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How Does Workers’ Comp Work?

First of all, just what exactly IS workers’ compensation? Workers’ compensation is a kind of insurance, paid for by an employer, which provides a level of wage replacement and coverage for medical expenses to employees who are injured on the job.

Each state has its own workers comp laws, so the details and regulations vary a bit state by state. We’ll cover the basics in this blog post.

In exchange for getting payouts from workers’ comp, the employee gives up their right to sue their employer for negligence. Exceptions to this can happen if the employer intentionally causes harm or injury to an employee.

Specialized private insurance companies provide workers’ comp insurance coverage to employers. In some states (California is one), there are state insurance programs available for businesses that can’t afford the private insurance.

What is covered?
Medical care:

  • Injuries that require medical care—injuries that happen while you are performing your job duties.
  • Injuries that happen while you are on your way to or from work are not covered, unless travel is part of your job or is involved in tasks assigned to you (running errands, for example).
  • Typical injuries include:
    • Repetitive motion and overuse injuries (RSIs), which can include carpal tunnel syndrome from keyboarding, to tendonitis, and back pain.
    • Hearing loss, most frequently as a result from noise at manufacturing plants or construction sites.
    • Stress related injuries: These are very much harder—though not impossible—to prove, and difficult for which to get workers comp benefits.
    • Stress resulting from workplace physical injuries, including sleep disorders, anxiety, and depression resulting as a direct result of a workplace injury.
    • Occupational illnesses: Illness that result from on-the-job exposure like black lung, asbestosis, or AIDs/HIV.

Temporary disability payments:

  • Partial wage replacement if an injury prevents you from doing your normal job. This amount is usually 2/3 of your usual weekly salary or hours.

Permanent disability:

  • If you are permanently or totally disabled as a result of your work-related injury or occupational disease, you will likely be entitled to a lifetime pension under your state’s workers’ compensation system. Each state’s workers’ comp laws are different, but each state has some kind of regulations to award a lifetime pension.

Death benefits:

  • Eligible dependents are usually entitled to workers’ comp death benefits when an employee dies as a result of work injuries or illness.
  • Eligible dependents include spouse, children, and/or other family members who lived with the employee.

Filing a workers’ comp claim
It’s very important to follow the correct procedures from the moment of your injury or illness in order to receive medical coverage and wage compensation.

Get medical treatment

  • If you are hurt, get immediate treatment at a doctor’s office or hospital. If you have an illness, get seen by a doctor.
  • If you do not see a doctor or receive treatment for some time after an accident, the workers’ comp adjuster will assume that you have no lasting damage or ill effects.
  • Get documents from the doctor or hospital, and make your own notes about everything that happened. Include everything about your injury or illness, how it happened, the financial impact, and how it is affecting your daily life. Keep track of, and take notes on, every conversation you have about your injury or illness. If you are able to take photos, do, or get photos from others.

Can you see your own doctor?

  • It depends on which state you live in. In some states you can see your own doctor, and in others you must request permission in writing, before the injury.
  • Most of the time you must initially go to a doctor or medical treatment group that your employer designates. If you must see a doctor who is paid by your employers, keep in mind that their business relationship may motivate the doctor to downplay the seriousness of your injury, or to report it as a preexisting condition.
  • Keep notes, and you may be able to change doctors if you are unhappy.
  • Talk to your human resources department, or to whoever handles your company’s worker’s comp claims.

File a work injury accident report immediately after receiving medical treatment for your injury or illness.

  • If you have a long-developing illness or injury, file a report as soon as you realize it was caused by your job.
  • If you do not file an injury accident report within 30 days (check your state regulations), you run the risk of losing your compensation and coverage.
  • Your employer may have their own claim forms that need to be filled out, and if not, you should be able to get forms from your state’s workers’ compensation board.
  • Make a copy of your completed form to keep before you turn in your filled-out form.
  • Give your completed form to your employer. They will now fill out their part of the form, and file it with the workers’ compensation claims administrator and state workers’ comp board office.

What needs to be included in the injury report:

  • What the injury is, including all parts of the body that are affected.
  • How the accident, injury, or illness occurred.
  • What other employees (or other people) were involved.
  • The date, time, and location of the accident, injury, or illness.
  • Medical treatment you have received.

Do you need a lawyer?
If you have a serious injury, are out of work for a few days to a week and more, if you have broken bones, a long-term illness, or are facing medical bills of more than $2,000, you may want to consult with a personal injury lawyer.

The lawyer will evaluate your claim, and can help you navigate within the workers’ comp world, or take your case to court to receive compensation.

Can you get in trouble for filing a Workers Comp insurance claim?
Although it is illegal in all but two states to fire someone for filing a workplace injury claim, sadly, it can still happen. It’s not always easy to prove this kind of discrimination. If this happens to you, you might want to consider seeing a personal injury lawyer.

Do your research
Don’t forget to speak to your company’s human resources department, or to whoever in your company handles workers’ comp claims, so you are fully informed on what procedures to follow and who to contact.

For more information on workers’ comp, check with your state workers’ compensation officials. This website will direct you to the contacts in your own state.

This entry was posted in Financial Education, Legal Matters, Personal Finance for Real People and tagged , , , , , , , , , , , , by sandynight. Bookmark the permalink.

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