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:
- On-the-job injuries. If you’re hurt in a workplace accident, workers comp insurance should pay your medical bills, at minimum. Once you’ve missed enough work shifts, you’ll typically qualify for lost wage payments as well.
- Occupational illnesses. 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 you’re released for full-time work again.
Workers Compensation Insurance Policies Vary From State to State
Each state has individual eligibility requirements for hurt or sick employees that apply for workers comp benefits. Three virtually universal requirements are:
- The company you work for must have workers compensation insurance.
- You must work for that company before your illness or injury occurs.
- 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 whether or not you’re covered under your employer’s policy before you apply for workers compensation.
6 Steps for Claiming Workers Compensation Benefits
The state you’re in will list specific steps to apply for workers comp benefits. Below, we’ll give you a basic overview of how the process typically works. Just know that your own experience and workers compensation claim process may vary:
- Seek appropriate medical treatment for your injury or illness immediately. Very few states refuse to cover emergency medical care for sick or injured employees. (Connecticut is an exception to this rule, so if you’re not sure, ask your supervisor!)
- If you need ongoing treatment, ask your supervisor if you must use an employer-approved healthcare provider. Some states require you to choose a doctor from a list of approved providers covered under your employer’s plan. Others let you choose your treating physician from the very first visit. Checking with your supervisor first ensures you won’t get stuck paying any surprise medical bills out of your own pocket.
- Ask what paperwork you need to complete in order to start your workers compensation claim. In most cases, there’s a specific form you must fill out and return to your employer. Other times, you’ll need to take an employer-provided form to your first doctor’s visit.
- Keep copies of all medical documents related to your injury or illness for your records. You don’t want the insurance company to deny your claim or stick you with any bills. Making copies of every receipt, prescription, x-ray, labwork results, etc. makes it less likely to happen to you.
- Submit every required form on time with the correct party to maximize any benefits you’re owed. Every workers compensation policy is different, but they all have a specific deadline for completing your claim paperwork. This is called the “statute of limitations,” and it’s usually best to apply as close to the accident date as possible. Make sure you follow the instructions exactly so you don’t miss out on lost wages or other benefits. Ask which forms you’re expected to file on your own, 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 answer to all these questions. If not, contact HR!
- If your claim’s denied and you plan to dispute that decision, file your appeal before the deadline passes. Your employer’s insurer should notify you in writing within 30 days after your accident. This letter should list detailed instructions on how to appeal your denial. It should also tell you how long you have to dispute their decision before it’s too late to appeal.
You May Qualify for Legal Assistance
You might think you don’t need a workers’ comp attorney to help with your claim. 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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