Frequently Asked Questions about Workers' Compensation

Frequently Asked Questions about Workers' Compensation

Q: What is workers' compensation?

A: To take the uncertainty out of the circumstances following a work-related injury or industrial illness, the workers’ compensation system provides a reliable procedure for resolving resulting problems. Broadly, if the injury occurs in the course of employment, regardless of whether the employer was negligent or otherwise at fault, the worker receives benefits that may include wage replacement, medical coverage or other assistance. The employee is not allowed to sue the employer for the injury and the employer must carry insurance or otherwise legally provide a means to cover workers’ compensation expenses. Most employers are subject to the workers' compensation system, but some states exempt smaller employers, and most federal workers and certain national industries are covered instead by comparable federal programs.

Q: What types of injuries or diseases are covered?

A: Virtually all types of work-related physical injury and industrial illness are covered by workers’ compensation. Very commonly covered conditions include repetitive-stress injuries (RSIs) like carpal-tunnel syndrome (CTS), back injuries, traumatic injuries, wounds or bodily reactions to substances. Many states also cover mental or emotional harm, but the standards for psychological coverage vary greatly from state to state. Pre-existing conditions are generally not covered unless aggravated at work.

Q: What types of benefits are offered?

A: Available benefits vary from state to state, but usually include compensation for medical expenses and disability benefits to replace wages, at least in part. States use various methods for calculating benefit amounts, such as schedules or formulas that may take into account the severity and type of injury and amount of lost wages. Some states offer other types of benefits, such as vocational rehabilitation. Death benefits are available to surviving dependents of workers who die from occupational injury or disease.

Q: Where does the money come from to pay workers' compensation benefits?

A: State laws require one of three payment methods or a combination thereof. Employers may need to carry workers’ compensation insurance; employers may self-insure by setting up a fund sufficient to cover outgoing benefits; or the state may administer its own fund into which employers are required to pay.

Q: What steps should I take if I am injured at work?

A: Of course, you should first obtain necessary emergency treatment. Second, give notice of the injury or disease to your employer as soon as possible. State laws vary about what type of notice is sufficient, whether a designated person needs to receive it, how soon it must be given and if there is a deadline. Also, some states require notice to other parties, such as the state workers’ compensation agency, local court or workers’ compensation insurer. Third, file your workers’ compensation claim with the state agency in a timely manner. Consult a knowledgeable workers' compensation attorney as early in the process as possible for advice about how to proceed every step of the way.

Q: Can I choose my own doctor?

A: Whether you can choose your own doctor depends on your state’s law. Most states allow emergency treatment without concern for consultation with the employer or insurer. Beyond an emergency, the choice of treating physician may belong to the employee, the employer, the workers’ compensation insurance carrier or the state. Sometimes the employee can choose from a list of providers compiled by the employer, insurer or state agency. Your state law may also control how to change providers or other situations, such as obtaining a second opinion.

Q: What if my claim for workers' compensation is denied?

A: Each state has a procedure for appeal of a denied claim. Normally the first review is by the state workers’ compensation agency, where there may be more than one level of claim re-evaluation and a hearing is usually held. Typically if the agency ultimately affirms the claim denial, the employee can appeal to the state court system, where there may also be more than one level of appeal. Representation by an attorney is helpful at any stage of appeal, particularly at any hearing and in court.

Q: What if my work injury was not caused by my employer, but by another party?

A: If you are harmed in the course of employment, you are entitled to workers’ compensation, regardless of the cause. You may be able to sue a third party that caused the injury, such as the manufacturer, distributor or seller of faulty equipment that caused the injury. If a co-worker caused the injury, most states do not allow you to sue your colleague, but some do. If you recover from a third party, your employer or its insurer may be eligible for workers’ compensation reimbursement or they may be able to join the suit.

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