Workers Comp: Frequently Asked Questions — FAQ

Work­ers’ com­pen­sa­tion is also known as workman’s comp, workman’s com­pen­sa­tion, and work­ers’ comp. These terms all mean the same thing. 

Work­ers’ Comp Laws help pro­tect work­ers from poten­tial­ly dev­as­tat­ing costs of work-relat­ed injuries. It also helps pro­tect employ­ers from poten­tial dam­ages that could crip­ple a busi­ness based on work­ers’ comp claims.

Work­ers com­pen­sa­tion ben­e­fits are avail­able to most employ­ees who are injured or become ill as a result of their job. This includes full-time, part-time, and in some cas­es, sea­son­al work­ers and con­trac­tors.

You must be an employ­ee. You must have been injured or become ill as a result of your job. And You are unable to work due to your injury or illness.

In some cas­es, you may also be eli­gi­ble for work­ers’ com­pen­sa­tion ben­e­fits if you are a vol­un­teer, a tem­po­rary work­er, or a self-employed worker.

You are enti­tled to full cov­er­age for Med­ical expens­es. Any tem­po­rary or per­ma­nent dis­abil­i­ty ben­e­fits and Death benefits.

Med­ical expens­es include the cost of med­ical care, such as doc­tor’s vis­its, hos­pi­tal stays, and pre­scrip­tion drugs are some of the major ben­e­fits. In addi­tion, depend­ing on your specifics, there may be addi­tion­al benefits. 

Tem­po­rary dis­abil­i­ty ben­e­fits are pay­ments that you receive while you are unable to work due to your injury or illness. 

Per­ma­nent dis­abil­i­ty ben­e­fits are pay­ments that you receive if you are unable to return to work at all due to your injury or ill­ness. Death ben­e­fits are pay­ments that are made to the sur­viv­ing spouse, chil­dren, or depen­dents of a work­er who is killed in a work-relat­ed accident.

Death ben­e­fits are pay­ments that are made to the sur­viv­ing spouse, chil­dren, or depen­dents of a work­er who is killed in a work-relat­ed accident.

The amount of ben­e­fits that you receive will vary depend­ing on the sever­i­ty of your injury or ill­ness, your lost wages, and your med­ical expens­es. Your Employ­er’s insur­ance and the laws of your state laws will also make your ben­e­fits vary.

Yes. Work­ers’ com­pen­sa­tion ben­e­fits are a no-fault sys­tem. This means that you do not have to prove that your employ­er was at fault for your injury or ill­ness in order to receive ben­e­fits. How­ev­er, there are some excep­tions to this rule. For exam­ple, if you are injured while com­mit­ting a will­ful or inten­tion­al act, you may not be eli­gi­ble for work­ers’ com­pen­sa­tion benefits.

No. Com­pa­nies with very few employ­ees may not be oblig­at­ed to pur­chase work­ers’ comp insurance.

No. Fed­er­al work­ers are cov­ered under a sep­a­rate work­ers’ com­pen­sa­tion pro­gram designed for fed­er­al workers.

In some states, inde­pen­dent con­trac­tors and sea­son­al work­ers may not be cov­ered. Also, domes­tic work­ers like babysit­ters or house­keep­ers are not covered.

No. an injured work­er is enti­tled to wage loss and med­ical ben­e­fits, only. Injured work­ers are not enti­tled to dam­ages for pain and suf­fer­ing.  How­ev­er, if there is a 3rd par­ty claim, then you may be enti­tled to pain and suf­fer­ing. You must con­sult a lawyer to under­stand all the options avail­able under the law.

Work­place relat­ed injury is relat­ed to any acci­dent such as any phys­i­cal injury, ill­ness, or a con­di­tion you expe­ri­ence dur­ing your employ­ment with your employ­er and is con­nect­ed with your work duties and tasks. Some­times these injuries can defined as occu­pa­tion­al injury or repet­i­tive stress injuries.

Chock­ing on a sand­wich while eat­ing at work. Fight with a co-work­er over per­son­al mat­ters. Car acci­dent while dri­ving to work from home or anoth­er place not con­nect­ed with work. These are just a few examples. 

An inci­dent that arose out of an act of God., such as earth­quake. An ordi­nary one-time ill­ness­es such as influen­za or headaches. Pre-exist­ing condition(s) before an employ­ee was hired or began per­form­ing a par­tic­u­lar job. Or, con­tract­ing ordi­nary dis­ease of life, such as Covid. These are just a few examples. 

Get med­ical treat­ment imme­di­ate­ly after a work-relat­ed injury or ill­ness.
Report your injury or ill­ness to your employ­er with­in man­dat­ed guide­lines in your state.
Fol­low the med­ical advice of health-care professional.

The most com­mon work injuries are slip, trip and falls, overex­er­tion and work with machines and equip­ment. Employ­ers and employ­ees who fol­low OSHA guide­lines and are well trained reduce the chance of work injury.

A broad range of work relat­ed acci­dent and result­ing injuries that may qual­i­fy you for work­ers’ com­pen­sa­tion ben­e­fits. Basi­cal­ly, any injury that was as a result of your work and requires med­ical attention.

The amount of time it takes to receive work­ers’ com­pen­sa­tion ben­e­fits can depend on a vari­ety of fac­tors, such as the sever­i­ty of the injury, the amount of evi­dence and doc­u­men­ta­tion pro­vid­ed, and the will­ing­ness of the par­ties to nego­ti­ate. Gen­er­al­ly, the process of fil­ing a claim, receiv­ing approval, and receiv­ing ben­e­fits can take any­where from a few weeks to sev­er­al months.

In gen­er­al, there are some gen­er­al time frames that may apply to the work­ers’ com­pen­sa­tion claims process. Over­all, the length of time it takes to receive work­ers’ com­pen­sa­tion ben­e­fits can vary wide­ly depend­ing on the spe­cif­ic cir­cum­stances of your case.

The amount of mon­ey an employ­ee receives in work­ers’ com­pen­sa­tion ben­e­fits depends on a vari­ety of fac­tors, such as the type of injury or ill­ness, the length of time the employ­ee was off work, and the employ­ee’s salary. Gen­er­al­ly, work­ers’ com­pen­sa­tion ben­e­fits are designed to cov­er a por­tion of lost wages and med­ical expens­es, and can range from a few hun­dred dol­lars to sev­er­al thou­sand dollars.

Gen­er­al­ly, work­ers’ com­pen­sa­tion does not cov­er pre-exist­ing con­di­tions unless the employ­ee can prove that the pre-exist­ing con­di­tion was aggra­vat­ed or wors­ened by their job duties. How­ev­er, work­ers’ com­pen­sa­tion ben­e­fits do not typ­i­cal­ly cov­er the pre-exist­ing con­di­tion itself, but only the por­tion of the injury or ill­ness that is relat­ed to the work­er’s job duties.

Yes. If a work­er has a pre-exist­ing con­di­tion that is aggra­vat­ed or wors­ened by their job duties, they may be eli­gi­ble for work­ers’ com­pen­sa­tion ben­e­fits. How­ev­er, the work­er must be able to demon­strate that the injury or ill­ness was caused or aggra­vat­ed by their job duties in order to be eli­gi­ble for benefits.

Yes. In some cas­es, the work­ers’ com­pen­sa­tion insur­ance car­ri­er may argue that the pre-exist­ing con­di­tion was the pri­ma­ry cause of the injury or ill­ness, rather than the job duties. In these cas­es, it may be nec­es­sary to con­sult with an expe­ri­enced work­ers’ com­pen­sa­tion attor­ney who can help you demon­strate the rela­tion­ship between your job duties and the injury or illness.

Over­all, work­ers’ com­pen­sa­tion ben­e­fits can be com­plex, and the spe­cif­ic cir­cum­stances of each case can vary wide­ly. If you have a pre-exist­ing con­di­tion and are unsure whether you are eli­gi­ble for work­ers’ com­pen­sa­tion ben­e­fits, it’s always a good idea to con­sult with an expe­ri­enced attor­ney who can help you under­stand your rights and obligations.

Gen­er­al­ly, there is a statute of lim­i­ta­tions for fil­ing a work­ers’ com­pen­sa­tion claim, which varies by state. In most states, the employ­ee must file a claim with­in a cer­tain amount of time after the injury or ill­ness occurred, or risk los­ing their right to pur­sue a claim.

The time lim­its are known as statutes of lim­i­ta­tions, and they are designed to ensure that claims are filed in a time­ly man­ner and that evi­dence and wit­ness­es are still avail­able. Fail­ing to file a claim with­in the statu­to­ry time lim­it may result in the claim being denied.

The spe­cif­ic time lim­it for fil­ing a work­ers’ com­pen­sa­tion claim varies by state, but it is typ­i­cal­ly between one and three years from the date of the injury or ill­ness, or from the date the work­er became aware of the injury or ill­ness. Some states also have short­er time lim­its for report­ing the injury to the employ­er or fil­ing ini­tial paperwork.

In most cas­es, an employ­er is not allowed to fire an employ­ee for fil­ing a work­ers’ com­pen­sa­tion claim. If an employ­ee believes they have been wrong­ful­ly ter­mi­nat­ed for fil­ing a claim, they may be able to file a wrong­ful ter­mi­na­tion claim.

If an employ­er does retal­i­ate against an employ­ee for fil­ing a work­ers’ com­pen­sa­tion claim, the employ­ee may have legal recourse and may be enti­tled to com­pen­sa­tion for any dam­ages they have suf­fered as a result of the retal­i­a­tion. This can include lost wages, ben­e­fits, and oth­er damages.

It’s impor­tant to note that while employ­ers can­not legal­ly retal­i­ate against employ­ees for fil­ing work­ers’ com­pen­sa­tion claims, they may still ter­mi­nate employ­ees for oth­er rea­sons, such as poor per­for­mance or vio­la­tions of com­pa­ny poli­cies. How­ev­er, if an employ­ee believes they have been ter­mi­nat­ed in retal­i­a­tion for fil­ing a work­ers’ com­pen­sa­tion claim, they should con­sult with an expe­ri­enced work­ers’ com­pen­sa­tion attor­ney who can help them under­stand their rights and pur­sue any avail­able legal remedies.

It is ille­gal for an employ­er to fire or retal­i­ate against an employ­ee for fil­ing a work­ers’ com­pen­sa­tion claim, and employ­ees should not hes­i­tate to file a claim if they have been injured or become ill as a result of their job duties.

No. Can­not ter­mi­nate your for being injured on the job

Fil­ing the incident/accident report with the insur­ance car­ri­er. Noti­fy the car­ri­er about your employ­ee ben­e­fits, includ­ing wage infor­ma­tion. And ensur­ing that your med­ical bills are paid by the carrier.

Yes. Your employ­er is oblig­at­ed to car­ry state man­dat­ed insurance.

Yes. Your employ­er must pro­vide light duty work based on med­ical advice.

No. Your employ­er can­not blame you for work injury.

No. Your employ­er can­not ask you for drug test if not part of employ­ment agreement..

Yes. Your employ­er must pay you for any mileage reim­burse­ment or trav­el for med­ical care

If an employ­er dis­putes a work­ers’ com­pen­sa­tion claim, the employ­ee can file an appeal with the rel­e­vant state agency. The appeal process can involve sub­mit­ting addi­tion­al evi­dence, attend­ing hear­ings, and pro­vid­ing testimony.

“No.” States have passed laws that pro­tect both the injured work­er and the employ­er for receiv­ing work­ers’ com­pen­sa­tion ben­e­fits. This includes the right to sue the employ­er for pain and suffering.

Yes. If a third par­ty is respon­si­ble for your injuries. A com­mon exam­ple is if you are involved in a work-relat­ed motor vehi­cle acci­dent and sus­tained injuries as a result of the neg­li­gence of a the oth­er dri­ver. In such case, you have a right to file a per­son­al injury action against the third par­ty seek­ing pain and suf­fer­ing for your injuries.

Yes. The law requires injured work­ers to report any income earned while out of work on work­ers’ comp. How­ev­er, you should always seek legal advice to make sure you are report­ing the infor­ma­tion correctly.

Should I accept the first com­pen­sa­tion offer after work injury? If you are not work­ing with a lawyer on the whole val­ue of your claim, you should not accept a first offer from an insur­ance com­pa­ny. You should also con­sid­er med­ical advice on long term affects of your injury.

In Work­ers Comp, Qual­i­fied Med­ical Eval­u­a­tor (PQME) is a doc­tor, gen­er­al­ly a spe­cial­ist, who is inde­pen­dent or neu­tral. He or she is not the employ­er’s / insur­ance com­pa­ny doc­tor nor is he or she a doc­tor of the injured work­ers doc­tor. A QME doc­tor’s opin­ion is sought if there is a dif­fer­ence of opin­ion between the treat­ing physi­cian and injured work­er or work­er’s per­son­al physi­cian. There­fore, a third opin­ion, inde­pen­dent and unbiased.