Workers’ compensation policies can be difficult and frustrating to navigate. Before hiring worker’s compensation attorneys, familiarize yourself with the basics of workers’ compensation policies. Workers’ compensation is insurance that provides cash or medical benefits for accidental job-related injuries and illnesses to employees. Employees rarely include independent contractors.
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If you are injured on the job, your employer may be required by law to pay workers’ compensation benefits. There are instances that workers’ compensation will and will not cover. Workers’ compensation only covers unintentional and accidental injury. The injury may result from a single event or repeated exposure while on the job. It doesn’t matter who is at fault for the injury; the accident can result from an employee’s own negligence and still be covered. Policies may even cover stress-related injuries due to work.
Workers’ compensation policies do not apply to conditions that existed before the employee was hired. The condition must have occurred while on the job. Workers’ compensation policies do not cover intentional acts. If an employee’s accident takes place while partaking in illegal activity, the employee will not be covered. In order to prevent false claims, an injury reported after the worker is told that they are being terminated or laid off will also not be covered.
In order to be awarded workers’ compensation, the employer must carry workers’ compensation insurance. Workers’ compensation benefits are state-regulated and vary from state to state. Each state has its own set of laws and penalties. There is no federal law requiring states to regulate workers’ compensation insurance policies. However, every state mandates that employers purchase workers’ compensation insurance, except for Texas. There are special laws for federal employees and employees of certain industries, such as the railroad. Under worker’s comp, employees give up the right to sue the employer but retain the right to sue negligent third parties.
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Benefits paid by workers’ compensation policies may include wage loss and/ or medical, rehabilitation, and death benefits. Medical care may be offered for treatment of the injury, temporary disability for the loss of wages, permanent disability for the permanent loss of function, and job displacement benefits that provide for job retraining. Workers’ compensation is usually paid for medical expenses that are necessary to diagnose the injury or illness. Each state has a maximum weekly rate, so you will want to make sure you understand your state’s benefits. A totally disabled employee may expect to receive 60% of their average weekly wage.
The laws vary from state to state, but for the first 30 days, the treating doctor is usually required to be part of a network and is assigned by the claims administrator. After this time period, the employee may request to be treated by their own physician. If your employer continues to tell you benefits are on the way, but you have not seen progress in your claim, an attorney should be contacted. Employers who do not process claims in a timely manner may be penalized.