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A Guide To Workers' Compensation Benefits

Last updated: April 12, 2023

Workplace injuries is alarmingly common. According to the National Safety Council, a worker is injured every seven seconds in the United States. This equals approximately 540 injuries per hour and at least 7 million work injuries annually. These injuries cause 99 days of lost productivity. 

Accordingly, each work-related injury has an average of 21 days of disability. On average, some employees are fortunate enough to return to work pretty soon, but not all are that fortunate. Many workers still suffer from long-term disabling effects from their work-related injuries.  

In times like this, where you get injured at work or suffer from a debilitating work-related condition that prevents you from making ends meet, it's best to receive workers' compensation benefits. 

Read on to learn more about workers' comp. 

What Are Workers' Compensation Benefits?

Employers are required by law to take reasonable precautions to ensure a safe and secure working space. Nevertheless, accidents in the workplace do occur. When they happen, workers' compensation benefits provide coverage. 

Workers' compensation benefits provide two functions: it covers the medical expenses of an injured employee. It pays compensation for a portion of the income they lose while they cannot return to work. At the same time, it typically shields employers from lawsuits by workers injured while working. 

Employees receive workers' compensation benefits regardless of who was at fault in the incident. Additionally, workers comp (as it is often abbreviated) provides death benefits to the employee's dependents in the event of death while at work.

According to Nationwide, workers' compensation is social insurance because it relies on a social contract between management and labour. This means employers are protected from civil suits by workers injured on the job in exchange for purchasing workers' compensation insurance.

What Benefits Do Injured Workers Receive?

Statutes in each state establish workers' compensation systems. State laws and court rulings govern the program, and no two states have the same laws and restrictions.

State laws determine how impairments are to be evaluated, how medical care is provided, and how many benefits an employee is entitled to. States also determine whether workers' compensation insurance is provided by state-run organizations and private insurance firms or the state alone. 

Furthermore, states also define how claims are to be processed and how disputes are to be settled, and they may come up with cost-controlling solutions like restrictions on certain healthcare services.

If your employer decides to expand their business to another state and you decide to relocate, you may have to deal with very different rules in the new state.  

However, the Office of Workers' Compensation Programs (OWCP), a division of the U.S. Department of Labor, generally administers four major disability compensation programs that offer federal employees (or their dependents) and other specific groups who suffered workplace injuries or occupational diseases the following benefits:

  • Health-Care Services
  • Wage Replacement Benefits
  • Vocational Rehabilitation Benefits
  • Other benefits

Keep in mind that the specific coverage for each of these benefit types varies by state. Also, medical benefits can cover various costs associated with different medical treatments and care, such as doctor visits, diagnostic testing, hospital treatment, medication, physical therapy, and certain types of medical equipment, such as wheelchairs. 

Who Are Eligible For Workers' Compensation?

Workers' compensation is not a benefit that every employee is entitled to. While most workers at private companies and those employed by the state or the federal government are eligible for coverage, certain conditions have designated specific categories of workers exempted from workers' comp.

These may include but are not limited to:

  • Independent contractors
  • Freelancers
  • Part-time workers
  • Seasonal employees
  • Domestic employees,
  • Agricultural employees

What Injuries Are Not Covered By Workers' Compensation?

The coverage of workers' compensation is only limited to injuries at work and while working. It does not include damages or illnesses sustained while you are off-duty. Moreover, some states offer workers' compensation benefits for long-term diseases and conditions acquired on the job.

The list includes repetitive stress injuries like carpal tunnel syndrome, chronic back pain, occupational diseases like stress-related gastrointestinal issues, and infectious diseases like COVID-19.

You should be aware that certain circumstances and conditions may render your claim invalid, given that workers' comp does not cover every type of workplace injury or condition. In particular, you might not be granted workers' compensation coverage if you get injured because of one of the following:

  • Drinking alcoholic beverages while at work;
  • Using illegal drugs;
  • Started a fight at work;
  • Self-inflicted injuries; and
  • Going against a written company policy.

How Much Money Can You Expect From Workers' Compensation?

The amount of compensation and benefits you receive will depend on which state you reside in and work in since workers' compensation insurance is mandated by each state. As each state sets its standards for worker's compensation benefits, payments for comparable injuries may vary from state to state.

For example, there may be instances where there is a significant discrepancy in compensation benefits and payouts between two employees who suffered identical injuries due to similar reasons. NPR noted that one received $45,000 from his workers' comp claim, while the other received lifetime benefits amounting to $740,000. 

What Is The Process For Filing A Claim?

Don't delay. Employees injured at work have one year to file their claims. On the other hand, claims for occupational diseases must be filed within two years of receiving written notice from an accredited healthcare provider. Also, the said notice must state that the condition exists and is work-related. Remember the following steps you should take when you get injured at work. 

Report Your Injury Or Exposure To Your Employer As Soon As Possible. 

You must inform your employer of your condition and the cause. Your employer may immediately reject your claim if unaware of your occupational ailment or injury. After considering all relevant data, your employer will decide whether to accept or reject a claim.

File A Claim For Benefits

Submit the completed and necessary documents, like the "Self-Insurer Accident Report" (SIF-2), to your employer or your company's agent, sometimes known as a "third party administrator". You may directly get a copy of the form from your employer.

You should file as soon as possible since you need to be able to prove your illness or condition is work-related. Someone else may do it on your behalf if you cannot submit a claim.

Communicate With Your Healthcare Provider

To ensure a smooth process for filing a claim, you must provide your healthcare provider is aware of the details of your injury. Your healthcare provider must also be able to assert that your injury or condition is job-related. This way, they could submit an initial report to your employer or their representative to support your claim. 

Stay In Touch With Your Employer Or A Third-Party Administrator.

If your address or contact details change, notify your employer immediately to prevent delays in receiving benefit checks or other correspondence.

Cooperate With All Reasonable Requests

It is essential to promptly provide all the requested documents by your healthcare provider, employer, and others authorized. This is to ensure that your claims be granted immediately and allow you to proceed with your treatment and recovery. 

Are you interested in determining your monthly VA Compensation Rate? If so, visit this 2022 VA Disability Calculator by Disability Help today. 

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Chloe Powers
Chloe works with policymakers on behalf of Disability Help to support their work at a strategic level, ensuring the conditions are in place for creative individuals and organizations to grow, reach their potential and effect relevant, sustainable change.
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