Workers compensation benefits are designed to cover most injuries or diseases caused or aggravated by work or working conditions. Workers' compensation is a state-mandated insurance program providing compensation to employees who suffer job-related injuries.
Employees injured on the job are guaranteed benefits regardless of who was at fault. In return for workers' compensation benefits, employees usually forfeit the right to sue their employer in court for damages for their injuries.
PRINCIPAL TYPES OF BENEFITS
Workers' compensation benefits include:
- Replacement income
- Medical expenses
- Rehabilitation
- Long-term or lump sum pension if you are permanently unable to work
- Temporary disability pension while you are unable to work
Medical benefits include all necessary medical, surgical and hospital services, supplies and nursing care. You must obtain authority from your employer or the insurance company before seeing any physician the first time, or you may be responsible for the cost of unauthorized treatment.
If there is a substantial reduction of income because of the accident, you may be entitled to compensation. Indemnity benefits are separated into several different categories depending upon your medical status and ability to work based upon the doctor's orders.
HOW TO PROCESS A CLAIM
If you are injured in the course and scope of your employment, you should first report your injury to your employer and request medical care. It is then the employer's responsibility to provide necessary medical treatment, to report your injury to the insurance company and the state.
Some States require notice within 2-30 days following the injury. If you fail to report an injury promptly, or you do not accept medical attention offered, you may lose your rights to benefits.
In the course of your medical treatment, you must follow the doctor's instructions. File your claim with your employer's insurance carrier and save all copies of paperwork throughout the whole process.
TYPES OF INJURIES THAT ARE COVERED
Workers' compensation is designed to provide benefits to injured workers regardless of whether the injury was the employer's or the employee's fault. As long as your injury is work-related, it is covered under workers' compensation. Typical injuries covered are:
- Repetitive stress injuries
- Illnesses or diseases that are a gradual result of work conditions
- Traumatic physical injuries
- Repeated trauma injuries
- Mental injuries - when associated with physical injury
- Occupational diseases
TYPES OF INJURIES NOT COVERED
Workers' compensation provides for almost every type of injury that may occur at the workplace. However, several types of injuries remain uncovered:
- Self- inflicted injuries (including injuries to you when you cause a fight)
- Injuries resulting from the commission of a serious crime
- Injuries caused when your conduct violates company policy
- Injuries received while intoxicated or under the influence of illegal drugs
WHO IS NOT COVERED?
Several classes of workers are not entitled to workers' compensation benefits. The following are employees not covered by workers' compensation:
- Business owners
- Independent contractors
- Federal employees are not covered under State workers' compensation schemes
- Domestic employees in private homes
- Farm workers
- Maritime workers
- Railroad employees
- Unpaid volunteers
For information on your particular case, contact your employer who will refer you to the claims person of your employer's insurance company or the insurance adjuster who is handling your file. If you have a problem you cannot resolve with the employer or insurance company regarding workers' compensation benefits, you should contact your State authorities.
Any attorney can assist injured employees in filing for benefits due as a result of industrial injury or disease. They can also litigate your claim, if they are appealed from the administrative process to the State court system.
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