Who pays workers' compensation benefits?
In most states, employers are required to purchase insurance for their employees from a workers' compensation insurance company (also called an insurance carrier). In some states, however, very small companies (with fewer than three or four employees) are not required to carry workers' compensation insurance. In some states, larger employers who are clearly financially stable are allowed to act as their own workers' compensation insurance companies (also called self-insuring).
When a worker is injured, his or her claim is filed with the insurance company -- or self-insuring employer -- who pays medical and disability benefits according to a state-approved formula.
Are all on-the-job injuries covered by workers' compensation?
Workers' compensation covers most, but not all, on-the-job injuries. The workers' compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer's or employee's carelessness. But there are some limits. Generally, injuries that happen because an employee is intoxicated or using illegal drugs are not covered by workers' compensation. Coverage may also be denied in situations involving:
- self-inflicted injuries (including those caused by a person who starts a fight)
- injuries suffered while a worker was committing a serious crime
- injuries suffered while an employee was not on the job, and
- injuries suffered when an employee's conduct violated company policy.
Does workers' compensation cover only injuries or does it also cover long-term problems and illnesses?
Your injury need not be caused by an accident -- such as a fall from a ladder -- to be covered by workers' compensation. Many workers receive compensation for injuries that are caused by overuse or misuse over a long period of time -- for example, repetitive stress injuries such as carpal tunnel syndrome or back problems. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions -- for example, heart conditions, lung disease, and stress-related digestive problems.
Do I have to be injured at my workplace to be covered by workers' compensation?
No. As long as your injury is job-related, it's covered. For example, you will be covered if you are injured while traveling on business, doing a work-related errand, or even attending a required business-related social function.
What kind of benefits will I receive?
The workers' compensation system provides replacement income, medical expenses, and sometimes vocational rehabilitation benefits -- that is, on-the-job training, schooling, or job placement assistance. The benefits paid through workers' compensation, however, are almost always relatively modest.
If you become temporarily unable to work, you'll usually receive two-thirds of your average wage up to a fixed ceiling. But because these payments are tax-free, if you received decent wages prior to your injury, you'll fare reasonably well in most states. You will be eligible for these wage-loss replacement benefits as soon as you've lost a few days of work because of an injury or illness that is covered by workers' compensation.
If you become permanently unable to do the work you were doing prior to the injury, or unable to do any work at all, you may be eligible to receive long-term or lump-sum benefits. The amount of the payment will depend on the nature and extent of your injuries. If you anticipate a permanent work disability, contact your local workers' compensation office as soon as possible; these benefits are rather complex and may take a while to process.
Can I be treated by my own doctor and, if not, can I trust a doctor provided by my employer?
In some states, you have a right to see your own doctor if you make this request in writing before the injury occurs. More typically, however, injured workers are referred to a doctor recruited and paid for by their employers.
Your doctor's report will have a big impact upon the benefits you receive. Keep in mind that a doctor paid for by your employer's insurance company is not your friend. The desire to get future business from your employer or the insurance company may motivate a doctor to minimize the seriousness of your injury or to identify it as a preexisting condition. For example, if you injure your back and the doctor asks you if you have ever had back problems before, it would be unwise to treat the doctor to a 20-year history of every time you suffered a minor pain or ache. Just say "no" unless you really have suffered a significant previous injury or chronic condition.
