How Does Workers’ Comp Work – Frequently Asked Questions

Workers’ compensation is liability insurance that provides employees with financial and medical care benefits when injured on-the-clock. Various steps and details influence how workers’ comp works in your claim, potentially influencing your chances of approval.

Employers must pay for workers’ compensation and cannot force employees to pay at their expense. An employee accepting workers’ comp benefits waives the right to sue the employer for damages.

According to the National Safety Council (NSC), the most costly workers’ compensation claims by cause of injury are vehicle accidents, averaging $90,914 per claim from 2021-2022. Other factors contributing to the above-average costs are burns ($63,119) and slips and falls ($51,047).

The type of injury you suffered may determine your settlement amount, which is why hiring an attorney is key. Workers’ comp may include medical, temporary or permanent disability, supplemental job displacement benefits, and death benefits.

Who is Covered Under Workers’ Compensation?

Workers’ compensation covers employees injured or suffering an occupational illness due to their job.

The injury must be directly related to the employee’s job and occur while performing work duties. Injuries not caused by you performing work tasks may be denied, thus it may only apply in the scope of employment.

If you had a pre-existing injury but your job made your condition worsen, you may be able to file for workers’ comp. You’ll have to prove your work has directly worsened your pre-existing injury.

Who is Exempt from Workers’ Comp Law?

Workers’ comp works under a no-fault system, meaning you can receive benefits even if you’re at-fault for your injuries. This expands the category of who can qualify for benefits, but there are always exceptions.

There are exceptions on who qualifies for workers’ comp depending on your state’s laws, such as:

• Sole proprietors with no employees
• Independent contractors
• Volunteers
• Family members in family businesses
• Executive officers

Furthermore, some industries or businesses are exempt from workers’ compensation, including private households, agriculture, real estate, taxi services, government, and religious organizations.

However, each state’s statute of limitations differ, so it’s important to understand if your claim would qualify through a workers’ compensation attorney.

What Should You Do if Injured at Work?

Here is a guide on what to do when suffering an injury or illness from a work-related task. Follow these steps carefully, as missing one may count as a mistake that reduces or eliminates your workers’ comp benefits.

1. Immediately report to your employer and inform them of the details. You should then receive medical treatment or call 911 or an ambulance if necessary.
2. Let the treating doctor know this was a work-related injury so they have that on file. You may request a summary visit, and details of your injury and medical costs for evidence.
3. File a workers’ comp claim after you’ve been treated 30 days after reporting the injury. However, you should do so immediately and not delay your benefits. Complete the form accurately and submit it to your employer.
4. Save all copies related to your injury including medical forms, incident records, and claim documents.
5. Contact a workers’ comp attorney as soon as possible to discuss your case’s details. An attorney can help you understand your state’s laws and legal matters surrounding your claim.

State regulations may have strict deadlines for submitting your workers’ comp claim. If the deadline expires, you may be denied benefits, so report your work-related injury to your employer as soon as possible.

How Do You Report a Workers’ Compensation Claim?

First, you must immediately report your work-related injury or illness to your employer and inform them of the accident. You’ll likely need to fill out a company-provided injury report form that varies per state.

The Centers for Disease Control provided workers’ comp data you should include in your claim when filing a work injury:

• The type of injury or illness you suffer from
• How your injury occurred
• The nature of medical care you received
• How much lost wages built up
• Number of days off work
• Your occupation, age, gender, date you started working, etc.

Depending on certain state laws, you may need to file another form to your state’s workers’ comp agency or through the United States Labor Employees’ Compensation Operations and Management Portal (ECOMP) if you’re a federal employer.

There are workers’ comp programs at state and federal levels that can assist you while you recover medical costs and benefits. The program may apply for:

• Employees of private organizations and state-local governments
• Federal employees and certain groups can file workers’ comp claims through the U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP).

Evidence to Save For Your Workers’ Comp Claim

Any evidence involving your work-related injury or occupational illness can help your claim. This evidence can take the form of:

• Images, photos, or videos of the injury, area of incident, etc.
• Medical documents, doctor summary visits, receipts of injury costs, lab results, and other medical receipts of your injury.
• Incident reports, police reports, or witness statements.
• A personal journal that records your date of injury, your pain levels, and limitations you have due to your condition.

Consulting an attorney can especially help with complex claims and can help you decide on the next steps to take on your case. Gathering insufficient evidence is one of the main reasons a workers’ comp claim may get denied.

What Do Doctors Measure in a Workers’ Comp Claim?

Keep in mind that most states require you to choose from your employer’s insurer’s network of physicians, not your own. In certain states, if you predesignated your doctor, you may receive medical care from them and reject your employer’s physicians.

Your doctor’s primary focus is to provide enough medical care for you to reach maximum medical improvement (MMI) while properly diagnosing your condition.

The doctor may require complete lab tests, X-rays, ultrasound, and other tests based on the type of injury you’ve suffered.

They then measure the extent of your injury and how it may affect your ability to work in the future. They may measure aspects of your injury such as:

• Severity of symptoms
• Movement limitations
• Functional capacity
• Potential for permanent impairment

The way they measure your condition is through check ups such as a functional capacity evaluation (FCE). Your doctor must analyze the likelihood of full recovery, the capabilities to return to work, and the level of disability benefits the victim must be eligible for.

How Long Does Workers’ Comp Last?

Workers’ comp benefits may last for multiple years, but overall length varies on severity and your state.

Temporary benefits may last three to seven days for hospitalizations or those fully recovering during that time period. Permanent disability benefits can last much longer, even for your whole life if you never fully get better.

Make sure to refrain from taking lump-sum payments without consulting with a workers’ comp attorney. If your condition deteriorates further, you may not be able to acquire further benefits if you accept their initial claim amount.

When Do You Submit a Workers’ Comp Claim?

Submit your workers’ comp claim as soon as possible, or before the state’s deadline. Each state has various laws for submitting workers’ comp claims, and most states require you to submit within 30 days. Reporting promptly can help you avoid delays and prevent loss of benefits.

How Long Does a Workers’ Comp Claim Usually Take?

Typically, a workers’ comp case may take about 1 to 2 years to settle in most states if you consider maximum medical improvement—the point where an injured worker isn’t likely to improve their condition in their current state.

However, the exact timeframe would depend on your injury and its severity, state laws, and case complexities.

Can You Qualify for Other Benefits While Receiving Workers’ Comp?

Yes, there are other benefits you can receive besides workers’ comp. Excluding workers’ comp benefits, injured workers can receive temporary and permanent disability benefits to assist with high medical expenses.

You may also receive Social Security Disability Insurance (SSDI) depending on your eligibility qualifications.

Your job may offer supplemental job displacement if you’re unable to perform the same duties and are forced to either transfer or work in a different position.

What Happens if Your Claim is Disputed?

If your claim is disputed, you should hire a workers’ comp attorney to help you in your case. The issue may likely go to a hearing before a workers’ comp judge. They then decide if you’re entitled to benefits based on the evidence presented.

If you can’t reach an adequate settlement, your case could become a full trial where a court judge makes a final decision.

This is why hiring an attorney is important in your case to help you organize your evidence and explain the process to you within the state laws and limitations.

Find Out How Workers’ Comp Works Through an Attorney

Understand your state’s laws and statutes of limitations through a workers’ comp attorney to raise your chances of approval.

LegalASAP can assist you in finding the type of attorney you need in your case through our partnered network across the United States. It’s important to file a claim as soon as possible due to the workers’ comp regulations deadline.

Submit a consultation form here to see if your claim qualifies within our network of attorneys. You may contact us for further questions or concerns you have at 888-927-3080.