What is Workers’ Compensation?
Workers’ compensation is a type of insurance that provides monetary support for people who have become ill or been injured on the job. The insurance also compensates the dependents of employees killed on the job. Most employers are required by law to have this kind of insurance. In addition to compensating workers, insurance protects employers from being sued by injured or sick employees.
What Are the Laws That Apply to Workers’ Compensation?
Most people are covered by state laws related to workers’ compensation. Several federal laws protect workers in government jobs and specific industries:
- Federal Employment Compensation Act. This law provides workers’ compensation for federal employees who are not part of the military.
- Federal Employment Liability Act. This law is not workers’ compensation, but it does provide railroad workers with a way to recover damages from employers if injured or killed on the job due to employer negligence.
- Merchant Marine Act. Similar to the Federal Employee Liability Act, this law allows seaman to sue in the event of negligent injuries.
- Longshore and Harbor Workers’ Compensation Act. This law provides compensation for shipyard workers in the maritime industry.
- Black Lung Benefits Act. Coal miners who developed pneumoconiosis, also known as black lung, can get disability payments through this law.
- State Workers’ Compensation Laws. Each state has its own set of laws related to workers’ compensation for all other types of industries and employers. Most employers must have this type of insurance under state law, but there are exceptions. Independent contractors, for instance, are generally not covered by workers’ compensation.
What Expenses Does Workers’ Compensation Cover?
While laws vary by state, workers’ compensation insurance mostly covers the same types of benefits:
- Medical expenses related to the accident or injury
- Ongoing costs of care
- Disability benefits
- Lost wages from being unable to work because of the injury or illness
- Death benefits to dependents if an employee dies as a result of a work accident
Examples of Accidents and Injuries Covered by Workers’ Compensation
According to reviews of incidents and workers’ compensation claims, the five most common types of injuries in the workplace are:
- Sprains and strains
- Puncture wounds and cuts
- Bone fractures
The common causes reported for these injuries are handling work materials, slips, trips, and falls, being hit by an object, accidents while using tools, and ongoing trauma. The latter refers to repetitive use injuries.
What Types of Incidents Are Not Covered by Workers’ Compensation?
Employers are required by law to provide reasonably safe work environments. Even so, accidents happen, and employees get hurt or sick because of working conditions. These accidents are covered by workers’ compensation insurance.
Not covered are intentional acts and situations in which the worker has been grossly negligent. For instance, if an employee comes to work drunk and gets injured, the insurance will not provide compensation. Emotional harm that is not the result of a physical incident is not covered either, nor are car accidents to and from work.
How Do Workers’ Compensation Claims Work?
When an employee is hurt on the job, they must file a workers’ compensation claim to get benefits. There is a time limit after which the employee misses the opportunity to receive those benefits. The steps a worker must take after an accident include:
- Notify the employer of the incident. This may require a formal incident report.
- Get the necessary paperwork from the employer, including the workers’ compensation claim form.
- Get information from the employer about rights and benefits.
- Give the completed forms to the employer to file the claim.
- Receive an approval or denial from the insurance company.
- In the case of approval, accept the amount or negotiate a lump sum or structured settlement.
- In the case of denial, request a review or make an appeal.
The employer’s responsibilities include providing information, forms, and guidance. They may also need to file a report with the state’s board of workers’ compensation. It depends on the laws in the state.
What if a Claim is Denied?
There are several reasons an insurance company might deny a workers’ compensation claim:
- The employee did report the incident or file the claim on time.
- The employer disputes the claim.
- The type of injury is not covered by the insurance policy.
- The employee did not receive any medical care for the injury.
- There is not enough evidence that the injury happened at work or resulted from work duties.
If you have been denied workers’ compensation, you can appeal or ask the insurance company to review the claim again. Your notification of denial should come with information about how to make an appeal.
The steps to appeal vary by state, but you will likely have to present evidence before a judge or your state’s workers’ compensation board. You will need evidence, such as medical bills and witness testimony from the accident.
If your claim is denied because of an error that can be corrected easily, you should have no problem overturning the decision and getting benefits. However, if the situation is more complicated, you may need a workers’ compensation lawyer to help you appeal.
For instance, if your employer is disputing the claim, a lawyer can help you prove the claim is valid. Your employer may say that you were not following safety guidelines, or that your injury didn’t occur at work, to get the claim denied. Proving otherwise can get complicated, so rely on an experienced lawyer.
Workers’ compensation insurance and laws protect both employees and employers. As an employee, know your rights and act quickly after an accident to ensure you have access to benefits. A lawyer specializing in workers’ compensation and labor laws can help you settle complicated or denied claims.