Workers' Compensation Benefits FAQ

Learn who qualifies for workers' comp, how to file a claim, how much you'll receive in benefits, and more.

Updated by , J.D. · University of Missouri School of Law

What is workers' compensation?

Workers' compensation is a state-mandated insurance program that provides benefits to employees who suffer job-related injuries and illnesses. Each state has its own laws and programs for workers' compensation.

The federal government also has a separate workers' comp system, mostly for federal employees.

For up-to-date information on workers' comp in your state, contact your state's workers' compensation office.

In general, an employee with a work-related illness or injury can get workers' comp benefits regardless of who was at fault—the employee, the employer, a coworker, a customer, or some other third party. But there are some exceptions (discussed below).

What are my rights if I'm injured at work?

State workers' comp laws protect a number of rights for injured employees, including the right to:

  • file a workers' comp claim without retaliation, including being fired, demoted, or laid off because of your claim
  • appeal if your claim is denied (more on that below)
  • receive medical treatment and all the other workers' comp benefits for which you qualify (more on that below), and
  • have a workers' comp attorney help you navigate the process and advocate on your behalf.

Some other workers' comp rights depend on the state where you work, such as the right to choose your own doctor or switch doctors (discussed below).

Do I have to be injured at my workplace to be covered by workers' compensation?

No. As long as your injury happened while you were working and because of your work, it's covered. For example, you will be covered if you're hurt while traveling on business, doing a work-related errand, or even attending a required business-related social function. Learn more about what does and doesn't count as a work-related injury or illness.

What workplace injuries are excluded from workers' comp?

Workers' compensation covers most work-related injuries—but not all. Generally, workers' comp doesn't cover injuries that happen because you were intoxicated or using illegal drugs. Coverage may also be denied for injuries that were self-inflicted (including injuries that happened in a fight that you started) or happened while you were committing a serious crime or doing something that violated your employer's policies.

Does workers' compensation cover long-term conditions and illnesses?

Your injury need not be caused by an accident—like a fall from a ladder—to be covered by workers' compensation. Many employees receive compensation for injuries resulting from work activities over a long period of time, such as repetitive stress injuries or chronic back problems. Depending on the circumstances and your state's laws, you might also receive benefits for some illnesses that you developed because of your work. But there are special rules for workers' comp eligibility for occupational diseases.

Does workers' compensation cover just my medical bills?

Workers' comp does pay for medical expenses that are necessary to diagnose and treat your injury. But it also provides temporary disability payments while you are recovering and unable to work, as well as compensation for permanent impairments caused by your work-related injury or illness (more on that below).

Depending on the state and the injury, it may also pay for rehabilitation, retraining, and other benefits. Learn more about types of workers' comp benefits.

How much does workers' compensation pay?

The actual amount that you receive in workers' comp benefits depends on a number of factors, including the laws in your state, the nature of your injuries, and how much you earned before you were injured.

For temporary disability benefits—payments intended to replace part of your wages when you can't work while you're being treated for your injuries—most states pay about two-thirds of your average pre-injury wages, up to a maximum that varies from state to state and from year to year.

Permanent disability benefits are usually determined by a complicated formula in state law that's based on which part of your body is affected and the extent of your impairment. (See our state-specific articles on workers' comp benefits for more information on how benefits are calculated in many states.)

Are workers' comp benefits taxable??

You generally don't have to pay taxes on workers' compensation benefits. However, some amount of your workers' comp benefits might be taxed if you're also receiving Social Security Disability benefits, and part of those benefits have been offset by your workers' comp benefits. (Read more on the Social Security Disability offset.)

Are all employees covered by workers' compensation?

No. First of all, not all employers are required to have workers' compensation coverage. State laws vary, but an employer's responsibility to provide coverage usually depends on how many employees it has, what type of business it is, and what type of work the employees are doing.

Second, every state excludes certain types of workers. Although these exclusions vary, they often include farm workers, domestic employees, and seasonal or casual workers.

Learn more about eligibility requirements for workers' comp benefits.

Can I be treated by my own doctor, and if not, can I trust a doctor provided by my employer?

States have different rules about who gets to choose the treating doctor in workers' comp cases. In some states, you have a right to see your own doctor. Other states require that you request this in writing before the injury occurs. More typically, however, an injured worker must—at least initially—go to a doctor or medical provider network that the employer designates.

Your treating doctor's report will have a big impact on the benefits you receive. (Learn more about the role of treating doctors in workers' comp cases.) Keep in mind that doctors who are paid by employers or insurance companies may have a conflict of interest. For instance, that business relationship may motivate some company doctors to minimize the seriousness of an injury or to identify it as a preexisting condition.

Depending on the rules in your state, you might be able to change treating doctors in your workers' comp case if you're unhappy with the one you were sent to or chose on your own.

How do you file a workers' compensation claim?

If you've experienced a work-related injury or illness, your first step (after obtaining any emergency medical care) is to report your injury to your employer in writing or over email. Some states have very short deadlines for reporting your injury—as short as a few days in some states—so don't wait to notify your employer.

Next, your employer should provide you with the necessary forms to file your claim. (If not, you can request them or obtain them from your state workers' agency's website.) Take note of your state's filing deadline so you don't forfeit your claim.

In many cases, you'll be sent for a consultative exam with a doctor chosen by the workers' comp insurer (or you'll be allowed to pick from a list of doctors). Be sure to attend this appointment. The insurance company will use this exam and the other medical evidence from your case to make its decision. If your claim is denied, contact a workers' comp attorney to help you with your appeal.

What should I do if my workers' compensation claim is denied?

If your employer's insurance company rejects your workers' comp claim, you'll usually receive a letter explaining the reasons for the denial and the process for appealing that decision.

If the letter doesn't give you full information about how and when to appeal, you can generally find that information on the website for your state's workers' compensation agency (which you can get to with the link above).

Make sure you read the information carefully—especially the deadline for filing an appeal—and act promptly. (For more details on the reasons for denials and what to do, see our article on denied workers' comp claims.)

Do all workers' compensation cases end in a settlement?

Most workers' comp cases are resolved through a settlement with the insurance company—but not all. Particularly if your injuries are relatively minor, you might decide simply to accept the benefits that the insurer pays voluntarily.

When that's not the case, you can either negotiate a settlement with the insurance company or have a workers' comp judge rule on the issue after a hearing or trial. Settlements are always a compromise, but they almost always mean that you get some money more quickly and with less risk.

See our article on getting a fair workers' comp settlement to learn more about the pros and cons of settling your claim, as well as the different types of settlements.

Can I sue my employer in court over a work-related injury?

Usually, no. As a general rule, you're limited to the benefits you receive through workers' comp, which means you can't sue for damages like pain and suffering or mental anguish.

But some states allow you to sue your employer in very limited circumstances, including when your employer intentionally hurt you or didn't have legally required workers' comp insurance.

Can I get Social Security Disability after a workers' compensation settlement?

Workers' compensation and Social Security disability are separate benefit systems. If you qualify under each of their separate eligibility requirements, it is possible to collect workers' comp and Social Security benefits at the same time—but one set of benefits may be reduced (or "offset").

Even if you receive Social Security disability benefits after you've settled your workers' comp claim, you could see a reduction in those benefits, depending on how your workers' comp settlement is worded. (For details, see our article on minimizing the workers' comp and Social Security disability offset.)

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