The National Safety Council reported that, in 2022, work-related medically consulted injuries surpassed 4.5 million. The country’s preventable injury death rate also rose slightly that year, compared to the one before, to 3.2 per 100,000 workers — that’s 4,695 deaths.
Despite laws and regulations being created and revised regularly, especially for dangerous industries like construction and agriculture, injuries continue to occur — albeit at much lower rates than in previous decades. And, while steps are taken to further prevent them, certain initiatives are also being implemented to handle any accidents that do occur, providing relief to both the workers and their dependents.
Today, we’ll be talking about workers’ compensation specifically: what it is, who it’s for, and how it can be claimed.
What is workers’ compensation?
Workers’ compensation, referred to as workers’ comp for short, is a state-based program that provides benefits to workers who have sustained an injury or become ill in a work-related accident — in other words, while on the job. The program covers expenses such as medical bills and disability pay among other benefits, helping employees get by while they are recovering and unable to work.
(Being a state-based program, it is only offered to private employees and people employed by local and state agencies. More on this in a minute!)
Who is eligible for workers’ compensation?
Workers' compensation benefits are typically available to people who meet four eligibility requirements. These are:
- Being an employee
- Having sustained a work-related injury or illness
- Working for an employer who carries workers’ comp insurance
- Reporting the incident and filing a claim within the deadline indicated by your state
Barring a few exceptions, most states require employers to have workers’ compensation coverage, even if only employing one person. In some cases, the minimum number of employees is set to between two and five. Each state’s workers’ compensation board can provide information on the laws that apply within that state.
WARNING
When an employee agrees to receive workers’ compensation, they automatically waive their right to sue their employer for negligence.
What does workers’ compensation cover?
Following an on-the-job accident, workers and their dependents can claim compensation to cover the following expenses:
- Medical treatment. This can include prescription medication, diagnostic testing, hospital stays and surgical procedures.
- Ongoing care. This includes physical therapy, which reduces pain and restores mobility, and occupational therapy, which helps patients regain the necessary abilities to perform daily activities.
- Lost wages. Typically, workers are paid two-thirds of their wages for any work period missed following an illness or injury. Each state sets an upper limit to the amount that can be paid to each employee.
- Funeral and burial costs. With funerals costing between $7,000 and $12,000 on average, laying a loved one to rest can be quite the financial burden for some families.
If a work-related injury or illness leaves an employee with permanent disability, permanent disability benefits may be paid. If the worker doesn’t survive the accident, then their dependents receive survivor benefits.
Where to file for workers’ compensation
Employees that become injured or ill while on the job and want to make a compensation claim must contact their state workers’ compensation board. This applies to workers employed by private companies as well as state and local government agencies.
The Department of Labor states that federal employees can also file a claim online, without the approval of their supervisor. This can be done through the Employees’ Compensation Operations and Management Portal.
How to claim workers’ compensation
So far, we’ve talked about what workers’ comp is and what it covers — but what is the process of claiming it? Let’s look at the five steps below:
Step 1: Report the incident to your employer
The first step when you’re looking to apply for compensation is to contact your employer and inform them about what happened.
The timeframes for providing your employer with written notice of your workplace injury will vary depending on your state, so it’s important to speak with someone from your state’s workers’ compensation board for information if you are unsure.
Regardless of the guidelines provided by your state’s board, however, it’s generally a good idea to report incidents as soon as they occur.
Step 2: Fill out the necessary paperwork
Once you have informed your employer about the accident, it will be their responsibility to provide you with a claim form for you to fill in and return. Only your employer can submit a workers’ compensation claim form.
Depending on what state you’re based in, you may also need to complete a First Report of Injury form to be submitted to the state workers’ compensation board.
Generally, the types of forms that workers must complete and submit through their employer will range depending on where they live and work, what type of illness or injury they sustained, and who the employer’s insurance provider is.
Step 3: Wait for your employer to file the claim form
Once you have filled in your compensation claim form, you must return it to your employer. In turn, your employer will file a claim with their insurance provider, submitting your form along with any other supporting documentation that may be required.
For example, depending on what your state’s workers’ compensation board requires, you may also need a medical report from your doctor. Every state has its own time limit for filing these types of benefits claims, meaning your employer will have to adhere to relevant laws.
Step 4: See if the insurance provider approves the claim
Your employer’s insurance provider will either approve or reject your claim. If it is approved, the insurer will let your employer know and then get in touch with you to relay the details.
These will outline the insurance provider’s offer regarding payments to cover medical bills, lost wages and other expenses. At this point, you can accept the offer or negotiate a lump-sum settlement or larger structured settlement.
If your claim is denied, on the other hand, you can request a reconsideration from the insurer or file a formal appeal. The latter is normally done through your state workers’ comp board.
Step 5: Join your employer’s return-to-work program
Return-to-work programs are designed to help injured workers resume their duties once they have made a recovery. If you’re unable to carry on with your regular responsibilities, your employer may modify your duties, providing training and assistance to help you develop the new skills.
These types of programs can span several weeks or months, depending on the required steps, and are designed to ensure the safe and efficient return of the employee.
Frequently asked questions
Do you still have some questions around workers’ compensation? Let’s answer them below!
Q: How long does it take to get workers’ comp?
Typically, and given that there are no unanticipated delays, you should start receiving your workers’ comp payments within two weeks of filing your claim.
Sometimes, insurance providers may not act in the claimant’s best interest, however, using underhand tactics to try and halt your case. This can sadly cause distressing delays.
Q: Do I have to see a specific doctor after my accident?
Although this can vary, insurance companies often select the doctors you can see, as they are the ones paying for the expenses. If you wish to see your own doctor, you can try to negotiate this — so long as it is pre-approved, there should be no issue.
Q: Can both federal and private employees file for workers’ comp?
Private sector employees and federal employees alike can file for workers’ comp, although the procedure is different. While private employees have to follow the laws that apply in their state, federal employees are protected under federal laws, which means they must seek their compensation through the Office of Workers’ Compensation Programs.
Key takeaways
Sustaining an injury or developing an illness due to the nature of your job can be distressing. You may be wondering “How do I start?”, “what exactly do I do?” and “Who can help?”
Hopefully, our guide has shed some light on what must be done, and you can get started with your application as soon as possible.
To recap what we talked about:
- Workers’ comp covers the expenses resulting from work-related accidents, including but not limited to bone fractures, cuts, tendonitis and injuries from falls.
- To claim workers’ compensation, your employer must carry the relevant insurance.
- A workers’ comp attorney can help ensure you receive the maximum benefits you are entitled to.
- If you agree to receive workers’ comp, you automatically waive your right to sue your employer.
Do you have any more questions about filing a claim for a work-related accident? Let us know in the comments section below.