\/www.dol.gov\/agencies\/ofccp\/contact\/district-area-offices\" target=\"_blank\" rel=\"noopener\"><span data-term-id=\"55270429\">Department of Labor<\/span><\/a>.<\/p>\n<h2><span data-term-id=\"55270384\">Workers\u2019 Compensation<\/span>: Basic\u00a0Info Workers Should Know<\/h2>\n<p><span data-term-id=\"55270384\">Workers\u2019 compensation<\/span> is a type of insurance coverage that operates under <span data-term-id=\"55270409\">state law<\/span>. This coverage benefits workers who experience a <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/what-types-of-injuries-are-compensable-under-workers-compensation.html\"><span data-term-id=\"55270424\">work injury<\/span><\/a>. It also covers employees who develop an <span data-term-id=\"55270396\">occupational disease<\/span>.<\/p>\n<p>Essentially, <span data-term-id=\"55270394\">workers\u2019 comp<\/span> insurance is a deal between workers and their employers. <span data-term-id=\"55270384\">Workers&#8217; compensation<\/span>\u00a0steps in if a worker gets hurt on the job or becomes sick due to their work. An <span data-term-id=\"55270413\">insurance company<\/span> (<span data-term-id=\"55270401\">insurance carrier<\/span>) usually provides this insurance.<\/p>\n<p>When a worker is injured, they can file a <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/the-workers-compensation-claim-process.html\"><span data-term-id=\"55270394\">workers\u2019 comp<\/span> claim<\/a>. This claim, if accepted, allows them to receive benefits that help cover the cost of <span data-term-id=\"55270397\">medical treatment<\/span>. This can include doctor visits and physical therapy. It also helps cover part of their <span data-term-id=\"55270403\">lost wages<\/span> if they need to take time off work.<\/p>\n<h3><strong>Workers\u2019 Compensation Also Protects Businesses<\/strong><\/h3>\n<p><span data-term-id=\"55270394\">Workers\u2019 comp<\/span> insurance is not just about protecting employees\u2014it also <a href=\"https:\/\/www.findlaw.com\/smallbusiness\/liability-and-insurance\/workers-compensation.html\">protects businesses<\/a>. <span data-term-id=\"55270384\">Workers\u2019 compensation<\/span> is considered the exclusive remedy for <span data-term-id=\"55270391\">workplace injuries<\/span>. This means employees generally cannot sue their employers for work\u2011related injuries, as long as <span data-term-id=\"55270394\">workers\u2019 comp<\/span> benefits are provided. By limiting <span data-term-id=\"55270422\">personal injury<\/span> lawsuits, <span data-term-id=\"55270394\">workers\u2019 comp<\/span> helps businesses avoid costly litigation.<\/p>\n<p>The system involves a trade-off: <span data-term-id=\"55270385\">injured workers<\/span> receive payments quickly, but these payments are capped. An employer is <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-can-i-sue-my-employer-instead.html\">protected from lawsuits<\/a> but must provide benefits to <span data-term-id=\"55270385\">injured workers<\/span> even if the employer is not at fault.<\/p>\n<p>A claim for a serious employee injury could\u00a0<a href=\"https:\/\/www.findlaw.com\/bankruptcy\/business-bankruptcy.html\">bankrupt\u00a0many small businesses<\/a>. Insurance, through paying <span data-term-id=\"55270410\">premiums<\/span> for <span data-term-id=\"55270399\">workers\u2019 compensation<\/span><span data-term-id=\"55270399\"> coverage<\/span>, provides a predictable cost for handling this risk.<\/p>\n<h2>Covered Workers Under <span data-term-id=\"55270384\">Workers\u2019 Compensation<\/span><\/h2>\n<p>Generally, <span data-term-id=\"55270394\">workers\u2019 comp<\/span> coverage only applies to employees. It does not apply to <span data-term-id=\"55270400\">independent contractors<\/span>.<\/p>\n<p>The <a href=\"https:\/\/www.findlaw.com\/smallbusiness\/employment-law-and-human-resources\/worker-classification-guide.html\">definition of\u00a0employee<\/a>\u00a0can vary. In general, anyone who performs work for a business in exchange for wages or other forms of compensation is an employee. Both full-time and part-time workers are considered employees under <span data-term-id=\"55270395\">workers\u2019 compensation<\/span><span data-term-id=\"55270395\"> laws<\/span>. Whether you work 40 hours a week or just a few, if you\u2019re hurt on the job,\u00a0you\u2019re typically entitled to <span data-term-id=\"55270392\">workers\u2019 compensation<\/span><span data-term-id=\"55270392\"> benefits<\/span>.<\/p>\n<p>Many states recognize migrant workers and seasonal workers as employees for <span data-term-id=\"55270384\">workers\u2019 compensation<\/span> purposes. This means that if these workers are injured on the job, they are eligible for benefits. Importantly, a worker\u2019s legal status generally does not affect their ability to receive <span data-term-id=\"55270392\">workers\u2019 compensation<\/span><span data-term-id=\"55270392\"> benefits<\/span>. If you\u2019re injured while working, you have the right to seek compensation, regardless of your\u00a0<a href=\"https:\/\/www.findlaw.com\/immigration\/immigration-overview\/immigration-faqs.html\">immigration status<\/a>.<\/p>\n<p>However, there are some exceptions:<\/p>\n<ul>\n<li>\n<p><strong>Family Members<\/strong>: In some states, business owners\u2019 immediate family members (such as their parents, spouse, and children) who work for them may not be required to be counted as employees when determining whether they must have\u00a0<span data-term-id=\"55270388\">workers&#8217; compensation<\/span><span data-term-id=\"55270388\"> insurance<\/span>. These exceptions usually do not apply to other family members, such as sisters, brothers, or in-laws.<\/p>\n<\/li>\n<li>\n<p><strong>Contractors<\/strong>: Under some laws, freelancers and\u00a0<a href=\"https:\/\/www.findlaw.com\/employment\/hiring-process\/independent-contractors-overview.html#:~:text=As%20an%20independent%20contractor%2C%20the,entitled%20to%20direct%20your%20work.\"><span data-term-id=\"55270400\">independent contractors<\/span><\/a>\u00a0are not considered employees. However, some states\u2019 <span data-term-id=\"55270394\">workers\u2019 comp<\/span> laws treat uninsured contractors\/subcontractors or employees of an uninsured subcontractor as employees. This means employers may be liable if they sustain <span data-term-id=\"55270391\">workplace injuries<\/span> while working for them.<\/p>\n<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.findlaw.com\/employment\/hiring-process\/part-time-temporary-and-seasonal-employees.html\">Temporary workers<\/a>, such as those hired through a staffing agency, are typically considered employees of the staffing agency and not the company where they perform work. As such, the staffing agency would usually be responsible for carrying <span data-term-id=\"55270388\">workers\u2019 compensation<\/span><span data-term-id=\"55270388\"> insurance<\/span>.<\/p>\n<p>Laws and regulations vary by state and situation. If you\u2019re unsure about whether you\u2019re considered an\u00a0employee\u00a0for <span data-term-id=\"55270384\">workers\u2019 compensation<\/span> purposes, it\u2019s best to consult with a <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/important-questions-to-ask-a-workers-compensation-lawyer.html\"><span data-term-id=\"55270414\">workers\u2019 compensation<\/span><span data-term-id=\"55270414\"> attorney<\/span><\/a>. They can help you understand your rights and guide you through the process.<\/p>\n<h2>Starting a <span data-term-id=\"55270389\">Workers\u2019 Compensation<\/span><span data-term-id=\"55270389\"> Claim<\/span><\/h2>\n<p>The process starts with reporting the <span data-term-id=\"55270391\">workplace injury<\/span> to the employer. The employer, or a co-worker, can then\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-employers-responsibilities.html\">contact the <span data-term-id=\"55270401\">insurance carrier<\/span><\/a> to start the claim. Sometimes\u00a0the employer might be <span data-term-id=\"55270415\">self-insured<\/span>, which\u00a0means they\u2019ll handle the <span data-term-id=\"55270394\">workers\u2019 comp<\/span> benefits themselves.<\/p>\n<p>If a worker has a job injury, it is essential for them\u00a0to get <span data-term-id=\"55270397\">medical treatment<\/span>. Examples of covered injuries include:<\/p>\n<ul>\n<li>A broken bone<\/li>\n<li>An injury from a car accident <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/the-going-and-coming-rule.html\">while on the job<\/a><\/li>\n<li>An illness from exposure to <a href=\"https:\/\/www.findlaw.com\/employment\/workplace-safety\/toxic-exposure-in-the-workplace.html\">harmful substances at work<\/a><\/li>\n<\/ul>\n<p><span data-term-id=\"55270417\">Medical benefits<\/span> from <span data-term-id=\"55270394\">workers\u2019 comp<\/span> insurance can cover these medical bills.<\/p>\n<h2>Set Payment Amounts<\/h2>\n<p><span data-term-id=\"55270392\">Workers\u2019 compensation<\/span><span data-term-id=\"55270392\"> benefits<\/span> are typically capped by law. The payment amount decreases over time as the employee recovers and <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-benefits-and-returning-to-work.html\">resumes their <span data-term-id=\"55270420\">job duties<\/span><\/a>.<\/p>\n<h2>Types of Covered Injuries<\/h2>\n<p>Common <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/what-types-of-injuries-are-compensable-under-workers-compensation.html\"><span data-term-id=\"55270391\">workplace injuries<\/span><\/a> covered under <span data-term-id=\"55270394\">workers\u2019 comp<\/span> include:<\/p>\n<ul>\n<li>Back injuries from falling or lifting heavy objects<\/li>\n<li>Burns or respiratory ailments related to the use of chemicals<\/li>\n<li>Work-related traffic accident injuries<\/li>\n<li>Injuries sustained from repetitive motions (for example, a wrist injury caused by typing)<\/li>\n<li>Some stress-related injuries<\/li>\n<\/ul>\n<p><span data-term-id=\"55270384\">Workers\u2019 compensation<\/span> generally covers all injuries incurred during <span data-term-id=\"55270420\">job duties<\/span>. This includes injuries that occur at an off-site location. For example, this can also include <a href=\"https:\/\/www.findlaw.com\/smallbusiness\/liability-and-insurance\/driving-on-company-time.html\">business travel<\/a>. However, injuries caused by employee misconduct, injuries outside the scope of work, and injuries caused by &#8220;acts of God&#8221; are not covered.<\/p>\n<h2><span data-term-id=\"55270392\">Workers\u2019 Compensation<\/span><span data-term-id=\"55270392\"> Benefits<\/span><\/h2>\n<p><span data-term-id=\"55270392\">Workers\u2019 compensation<\/span><span data-term-id=\"55270392\"> benefits<\/span> cover the costs associated with\u00a0<span data-term-id=\"55270387\">medical care<\/span>,\u00a0<span data-term-id=\"55270403\">lost wages<\/span>, and\u00a0<span data-term-id=\"55270427\">retraining<\/span> or <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/rehabilitation-rights-of-injured-workers.html\"><span data-term-id=\"55270433\">vocational rehabilitation<\/span><\/a>\u00a0if the injury forces you to seek a new position or line of work. <span data-term-id=\"55270384\">Workers\u2019 compensation<\/span> payments do not account for any pain and suffering the <span data-term-id=\"55270393\">injured employee<\/span> might experience.<\/p>\n<p>It may also include <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/the-difference-between-workers-comp-and-disability-benefits.html\"><span data-term-id=\"55270390\">disability benefits<\/span><\/a> if a worker is unable to work due to an injury or disease. These benefits can be for:<\/p>\n<ul>\n<li><span data-term-id=\"55270419\">Temporary disability<\/span><\/li>\n<li><span data-term-id=\"55270407\">Permanent disability<\/span><\/li>\n<li><span data-term-id=\"55270416\">Total disability<\/span><\/li>\n<li><span data-term-id=\"55270411\">Death benefits<\/span> (for <span data-term-id=\"55270398\">dependents<\/span> if the worker dies from a <span data-term-id=\"55270386\">work-related injury<\/span>)<\/li>\n<\/ul>\n<p>The amount of these benefits often depends on the worker\u2019s average weekly wage before their injury.<\/p>\n<h2><span data-term-id=\"55270384\">Workers\u2019 Compensation<\/span> vs. Civil Lawsuit<\/h2>\n<p>Suppose the injury is caused by the employer\u2019s purposeful disregard for employee safety. In that case, the <span data-term-id=\"55270385\">injured worker<\/span> can usually <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-can-i-sue-my-employer-instead.html\">file a lawsuit<\/a> instead of\u00a0proceeding with a <span data-term-id=\"55270389\">workers\u2019 compensation<\/span><span data-term-id=\"55270389\"> claim<\/span>.<\/p>\n<p>If the employee is successful in the lawsuit, they might recover more money than through a <span data-term-id=\"55270389\">workers\u2019 compensation<\/span><span data-term-id=\"55270389\"> claim<\/span>. They may also be able to seek <a href=\"https:\/\/www.findlaw.com\/litigation\/filing-a-lawsuit\/attorneys-and-fees.html\">attorney fees<\/a> and punitive damages. Punitive damages are financial awards meant to punish wrongful conduct and deter similar future behavior.<\/p>\n<h2>Who Owns <span data-term-id=\"55270388\">Workers\u2019 Compensation<\/span> <span data-term-id=\"55270401\">Insurance<\/span><span data-term-id=\"55270401\"> Carriers<\/span>?<\/h2>\n<p><span data-term-id=\"55270388\">Workers\u2019 compensation<\/span> <span data-term-id=\"55270413\">insurance<\/span><span data-term-id=\"55270413\"> companies<\/span> can either be privately owned or publicly owned through a government fund. This means they could either be owned by private individuals or business entities or be part of a state-run program.<\/p>\n<p>Whether an <span data-term-id=\"55270413\">insurance company<\/span> is privately owned or a public fund can influence the <a href=\"http:\/\/xn--%20%20%20workers%20compensation%20benefits%20and%20returning%20to%20workhttps-4z82cda42b\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-benefits-and-returning-to-work.html%20%E2%80%94%20%E2%80%94%20Workers%E2%80%99%20Compensation%20Eligibilityhttps:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-eligibility.html%20%E2%80%94%20%E2%80%94%20Workers%E2%80%99%20Compensation%20Benefits%20Explainedhttps:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-benefits-explained.html%20%E2%80%94%20%E2%80%94%20Workers%E2%80%99%20Compensation%20In-Depthhttps:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-in-depth.html%20%20%E2%80%94%20%E2%80%94%20Workers%E2%80%99%20Compensation%20Legal%20Basicshttps:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-compensation-basics.html%20%E2%80%94%20%E2%80%94%20What%20Is%20Workers%E2%80%99%20Compensation%20Insurance?https:\/\/www.findlaw.com\/injury\/workers-compensation\/what-is-workers-compensation-insurance.html%20%20%E2%80%94%20%E2%80%94%20Are%20Workers%E2%80%99%20Compensation%20Benefits%20Taxable?https:\/\/www.findlaw.com\/injury\/workers-compensation\/are-workers-compensation-benefits-taxable.html%20%E2%80%94%20%E2%80%94%20The%20Workers%E2%80%99%20Compensation%20Claim%20Processhttps:\/\/www.findlaw.com\/injury\/workers-compensation\/the-workers-compensation-claim-process.html\"><span data-term-id=\"55270418\">claims process<\/span><\/a>. Private insurers might be more focused on controlling costs as they aim to make a profit. They might scrutinize claims more closely or be more likely to dispute certain costs.\u00a0<\/p>\n<p>Public funds, on the other hand, might be more focused on ensuring coverage for as many workers as possible. They might be less likely to dispute claims. However, they might have stricter guidelines on what types of injuries are covered. <span data-term-id=\"55270409\">State laws<\/span> regulate both types of insurers. Both are required to pay legitimate claims.<\/p>\n<p>The cost of the <span data-term-id=\"55270401\">insurance carrier<\/span> can vary. This depends on how risky the business\u2019 work is and how many employees they have. Each state has its own rules about where employers may buy <a href=\"https:\/\/www.findlaw.com\/smallbusiness\/liability-and-insurance\/workers-compensation-faq.html\"><span data-term-id=\"55270394\">workers\u2019\u00a0comp<\/span> insurance<\/a>. Five states and two U.S. territories require employers to get coverage exclusively through state-operated funds:<\/p>\n<ul>\n<li>North Dakota<\/li>\n<li>Ohio<\/li>\n<li>Puerto Rico<\/li>\n<li>U.S. Virgin Islands<\/li>\n<li>Washington<\/li>\n<li>West Virginia<\/li>\n<li>Wyoming<\/li>\n<\/ul>\n<p>In many other states, insurance may be purchased from the state fund or from private insurers. In the states that have them, state funds may serve as an insurer of last resort for businesses that cannot find coverage from a private insurer. A <a href=\"https:\/\/lawyers.findlaw.com\/workers-compensation-law\/\" target=\"_blank\" rel=\"noopener\"><span data-term-id=\"55270414\">workers\u2019 compensation<\/span><span data-term-id=\"55270414\"> attorney<\/span><\/a> can help businesses understand their insurance needs and their <span data-term-id=\"55270409\">state laws<\/span>.<\/p>\n<h2>How Insurers Handle <span data-term-id=\"55270394\">Workers\u2019 Comp<\/span> Claims<\/h2>\n<p>When a <span data-term-id=\"55270389\">workers\u2019 compensation<\/span><span data-term-id=\"55270389\"> claim<\/span> is filed, the <span data-term-id=\"55270401\">insurance carrier<\/span> takes on the role of reviewing and processing the claim. A <span data-term-id=\"55270384\">workers\u2019 compensation<\/span> insurer is a business. This means they have an interest in managing costs. They might do this if they believe claims are invalid or too expensive.<\/p>\n<p>The insurer will review the claim. They will look at all relevant details, including:<\/p>\n<ul>\n<li>The details of the accident<\/li>\n<li>The nature of the <span data-term-id=\"55270386\">work-related injury<\/span><\/li>\n<li>The <span data-term-id=\"55270397\">medical treatment<\/span> received<\/li>\n<\/ul>\n<p>This review process helps them determine whether their <span data-term-id=\"55270384\">workers\u2019 compensation<\/span> policy covers the claim. The insurer will also evaluate <span data-term-id=\"55270405\">medical expenses<\/span>. They check to see if the costs are reasonable and necessary based on the injury. They might <a href=\"http:\/\/findlaw.com\/injury\/workers-compensation\/common-workers-compensation-defenses.html\" target=\"_blank\" rel=\"noopener\">dispute certain costs<\/a>.<\/p>\n<p>Remember, these insurers are regulated by <span data-term-id=\"55270409\">state laws<\/span>. These laws require them to act in good faith, meaning they must deal fairly and honestly with claimants. If an insurer unjustly <a href=\"https:\/\/www.findlaw.com\/injury\/workers-compensation\/workers-comp-denied-here-are-your-next-steps.html\">denies a claim<\/a>, they can face legal consequences.<\/p>\n<h2>How an Attorney Can Help With Your <span data-term-id=\"55270394\">Workers\u2019 Comp<\/span> Claim<\/h2>\n<p>Not all injury cases are treated similarly under the <span data-term-id=\"55270402\">workers\u2019 compensation<\/span><span data-term-id=\"55270402\"> system<\/span>. Understanding these basics can help you navigate what can be a complex and overwhelming process. If you need help, contact a\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/workers-compensation-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\"><span data-term-id=\"55270432\">workers\u2019 compensation<\/span><span data-term-id=\"55270432\">\u00a0lawyer<\/span><\/a> for help. They can guide you through the process and ensure you meet all filing deadlines. They can also help gather medical evidence and other documentation to support your claim.<\/p>\n<p>Getting legal help is especially critical if your employer\u2019s <span data-term-id=\"55270413\">insurance company<\/span> has denied your claim. An attorney can help you appeal your claim and better your chances at ultimately collecting benefits for your <span data-term-id=\"55270431\">workplace accident<\/span>. They can also assess if <span data-term-id=\"55270384\">workers\u2019 compensation<\/span> is the best path forward, or if you should pursue a <span data-term-id=\"55270422\">personal injury<\/span> case.<\/p>\n<p>Because <span data-term-id=\"55270409\">state law<\/span> is relevant, your legal advisor should be licensed in the state where you work. FindLaw\u2019s directory of <a href=\"https:\/\/lawyers.findlaw.com\/workers-compensation-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\"><span data-term-id=\"55270394\">workers\u2019 comp<\/span> attorneys<\/a>\u00a0can get you started. Select your state or city to review contact and ratings information for local experts. Then, reach out for expert legal advice and peace of mind.<\/p>\n\n\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <g id=\"thumbs-up\" clip-path=\"url(#clip0_604_3418)\">\n                        <path id=\"Vector\"\n             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1.47599C3.0346 1.78839 2.79235 2.22309 2.72003 2.7L1.34003 11.7C1.29652 11.9866 1.31586 12.2793 1.39669 12.5577C1.47753 12.8362 1.61793 13.0937 1.80817 13.3125C1.99842 13.5313 2.23395 13.7061 2.49846 13.8248C2.76297 13.9435 3.05012 14.0033 3.34003 14H9.00003Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n                    <\/g>\n                    <defs>\n                        <clipPath id=\"clip0_604_3423\">\n                            <rect width=\"22\" height=\"22\" fill=\"white\"\/>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        <\/button>\n    <\/div>\n    <span class=\"was-this-helpful__taken-action fl-text-sm-bold\"><\/span>\n    <div class=\"was-this-helpful__feedback-container\">\n        <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n            <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n        <\/div>\n        <form class=\"was-this-helpful__feedback-form\">\n            <div class=\"was-this-helpful__feedback was-this-helpful__feedback--positive\">\n                <fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this helpful?<\/legend>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--understandable\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Easy to understand\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--understandable\"\n                        >Easy to understand<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--solved-problem\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Solved my problem\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--solved-problem\"\n                        >Solved my problem<\/label>\n                    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class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this not helpful?<\/legend>\n                    <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n                        <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--missing-info\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Missing Information\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--missing-info\"\n                        >Missing the information I need<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--complicated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Too complicated\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--complicated\"\n                        >Too complicated \/ too many steps<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--dated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Out of date\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--dated\"\n                        >Out of date<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--negative-other\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--negative-other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__form-buttons-container\">\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--positive at-feedback-submit fl-button secondary\"\n                    type=\"submit\"\n                >\n                    <span class=\"fl-button-content\">Submit<\/span>\n                    <i\n                        class=\"fa fa-angle-right medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--cancel fl-button primary disabled\"\n                    type=\"reset\"\n                >\n                    <span class=\"fl-button-content\">Cancel<\/span>\n                    <i\n                        class=\"fa fa-times-circle medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n            <\/div>\n        <\/form>\n    <\/div>\n    <div class=\"was-this-helpful__thank-you-message\" role=\"status\">\n        <i class=\"was-this-helpful__thank-you-message-icon fa fa-check\"><\/i>\n        <p class=\"was-this-helpful__thank-you-message-text\" aria-live=\"polite\"><\/p>\n    <\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"fl-section-sidebar\"><div class=\"fl-editors-summary\" data-testid=\"fl-editors-summary\">\n    \n    <div class=\"fl-editors-summary-content\" data-testid=\"fl-editors-summary-content\">\n                    <h2>Can I Solve This on My Own or Do I Need an Attorney?<\/h2>\n                <div class=\"fl-editors-summary-content-main\" data-testid=\"fl-editors-summary-content-main\">\n            \n        <\/div>\n        <ul class=\"fl-list-style-none\">\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    A lawyer can help seek fair compensation on your behalf\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Accident and injury claims are complex and insurance carriers have lawyers on their side\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    An attorney can increase your chances of receiving maximum benefits\n\n                <\/li>\n                    <\/ul>\n                    <div class=\"fl-editors-summary-content-description\" data-testid=\"fl-editors-summary-content-description\">\n                <p>Get tailored legal advice and ask a lawyer questions about your injury. Many attorneys offer free consultations.<\/p>\n\n            <\/div>\n                            <div class=\"fl-editors-summary-content-link fl-flex\" data-testid=\"fl-editors-summary-content-link\">\n                <i class=\"fa fa-angle-right medium\" aria-hidden=\"true\"><\/i>\n                <p class=\"find-attorney\"><a href=\"https:\/\/lawyers.findlaw.com\/personal-injury-plaintiff\/#USER_GEO\/?fli=esum:FL3905\" target=\"_blank\" rel=\"noopener\">Find a local attorney<\/a><\/p>\n\n            <\/div>\n            <\/div>\n<\/div>\n\n\n\n<div class=\"email-subscription fl-mb30\">\n    <div class=\"email-subscription-header\">\n        <div class=\"email-subscription-header-content\">\n            <h3 class=\"fl-callout-sm fl-no-margin\">Stay Up-to-Date With How the Law Affects Your Life<\/h3>\n        <\/div>\n        <div class=\"email-subscription-header-image fl-flex fl-items-end\">\n            <img decoding=\"async\"\n                src=\"https://www.findlaw.com/static/c/images\/images\/w_1200,c_limit,dpr_auto\/f_auto,q_auto:eco\/v1745902396\/ability-law\/wp-prod\/general-components-subscribe-module-Image-subscribeModule_1\/general-components-subscribe-module-Image-subscribeModule_1.png?_i=AA\"\n                alt=\"\"\n                loading=\"lazy\"\n            \/>\n        <\/div>\n    <\/div>\n\n    <div class=\"email-subscription-content fl-flex fl-flex-wrap\">\n        <div class=\"email-subscription-content-text fl-mb25\">\n            <h4 class=\"fl-no-margin\">Enter your email address to subscribe<\/h4>\n        <\/div>\n\n        <form class=\"email-subscription-content-form\">\n            <input type=\"hidden\" name=\"distributionList\" value=\"latl\" \/>\n            <label for=\"email-subscription-content-form-group-input\" class=\"fl-text-sm-bold\">Email (Required)<\/label>\n            <div class=\"email-subscription-content-form-group\">\n                <input id=\"email-subscription-content-form-group-input\" name=\"email\" autocomplete=\"email\"\/>\n                <button type=\"submit\" aria-label=\"Submit\">\n                    <i class=\"fa fa-angle-right\" aria-hidden=\"true\"><\/i>\n                <\/button>\n            <\/div>\n            <p class=\"email-subscription-content-form-success subscribe-success-message fl-text-sm-bold\" aria-hidden=\"true\" role=\"status\">Thank you for subscribing!<\/p>\n            <p class=\"email-subscription-content-form-error subscribe-error-message fl-text-sm-bold\" role=\"alert\" aria-hidden=\"true\"><\/p>\n\n            <div id=\"email-subscription-content-form-recaptcha\" class=\"email-subscription-content-form-recaptcha subscribe-recaptcha\"\n                data-sitekey=\"0x4AAAAAAABGBEkK9kEeKxO-\"><\/div>\n        <\/form>\n\n        <div class=\"email-subscription-content-footer fl-text-sm\">\n            <p><a href=\"https:\/\/newsletters.findlaw.com\/\" target=\"_blank\" rel=\"noopener\">Learn more about FindLaw\u2019s newsletters<\/a>, including our terms of use and privacy policy.<\/p>\n\n        <\/div>\n    <\/div>\n<\/div>\n\n<div class=\"general-list\">\n    <h3>Helpful Links<\/h3>\n    <ul class=\"fl-list fl-no-margin\">\n                                    <li class=\"fl-list-item fl-flex\">\n                    <i class=\"fa fa-angle-right medium\" aria-hidden=\"true\"><\/i>\n                    <a class=\"fl-list-item-link\" href=\"https:\/\/www.findlaw.com\/litigation\/filing-a-lawsuit\/can-i-sue.html\">\n                        Can I Sue?\n                    <\/a>\n                <\/li>\n                                                <li class=\"fl-list-item fl-flex\">\n                    <i class=\"fa fa-angle-right medium\" aria-hidden=\"true\"><\/i>\n                    <a class=\"fl-list-item-link\" href=\"https:\/\/www.findlaw.com\/injury\/car-accidents\/car-who-is-liable.html\">\n                        Car Accident Liability\n                    <\/a>\n                <\/li>\n                                                <li class=\"fl-list-item fl-flex\">\n                    <i class=\"fa fa-angle-right medium\" aria-hidden=\"true\"><\/i>\n                    <a class=\"fl-list-item-link\" href=\"https:\/\/www.findlaw.com\/employment.html\">\n                        Employment Law\n                    <\/a>\n                <\/li>\n                        <\/ul>\n<\/div>\n\n\n    <div class=\"popularDirectory\">\n        <div class=\"general-popular-directory \">\n            <div class=\"general-popular-directory-title\">\n                <h3>Attorney Directory<\/h3>\n            <\/div>\n            <ul>\n                                    <li><a href=\"https:\/\/lawyers.findlaw.com\/workers-compensation-law\/\" target=\"_blank\" rel=\"noopener\">Workers&#8217; Compensation Lawyers<\/a><\/li>\n                                    <li><a href=\"https:\/\/lawyers.findlaw.com\/labor-law\/\" target=\"_blank\" rel=\"noopener\">Labor Lawyers<\/a><\/li>\n                                    <li><a href=\"https:\/\/lawyers.findlaw.com\/employment-law-employee\/\" target=\"_blank\" rel=\"noopener\">Employment Rights Lawyers<\/a><\/li>\n                                    <li><a href=\"https:\/\/lawyers.findlaw.com\/premises-liability-plaintiff\/\" target=\"_blank\" rel=\"noopener\">Premises Liability Lawyers<\/a><\/li>\n                                    <li><a href=\"https:\/\/lawyers.findlaw.com\/railroad-worker-injury-fela\/\" target=\"_blank\" rel=\"noopener\">Railroad Worker Injury and FELA Lawyers<\/a><\/li>\n                                    <li><a href=\"https:\/\/lawyers.findlaw.com\/construction-accident\/\" target=\"_blank\" rel=\"noopener\">Construction Accidents Lawyers<\/a><\/li>\n                                    <li><a href=\"https:\/\/lawyers.findlaw.com\/personal-injury-plaintiff\/\" target=\"_blank\" rel=\"noopener\">Personal Injury Lawyers<\/a><\/li>\n                            <\/ul>\n        <\/div>\n    <\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>FindLaw explains Workers\u2019 compensation basics for injured employees. Learn about employee rights, state laws, claim steps, how to find legal help, and more.<\/p>\n","protected":false},"author":41135,"featured_media":0,"parent":353560,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"app\/Http\/Controllers\/Templates\/ArticleWithBreadcrumbsController.php","meta":{"_acf_changed":false,"_stopmodifiedupdate":true,"_modified_date":"","_autodraft_ids":[],"_cloudinary_featured_overwrite":false,"_sb_is_suggestion_mode":false,"_sb_show_suggestion_boards":false,"_sb_show_comment_boards":false,"_sb_suggestion_history":"","_sb_update_block_changes":"","_is_real_time_mode":false,"_realtime_collaborators":"","footnotes":"","cf_checklist_status":[]},"categories":[2734],"tags":[],"state_laws_tags":[],"flmsa":[],"class_list":["post-353602","page","type-page","status-publish","hentry","category-injury"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/353602","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/users\/41135"}],"replies":[{"embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/comments?post=353602"}],"version-history":[{"count":3,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/353602\/revisions"}],"predecessor-version":[{"id":398375,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/353602\/revisions\/398375"}],"up":[{"embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/353560"}],"wp:attachment":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/media?parent=353602"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/categories?post=353602"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/tags?post=353602"},{"taxonomy":"state_laws_tags","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/state_laws_tags?post=353602"},{"taxonomy":"flmsa","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/flmsa?post=353602"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}