If you get hurt or become sick on the job, you probably have the right to compensation in the form of workers' comp benefits. In fact, workers' comp may be your only remedy for work-related injuries. Understanding the workers' comp system is key to ensuring that you receive all the benefits to which you're entitled.
Workers' compensation is a system created by state law to provide benefits to employees who sustain on-the-job injuries, while also protecting employers from the liability of employee lawsuits. Under the workers' comp system, employees are entitled to lost income and medical expenses when they suffer a work-related injury or illness, regardless of who was at fault. In return for these benefits, employees give up the right to sue their employers in court for workplace injuries.
Workers' comp laws can differ substantially from state to state, so it's important to be familiar with the laws in your particular area. But there are many similarities among the states as far as who is eligible for workers' comp, what injuries are covered, the types of benefits available, and the process for making a workers' comp claim.
Benefit amounts vary from state to state, but it's fairly typical for states to provide two-thirds of your previous wages in benefits, subject to a weekly cap. In addition, workers' comp benefits can cover the cost of your medical care.
A number of factors determine exactly how much you'll receive in workers' comp, and for how long. They include:
As you'd expect, temporary injuries are typically worth less than permanent ones. Likewise, if your injuries have left you "totally disabled" (that is, completely unable to work), you'll receive more than if you're only "partially disabled" (still able to perform a less demanding job).
To be eligible for workers' comp, you must meet your state's deadlines for reporting your injury and filing a workers' comp claim. In addition, all of the following must be true:
Below we'll discuss these criteria in more detail.
The workers' comp system is designed to protect employees who suffer work-related injuries. It does not protect workers who are not employees, such as independent contractors and volunteers.
However, just because you are called an independent contractor doesn't mean you are one. Whether workers are employees or independent contractors in the eyes of the law typically depends not on what they are called or how they are classified for tax purposes, but on how much control they have over their work.
Volunteers generally aren't entitled to workers' comp coverage, but some states make exceptions for certain volunteers, such as volunteer firefighters or police officers.
To recover workers' comp benefits, you need to show that your injury or illness is "work-related." An injury generally is considered work-related if you were doing something for the benefit of your employer, and you were injured or became ill as a result. The injury need not take place at the worksite, but must take place during the course of your employment.
An injury typically is not considered work-related if:
Example. James, a salesperson, suffers an injury from a car accident while driving from his office to his client's place of business. James will likely be covered by workers' comp because his trip was business-related and occurred during the workday. However, if James was injured while driving home in his car after his workday was over, he probably wouldn't be entitled to workers' comp.
The vast majority of employers are required by state law to carry workers' comp insurance, but there are exceptions. For example, very small employers (between two to five employees, depending on the state) are not required to offer workers' comp coverage in some states. A few states don't require charities to purchase workers' comp insurance. Texas is the only state that does not require private employers to purchase workers' comp insurance.
If you are injured on the job and your employer doesn't have workers' comp insurance despite a state requirement, you can file a personal injury lawsuit against your employer in civil court. Some states have an uninsured employers fund, and in those states, you can make a claim against the state fund instead.
Certain types of workers are exempt from or otherwise not covered by state workers' comp coverage. While these job categories vary from state to state, the most common exceptions to state workers' comp include:
When people think of a workers' comp injury, they often picture a one-time, traumatic injury, like a fall from a ladder. But in many states, workers' comp coverage extends to the following types of injury and illness as well:
Finally, depending on your occupation and the rules in your state, you might also be eligible for workers' comp benefits if you get COVID-19 as a result of your job.
Workers' comp coverage generally does not extend to the following types of injuries:
A workers' comp case can be broken down into four steps:
Appealing a workers' comp denial can be complicated and time-consuming. It often involves a medical exam and several legal proceedings.
If your employer's insurance company disagrees with a decision by your treating doctor about your medical treatment, the insurer usually has the right to demand that you be evaluated by a doctor of its choice at an Independent Medical Examination (IME). After the IME, the doctor will prepare a report, which you can dispute if it contains any factual inaccuracies.
A workers' comp judge will often require you to participate in a settlement conference or mediation. At the mediation, a neutral third party will help you and the insurer attempt to resolve your claim informally.
The workers' comp hearing is your opportunity to make your case to a judge if you are unable to settle your claim. The hearing usually involves arguments by the lawyers, testimony by witnesses (including your own testimony), and presentation of evidence such as medical records, documents showing lost wages, and doctors' reports. The judge will then make a decision. You have the right to appeal the decision if the judge rules against you.
Workers' comp typically pays for a number of different types of benefits:
Some workers' comp claims are straightforward, but many are contested, lengthy, and complex. An experienced workers' comp lawyer can walk you through the process, keep track of deadlines, and represent you during your appeal.
Hiring a workers' comp lawyer won't cost you anything out of pocket. In most states, workers' comp attorneys charge a percentage of your benefits if you win your case, and nothing (or only case-related expenses) if you lose.