Your Rights in the Workplace: Workers’ Compensation

 

Your Rights in the Workplace: Workers’ Compensation

If you are injured on the job—or suffer a work-related illness or disease that prevents you from working—you may be eligible to receive benefits from your state workers’ compensation program. Among other things, worker’s compensation will cover your medical bills and pay you for your time off work and any permanent injury you suffer. If you are eligible for workers’ compensation benefits, however, you typically can’t sue your employer for the injury in court.

Are all on-the-job injuries covered by workers’ comp?

The workers’ compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer’s or employee’s carelessness. However, there are some limits. Injuries caused by an employee’s intoxication or use of illegal drugs are not covered by workers’ comp. Coverage may also be denied for:

• an employee’s conduct that violated company policy
• self-inflicted injuries (including those suffered by a person who starts a fight)
• injuries suffered while a worker was committing a serious crime.
• injuries suffered while an employee was not performing work-related tasks.

If your employer’s conduct is flagrant (for example, your employer did something deliberate or negligent that harmed you), you may be allowed to circumvent the workers’ compensation system and sue your employer in court. Although you won’t be assured of the outcome (because you’ll need to prove that your employer is at fault for your injury), you could win much larger amounts of money than you could collect through workers’ compensation.

Does workers’ compensation cover only injuries, or does it also cover long-term problems and illnesses?
Your injury does not need to be caused by an accident—such as a fall from a ladder—to be covered. Many workers, for example, receive compensation for repetitive stress injuries (such as carpal tunnel syndrome and back problems) that are caused by overuse or misuse over a long period of time. You can also be compensated for some illnesses and diseases that are the gradual result of work conditions or toxins, such as heart conditions, lung disease, cancer, and stress-related digestive problems.

Does workers’ compensation cover COVID-19?

In many states, healthcare workers, first responders, and other front-line personnel can get workers’ compensation benefits for COVID-19 even if they can’t prove they got it at work. There is a legal presumption in those states that such an infection is work related and payable under workers’ compensation. For most other workers, COVID-19 generally won’t be covered by workers’ comp. Given the community spread of the virus, it’s virtually impossible for most workers to prove their illness was work related.

Do I have to be injured at my work to be eligible for workers’ compensation?

No. As long as your injury is work related, it’s covered. For example, you’ll be covered if you are injured while traveling on business, running a work-related errand, or even attending a required, business-related social function.

Most workers are eligible for workers’ compensation coverage, but every state excludes some workers. In addition, some states don’t require smaller employers—those with fewer than three to five employees, depending on the state’s rules—to carry workers’ compensation insurance. If you work for one of these employers, you may be excluded from the state program. Exclusions are:

• independent contractors
• casual workers
• business owners
• domestic employees in private homes
• farmworkers
• maritime workers
• railroad employees.

Check the workers’ compensation law of your state to see whether these exclusions affect you. Federal government employees are also excluded from state workers’ compensation coverage, but they receive workers’ compensation benefits under a separate federal law.

How do I claim workers’ compensation benefits?
Promptly report the work-related injury or sickness to your employer. Most states require you to do this within 2 to 30 days following an injury. If an injury occurs over time (for example, a respiratory problem or back injury), you must report your condition soon after you discover it and realize that it is caused by your work.

1. The first step in filing a workers’ comp claim is for the employee to report their work-related illness or injury to the employer.
2. The employer should notify the insurance provider and the state workers’ compensation board if required.
3. The employer will need to report severe workers’ comp injuries to the Occupational Safety and Health Administration.

Workers’ comp claims can be disputed if an employer does not believe the injury or illness was caused by work. And the employee may need to appear before a workers’ compensation board to make their case for receiving workers’ compensation benefits. Next, get the medical treatment you need. In an emergency, you can go to the nearest hospital or emergency room. However, for nonemergency care, you must follow your state’s rules on which doctors you can see for a work injury. 

In many states, you will also need to file an official workers’ compensation claim with the insurance company before you can receive benefits. Your employer should provide you with the necessary forms. You can also contact your state’s workers’ compensation agency. Finally, make sure you save copies of all correspondence with your employer, its insurance carrier, and your doctor concerning your workers’ compensation claim. You might need this paperwork if you run into problems later.

Can I be treated by my own doctor?
Some states allow the worker to choose the doctor, while other states allow the employer (or its insurance company) to choose. Other states have more complicated rules. For example, in some states, the worker can select the doctor, but it must be from a list approved by the employer. The doctor’s report will have a big impact on the benefits you receive. While it’s crucial that you tell the doctor the truth about your injury and your medical history (your benefits may be denied based on fraud if you don’t), be sure to clearly identify all possible job-related medical problems and sources of pain. This is no time to downplay or gloss over your injuries.

Who pays workers’ compensation benefits?
In most states, employers are required to buy an insurance policy from a workers’ compensation insurance company. In some states, larger employers that are clearly solvent are allowed to self-insure or act as their own insurance companies, while small companies (with fewer than three or four employees, for example) are not required to carry workers’ compensation insurance at all. When a worker is injured, the employee’s claim is filed with the insurance company or self-insuring employer which pays medical and disability benefits according to a state-approved formula.

What Does Workers’ Comp Insurance Cover?

• Lost wages are partially covered when the employee needs time away from work to recover from a work-related illness or injury.
• Medical expenses including hospital visits, medications and emergency surgeries are all covered by workers’ compensation.
• Disability benefits are available if the injury caused a partial or permanent disability.
• Ongoing care costs, such as physical therapy, are covered by workers’ compensation.
• Death benefits typically include funeral costs and survivor benefits for the worker’s family.

Workers’ comp benefits are paid no matter who was at fault. And workers’ compensation laws typically prevent employees from suing their employers for a work-related injury or illness.

More information
State by State Workers Comp Rules, Laws and Regulations

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