Will Workers’ Comp Cover My Injury?

Were you injured on the job recently? Is your company telling you workers’ comp does not cover your job-related injury? If so, you need to understand all the details of how workers’ compensation works.

Learn more about workers’ comp below and the type of injuries covered. This is general information only, and if you have specific questions about your accident and injury, speak to a Greenfield workers’ compensation attorney today.

Workers’ Compensation Overview

Workers’ compensation is offered in every state to give injured workers important benefits if they are hurt. The system protects injured employees by giving them the medical care they need, even if the accident was the employee’s fault. Generally, it covers medically necessary treatments and partial income.

Workers’ comp insurance also protects workers from being sued by their company for job-related injuries. If workers accept workers’ compensation, they typically cannot sue. However, in limited cases, an employer might exit the workers’ compensation system and file a third-party liability claim.

Workers’ comp benefits always cover medical costs, but you can receive four types of income loss benefits, depending on the type and severity of the injury:

• Temporary partial disability (TPD): If you can go back to part-time or limited-duty work as you recover but make less than you did before, you may get TPD. Amounts vary by state, but many provide two-thirds of the difference between your average weekly income, up to a maximum that changes regularly.
• Temporary total disability (TTD): If you cannot work at all temporarily, TTD benefits may be appropriate. You may receive approximately two-thirds of average weekly earnings for a fixed period.
• Permanent partial disability (PPD): If you have a permanent injury but still can do limited work, you can receive PPD. The award relies on the permanent impairment rating that your doctor provides. The amount also may vary based on your state’s schedule and impairment levels according to the loss of use of various body parts.
• Permanent total disability (TPD): If you are completely and permanently disabled, you may receive permanent total disability. You can receive approximately two-thirds of the average weekly income, up to a maximum amount.

What Is a Job-Related Injury?

Your injury must be job-related to be covered by workers’ compensation. Whether an injury is covered depends on if it occurred during one’s ‘normal course of employment. This refers to duties or tasks that the worker must perform as part of their job.

For instance, if you have a car accident while taking company mail to the post office, your injuries will be covered by workers’ compensation; however, if you suffered an injury in a car accident while on lunch break from work, that won’t fall under the coverage of workers’ compensation.

The scope of job-related injury has widened in many states in recent years. If you sustain an injury on the job, you must report the incident to your HR department. Then, speak to an experienced workers’ comp attorney in your state to see if the injury is covered.

You must meet four criteria to qualify for for workers’ comp:

• The company must employ you.
• Your company carries workers’ comp insurance, a requirement for most employers in most states.
• Your illness or injury has to be related to your job.
• You must meet state deadlines for reporting your injury and filing for workers’ comp.

Certain employers in various states, such as temp agencies and seasonal workers, farm workers, and domestic workers, may not be required to carry workers’ comp insurance. If you are in any of these categories, talk to a workers’ compensation attorney today.

Also, workers’ comp does not typically cover consultants, independent contractors, and freelancers. They are not employees. Sometimes, an employer can misclassify an employee as a contractor to avoid paying payroll taxes and workers’ comp.

Benefits Offered Under Workers’ Compensation

Most workers’ comp systems in the various states cover the following benefits.

However, your state’s specific laws can be different, so contact a workers’ comp attorney in your state for more information:

• Medical expenses: Workers’ compensation in your state covers all medically necessary treatments, medications, treatments, and visits. These benefits typically have a maximum dollar amount. Co-pays and deductibles are covered. You can be eligible for travel expenses if your medical treatments require it. Long-term and future care, such as physical therapy, is also covered when medical expenses are determined.

• Lost earnings: Determining disability benefits involves calculating a percentage of your salary or income, and these benefits may be applicable if the injury has left you where you cannot work either temporarily or permanently. How much you receive for lost income depends on the severity of the injury and how it affects your ability to return to work. Note that the income you are entitled to can vary by state, so speak to a workers’ compensation attorney in your area for more information.
• Job rehabilitation: This benefit aims to assist an injured worker in returning to work if they cannot perform their previous duties due to the injury. Job rehabilitation can include training, career counseling, and general assistance in finding new work.
• Death benefits: Determining disability benefits involves calculating a percentage of your salary or income, and these benefits may be applicable if the injury has left you where you cannot work either temporarily or permanently. Death benefits usually pay for burial and funeral costs, as well as give a lump sum to pay the family for their loss.

Workers’ compensation benefits do not include payment for pain and suffering. To receive compensation for pain and suffering, the injured worker must file a lawsuit, although such action is typically not permissible against the employer.

Instead, if appropriate, you can file a third-party liability claim against the negligent entity, such as a contractor, equipment manufacturer, or property owner.

Talk to a workers’ compensation attorney if you think a party other than your employer was negligent in your accident. They will determine if you should exit the workers’ comp system and file a third-party liability claim.

For example, if you suffered an injury on a piece of shop equipment, you cannot sue your company for a hand injury. However, if the equipment was defective in some way or had improper or inadequate warnings, a third-party lawsuit can be possible.

How Do You File a Workers’ Compensation Claim?

First, talk to a lawyer. They can handle most of the important tasks for you and reduce the chances of a delay or denial.

If you sustain an injury at work, inform your employer within 30 days of the incident, with earlier notification preferable. Ask your HR department to write a report about your injury and send it to their workers’ comp insurance company.

Your company will then need to complete an employer’s report of injury form and send it to the insurance company. The insurance provider must file a report with the state workers’ compensation board. In most states, the insurance company has approximately 30 days to accept or deny the workers’ comp claim.

Can You See Your Doctor?

Many states allow you to choose your doctor for medical treatments during a workers’ comp claim. Call a lawyer to find out if you live in such a state.

Even if you do, a company doctor may need to check you for insurance purposes. They can deny your claim or reduce benefits if you do not see their doctor. Talk to a lawyer about what to expect at your exam.

Depending on state laws, you can select a doctor for a second opinion the company physician treats you. Get an independent doctor’s opinion about your condition.

How Much Can You Receive for a Workers’ Comp Claim?

You can receive workers’ comp benefits when you’re hurt and cannot work. Amounts vary, but many states allow lost income of two-thirds of your average weekly earnings, plus medical expenses. If the injury causes a loss of part of your body, you can receive more money for a permanent disability.

The amount of the benefits you receive for the disability depends on:

• How severe the loss is
• What is your permanent impairment rating is
• How the accident happened

How Can a Workers’ Comp Attorney Help You?

Many may wonder why you need a workers’ comp attorney to file for benefits. After all, employees can file for workers’ comp independently through their employer. However, hire an attorney for the best chance of prevailing in your case and obtaining the maximum benefits.

Your workers’ comp attorney will build your case from beginning to end, collect evidence to prove your injuries, and negotiate a fair settlement. Or, they will represent you in your workers’ comp hearing if your case faces a denial. An experienced attorney also can provide detailed legal advice about making a third-party claim if needed.

Your workers’ comp lawyer will communicate with the insurance company for you. You will not have to deal with any more insurance or legal questions about your case. They will also collect all evidence needed to receive medical benefits and vocational rehab. Your attorney will also fight for the most lost income possible.

It is usually beneficial to at least have a workers’ comp attorney review your case, even if it seems straightforward.

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