Workers Compensation: What It Is and How to Make a Claim

If you suffer a workplace injury or illness, you may qualify for workers compensation benefits. Keep reading to learn what workers compensation typically covers, how to apply or appeal a claim denial and qualify for legal assistance below.

Workers Compensation Basics: What Does It Usually Cover?

Every state has its own unique law that defines the workers compensation process for injured or sick employees. (The only workers who follow a different process for securing benefits are federal employees.) However, every U.S. state requires most private employers to provide some kind of workers compensation coverage for their employees.

Workers comp insurance typically covers employees who experience:

1. On-the-job injuries. Workers comp insurance should at least pay medical bills related to injuries from workplace accidents. Once you miss enough work shifts, then you’ll typically qualify for lost wage payments as well.
2. Occupational diseases. These are conditions you might develop over time that result directly from completing your job duties. Examples might include hearing loss, herniated disc, carpal tunnel/repetitive motion injuries, mesothelioma or silicosis.

In most cases, your injury must force you to miss work for several days to qualify for lost wage benefits. If your employer’s policy isn’t posted in a visible area (i.e., your break room), contact to your company’s HR department. They can answer your specific questions about workers compensation benefit amounts, claim deadlines, etc.

Most employers just want injured employees to get medical treatment so they can come back to work after they recover. Some people ease back into full-time work because their doctor gives them certain work restrictions. This might include limiting how much weight you lift, how long you can stand or other limitations during work shifts. Your employer’s policy might reference these restrictions as “light duty” work. Workers compensation is designed to cover your medical bills and partial wages until can go back to work full-time.

Workers Compensation Insurance Policies Vary From State to State

Each state has individual eligibility requirements for hurt or sick employees applying for workers comp benefits. Three virtually universal requirements are:

1. The company you work for must have workers compensation insurance.
2. You must work for that company before your illness or injury occurs.
3. Your illness or injury must be work-related and happen while you’re clocked in.

Volunteers, seasonal or temporary employees, and domestic workers typically are not covered under workers comp. Ask your supervisor if you’re covered under your employer’s policy before you apply for workers compensation.

6 Steps to Apply for Workers Compensation Benefits

The state you’re in will list specific steps to apply for workers comp benefits. Below is a basic overview of how the process typically works:

1. Seek appropriate medical treatment immediately. Few states refuse to cover emergency medical care. (Connecticut is one exception, so ask your supervisor!)
2. Ask your employer if you must use an employer-approved doctor for ongoing treatment. Some states make you choose from a list of approved providers under your employer’s plan. Others let you choose your physician from the first visit. Checking with your supervisor first ensures you won’t pay any surprise medical bills yourself.
3. Ask what paperwork you must complete to start your workers compensation claim. You usually fill out and return a specific form to your employer. Otherwise, take an employer-provided form to your first doctor’s visit.
4. Keep copies of all related medical documents for your records. You don’t want the insurer to deny your claim or leave any bills unpaid. Keeping copies of everything makes that less likely.
5. Submit every required form on time and to the right place. Every state has a specific deadline for completing your claim paperwork. This is called the “statute of limitations,” and earlier is always better. Follow instructions exactly so you don’t miss out on lost wages or other benefits. Ask which forms you must file yourself, if any, and who those forms should go to. Do you need to send them via certified mail, for example? Or can you do it online? Your supervisor should know the answers. If not, contact HR!
6. Check the deadline to appeal if an insurer denies your claim. The insurer should notify you in writing within 30 days. This letter should list detailed instructions as well as the deadline to appeal your denial.

You May Qualify for Legal Assistance

You might think you don’t need a workers’ comp attorney. However, people with preexisting conditions are much more likely to get denied workers compensation. Any time and employer can avoid paying workers unexpected benefits, it keeps their insurance costs low. That’s why we recommend talking to a workers’ comp attorney as soon as possible after your injury. Workers comp lawyers always work on contingency, so you’ll pay nothing for legal advice about your case. And if your employer denies your claim, an experienced attorney can fight to get the most benefits your injury deserves. In fact, the lawyer won’t charge you anything for legal assistance unless your case wins. And if you do win, you’ll only pay a small, one-time fee.

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