Most states require employers to provide workers’ compensation coverage to their employees. Though employers are also obliged to provide a safe workplace for their employees, accidents can still happen, which both parties have no control over.
If you’re an employee, you must understand the concept of workers’ compensation, your benefits under this plan, what it covers and excluded injuries, and if your specific situation would already require a workers compensation attorney or not.
What Is Workers’ Compensation
Workers’ compensation is insurance that pays for an employee’s medical expenses and compensates a portion of their lost wages when they get injured or become ill while on the job. If the accident or illness resulted in death, death benefits will be granted to the employee’s beneficiaries.
Understanding Workers Compensation Insurance
As mentioned, most states require employers to provide workers’ compensation. However, in the case of those that don’t, it’s still recommended for employers to offer it to their employees. This is because, without workers’ compensation, employers aren’t protected against possible civil lawsuits that an injured employee might file against them.
Once an employee accepts a workers’ compensation coverage, this means that they’re giving up their recourse of filing a lawsuit against their employer if ever they get ill or injured at work. However, this doesn’t mean that an employee won’t be able to file a lawsuit against an employer for an on-the-job injury or illness. Two circumstances would only allow them to do so–if the injury was caused by the employer’s intentional misconduct and if the injury occurred outside the scope of the employee’s job assignment.
Workers’ compensation insurance protects both employers and employees. Employees are assured that whatever happens to them while on their job’s premises, there’s insurance that’ll cover their medical expenses and wage loss. On the employer’s side, providing workers’ insurance prevents employees from filing civil lawsuits, which might negatively affect them and their business.
How Do Workers’ Compensation Claims Work
Each state has a specific filing deadline for claims submission. Employees and their employers must act immediately when a work-related injury happens to prevent the denial of claims for filing beyond the deadline provided. The employee is responsible for filling out claim forms that’ll be provided by the employer. Usually, it’s the employer’s responsibility to submit the claim to the insurance carrier.
If a claim got denied, the employee has the right to hire a workers’ compensation attorney if they believe that it was denied incorrectly.
Benefits Of Workers’ Compensation Insurance
Benefits vary depending on the state, but the following are the typical benefits that workers’ compensation provides:
- Medical Coverage: All medical expenses resulting from work-related or on-the-job injuries are covered under this type of insurance. This includes prescription drugs needed for treatment, as well as medical supplies and equipment.
- Death Benefits: The surviving relatives and beneficiaries will receive death care compensation, which includes funeral benefits if the disease or accident results in death.
- Rehabilitation Services: Workers’ compensation insurance also covers related injuries that need rehabilitation, like physical therapy, occupational therapy, and even psychological counseling.
- Wage Loss: Most states mandate insurance to cover lost wages incurred for the whole duration of the disability. For some, especially for those with temporary disabilities, the insurance can only cover lost wages for the specified number of weeks. The amount of the benefit usually covers half to two-thirds of the average weekly wage of the employee.
For insights into maximum work benefits, consider Shuman Legal’s expertise in workers’ compensation cases.
Injuries And Illnesses Covered Under Workers’ Compensation Insurance
A worker is entitled to workers’ compensation if they suffer an injury or disease in the course of their employment or as a result of their employment in a significant way. Employees are also entitled to compensation if they had contracted any illness resulting from chemicals at work and other possible factors that may affect their health.
Some injuries and diseases that develop over time or don’t show up for a long time after the initial exposure or contraction may also be eligible for compensation.
Injuries Excluded Under Workers’ Compensation Insurance
If a worker got injured while traveling from home to work and vice-versa, they don’t get eligibility for compensation. This is unless the accident occurs as a result of a deviation from their usual route that their employer directed, requested, or authorized.
Injuries caused by self-infliction, intoxication, or drug misuse are also excluded.
Who Pays Workers Compensation’s Premium
Unlike health insurance where premiums are deducted from employee’s payroll, worker’s compensation premiums are paid by employers. Premium rates differ by state. Employers can either choose between a state-run worker’s compensation program or through a private insurance company.
State-Run Insurance Program
Employers may choose to use a state-run program to handle workers’ compensation claims. These programs offer insurance funds to employers and are typically managed by the state’s department of labor, commerce, or industrial relations.
This type of service is usually employed by smaller companies or businesses with a low incidence of occupational injuries. Employers pay for the premiums, and when a claim is filed, the government program’s monitoring agency pays for it.
Private Insurance Companies
Workers’ compensation funds may also be provided by large private insurance providers to businesses of all sizes. If the employer chooses a third-party insurance provider to manage workers’ compensation concerns, any grievance or payout dispute will most likely be referred to these agencies.
Final Thoughts
Accidents can happen any time, regardless of how cautious you are as an employee at work or how vigilant you are as an employer. You and your employer will avoid even larger damages caused by an accident if both of you have a good understanding of how workers’ compensation works.
