Groups » The Basics of Workers’ Compensation Programs: A Must-Read for Employees

Workers’ compensation is a type of insurance that provides medical benefits and replaces lost wages in the event of an individual suffering from a work-related injury. While this may seem simple enough, not all injuries are compensable, and benefits can be received only when an employee meets eligibility requirements.

If you are a victim of a work-related injury, you may be entitled to workers’ compensation. Before filing a claim though, read on for some information that will help you take the right decisions.

Compensation vs. Lawsuit

Workers’ compensation can be considered a substitute for a lawsuit against employers. Irrespective of who was at fault for the accident, as an injured employee, you may be entitled to compensation benefits in exchange for not filing a lawsuit.

Do note that you can still file a lawsuit if someone other than your employer was responsible for your injury or if the accident was a result of a defective product or malfunctioning equipment being used.

Scope of Coverage

The scope of workers’ compensation coverage varies from state to state. Additionally, coverage depends on the type of occupation too. As such, certain categories of employees like agricultural workers, railroad workers, maritime workers, domestic workers, volunteers, or independent contractors may be exempt from workers’ compensation in some states. On the other hand, some states may require coverage only if an employer hires a particular number of workers.

Types of Injuries Covered

Workers’ compensation covers work-related injuries, which means that most injuries that occur in connection with work are covered. Here are some examples:

• Preexisting conditions like back injuries that are aggravated by the workplace.


• Diseases such as lung cancer that are contracted as a result of exposure to toxins and chemicals at the workplace.


• Injuries caused while attending work-sponsored activities or during breaks.


• Injuries caused by company equipment or facilities.


• Mental and/or physical strain caused by work-related stress, increased duties, or harassment by a senior employee.

Workers’ compensation provides benefits to injured employees even if the injury was caused by the individual’s carelessness. However, there are some limits and coverage may be denied in following situations:

• Injuries caused when the employee was not on the job.


• Injuries caused as a result of being intoxicated.


• Injuries caused when committing a crime.


• Injuries caused when the employee’s conduct violated company policies.

Furthermore, keep in mind that an employee need not be injured at the workplace to be covered by workers’ compensation. Employees injured while running work-related errands, attending business-related social functions, or traveling on business can be covered by workers’ compensation. That being said, according to Chicago workers' compensation lawyers, employees may not be covered for injuries sustained while commuting to or from work or when going out for lunch.

Compensation Received

Just like the scope of workers’ compensation coverage, compensation received can vary by state and depends on the type of injury and factors that led to the incident. Here is some general information on compensation that can be received in the event of a workplace or work-related injury.

• Healthcare Expenses: Workers’ compensation covers medical expenses necessary to diagnose and treat injury. This means that costs related to doctor visits, medication, surgeries, special equipment like wheelchairs, and services like acupuncture, pain therapy, and counseling will be covered. Costs related to investigative or experimental treatment may not be covered. Moreover, employees might not be able to choose healthcare providers.


• Rehabilitation Costs: Medical and therapeutic care that is required to help individuals recover from injury is covered by workers’ compensation. The program also covers care and training necessary to help an employee regain skills and abilities to return to the same job or a different one.


• Disability Benefits: These benefits compensate an injured employee for wages lost in the event the injury makes it impossible for them to get back to work temporarily or permanently. Benefits received depend on the amount the employee earned prior to the injury- this is typically 2/3rds of the wages. Some states set a cap on the benefits, but since employees aren’t required to pay income tax on them, the amount received is closer to wages received earlier.


• Death Benefits: Workers’ compensation programs also provide death benefits to people related to the deceased worker. Benefits are calculated as a percentage of the worker’s wages and are provided as a lump sum or as maximum or minimum amounts.

Conclusion

Workers’ compensation helps employees receive compensation for medical bills, treatment, and other costs in the event of work-related injuries. Claiming benefits can be complicated in certain cases, with laws differing from state to state. If you have suffered a work-related injury and are unsure of the benefits you can claim, the information provided in this post is sure to help you.

File the claim form as soon as you can to avoid delays in receiving benefits. If a dispute arises and you fail to receive compensation, do get in touch with a skilled workers’ compensation lawyer to help you get the benefits you deserve.

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