No one wants to get injured at work. A sudden accident can be devastating to a family’s livelihood. If you have recently been injured at work and don’t know what to do, you may be entitled to workers’ compensation.
Frequently, injuries received in the workplace are not sudden but, instead, due to repetitive strain or environmental factors. If your injury has happened over time and you are now unable to work or unable to work as much, you may still be able to get workers’ compensation benefits.
Applying for or accepting workers’ compensation may be a necessity after an accident. Being injured on the job should not cause shame. In fact, millions of people have to apply every year. In 2013 alone, workers’ comp covered 129.6 million employees.
However, it is important to get the application process started as soon as possible after the accident or initial diagnosis so you can start getting the help you need right away.
What is “Workers’ Comp”?
Workers’ Compensation (also called workman’s comp) is a type of aid given to an employee when they become injured or ill on the job. It is also used to cover the funeral costs and additional expenses a family may face if their loved one dies on the job or from and accident or illness resulting from it. It may or may not be the employer’s fault. The benefits you, the employee, would receive cover medical expenses incurred due to the injury or illness as well as compensation for lost income.
Anyone who suffers from a sudden accident like a slip or fall may be eligible. Injuries due to stress and strain, like carpel tunnel syndrome, are also covered by workers’ comp in many cases. Illnesses caused by the work environment are also covered by workers’ compensation.
Eligibility requirements for various types of injuries and the kind of compensation you can receive for them vary by state. If you have questions about your state’s individual laws and policies you can contact it’s workers’ compensation office directly via the US Department of Labor Website.
Am I Eligible to Receive Workers’ Comp?
Unfortunately, eligibility depends on a lot of factors. Based on your state, your employer may not be required to offer workers’ comp coverage.
Farm workers, seasonal workers, independent contractors (freelancers), “casual” workers, workers employed by very small businesses (in most industries), and some other individual cases are usually ineligible. However, occasionally an employer will accidentally or intentionally label an employee as an independent contractor. If you are by every definition fully employed but were denied for this reason in the past and it may still be possible to correct.
Some states are required or allowed to provide workers’ comp for volunteers. In many states, if a volunteer receives anything for their work above maintenance or reimbursement they are considered a “covered” worker and are both eligible and required to provide workers’ compensation. However, what you received may be evaluated differently depending on your state. Both your attorney and state workman’s compensation office should be able to help you determine your eligibility.
How Much Help Can I Get?
In nearly every case, victims receive medical benefits. These benefits cover the total cost of the ill or injured employee’s health care costs. Only 1/4 or less of employees covered by workers’ comp receive cash wage replacement or a lump sum due to the temporary nature or successful treatment of their condition.
Cases in which the employee receives cash payments include temporary total disability, temporary partial disability, and permanent partial or complete incapacity. The amount received depends on the state in which the injury occurred, recovery time, the severity of the injury, and many other factors.
It can be difficult to estimate how much you will receive but a good rule of thumb is that if you are, even temporarily, completely unable to work (even in a reduced capacity) for longer than a seven day period, you may receive up to 2/3 of your wage at the time of injury.
Eligible dependents are also granted death benefits. Eligibility varies by state and may be either a lump sum to cover final costs like funeral expenses or include temporary cash payments to make up for some lost income.
You can find out more about the benefits you may be eligible for on this page of the Social Security Administration’s website.
Cheating or malingering is a common problem for workers’ compensation programs. If you choose to accept benefits, an insurance agent will regularly visit you. As long as you have a legitimate illness or injury, follow the proper deadlines and procedures, and don’t try to extend your benefits unless you can prove your injury has worsened, you will most likely be minimally inconvenienced by these checks.
Does Workers’ Comp Cover Mental Health?
Yes, as long as it is directly related to a workplace problem workers’ comp often covers mental health issues developed by employees.
The big question here is whether you can prove it or not. Though we know mental health concerns exist, unlike a physical injury there are no visible outward signs. If you believe you are entitled to workers’ comp for a mental health reason, it is best to work with a lawyer. They can walk you through the process necessary to prove your condition and improve your chances of a successful claim.
It will not cover the condition in and of itself. Workers’ comp will cover the injury if your work makes it worse. Even if the condition had healed or been treated successfully in the past, any activity that causes a condition to flare up or reoccur would most likely cover by workers’ comp–as long as you can connect the reoccurrence with the initial incident that caused your claim.
How Long Do I Have to Take Action?
Filing as soon as you know you have a work-related injury or illness is critical. The time you have to file a claim may be as little as 30 days or as long as two years, maybe even longer, depending on the type of injury. As with anything, there are also plenty of exceptions.
If your injury or illness caused you or your family member to be unable to file or contact an attorney (such as coma, quarantine, or extensive medical procedures), you will almost always receive an extension. Any extension requires you to meet your state’s description of those circumstances.
In any case, even if your condition doesn’t seem too dangerous, file now. Do not wait it out. If your situation gets better after you have filed, there is no penalty. If your condition worsens- you have coverage. That can be invaluable, especially to a family that is wholly dependent on a single breadwinner. There is also a time limit if you plan on filing for death benefits.
Once you have workers’ comp and are receiving treatment, there are other deadlines to keep in mind, too. Medical bills must be submitted to an employer for compensation on time and to the appropriate place- your employer or their workers’ compensation insurance company.
If your condition gets worse while you are on workers’ comp, you can reopen the case within a certain time limit (in most states and situations unless you are already receiving the maximum possible benefits.)
One of the best things you can do to make the process easier and keep your deadlines in check is to contact an experienced attorney. Your employer is not a reliable source of workers’ compensation information. They may be trustworthy, but they could also be misinformed. If they offer a brochure or other informational paperwork, take it. Then get a second opinion.
What If the Accident Was My Fault?
If you were injured at work due negligence on your part, you might still be eligible for benefits. You must, of course, meet all of the other requirements. Injuries caused by a customer, client, or other 3rd parties then you may also be eligible.
Workmans’ Compensation is faultless. You are covered even if you made a mistake and it leads to injury or illness. It could be as simple as slicing your finger while dicing an onion of slipping on a floor you just mopped–as long as it was a real accident. Self-injury is not tolerated and may result in more than ineligibility for benefits.
The same sort of faultless system works for an employer- they are not required to pay more or less if negligence on their part cause you to become ill or have an accident. Do remember that if you take workers’ comp, you are giving up your right to sue your employer.
Am I Still Covered if I Was Injured in a Car Accident or at a Company Event?
If you were in a car crash: As long as you were on the clock and performing a work-related task you do not have to be in the office space of your employer. However, the when, why, and how of car accidents must be worked out and clearly explained to determine your eligibility. In this case, it is best to contact your local workers’ compensation office or an attorney.
Please note, travel to and from work or during a break is considered ineligible in the majority of cases.
Any injury that occurs at a company-sponsored event is also covered. The definition of these events may vary from state to state.
What Happens If I Am Turned Down?
It is possible to be turned down due to some factors. Reasons could include general mistakes or lack of information, ineligibility due to a positive drug test, or maybe your injury was ruled as due to an activity that violated company policy or happened to be self-inflicted.
In any case, if you feel that there was a mistake on your part or that of your employer, get as much information as you can on why you were turned down and any evidence you have that counters that claim.
It may still be possible to receive benefits after the application is corrected. You must provide new evidence, however. Make sure that if you intend to reapply you do so on time as, depending on the circumstances, you may still be working during the initial period.
Can I Lose My Job?
Employers cannot fire you for making a claim–it’s a standard business practice, and though no company wants to pay more than they have to, it’s not a big deal. If you are still capable of work, laws are preventing you from being fired for your injury or workman’s comp claim.
However, if you were found to have received the injury due to taking part in criminal activity or while under the influence of drugs or alcohol you will be ineligible for workers’ comp and may lose your job.
You may also be fired due to unrelated circumstances regardless of a workers’ comp claim or leave. If your performance was sub-par, if a layoff is necessary for financial reasons or restructuring, or if one of the dozens of other unrelated reasons call for it, you may lose your job just like anyone else.
How Long Does It Take to Get Workers’ Comp?
That depends on the benefits you expect to receive. In most cases, medical benefits can be covered immediately after an accident as long as you make it clear to your doctor or other medical staff that you are going to file a claim and it was a work-related accident. Having a medical report created soon after the incident, by visiting a health-care provider, can help you file your claim successfully.
Non-medical benefits are not paid until your claim has been officially processed, you have been approved, and any other state, company or insurer related procedures have been completed. These methods help to determine the severity of your illness or injury and the amount and duration of payments.
Will This Hurt My Employer?
Unless your employer has done something wrong, no. Workers’ compensation isn’t meant to punish a company but to help them and their employees. Many businesses choose to purchase workers’ comp insurance even when they do not have to as it reduces their chances of being sued in case of an accident. It also provides an affordable way to make sure any and all employees are taken care of if the unforeseeable happens.
If you are worried that the conditions that caused you to become ill or injured could affect another employee, you may be able to file a federal complaint even if you accept worker’s compensation.
How Do I Get Started?
You can file on your own or with the help of an attorney. Before you begin, make sure you get your medical injury or illness on record with your employer (specifically the HR department) and a doctor as soon as you can.
If you plan on filing by yourself, do as much research as you can and contact your state’s workers’ compensation office immediately. They can help you find or send you all of the appropriate paperwork.
Federal employees may also find information about filing from the Division of Federal Employees’ Compensation (DFEC).
If you plan on filing with the help of an attorney, make an appointment for a consultation as soon as you can with an experienced workman’s compensation attorney in your area. If there is more than one, it never hurts to get a second opinion if you are not happy with your initial consult.
How Much Do I Have to Pay A Workers’ Compensation Lawyer?
State law limits the amount of money a workers’ comp attorney may charge you, so you don’t have to worry about huge fees. They can typically cost no more than 20% and as little as 10% of the total awarded benefits. That might sound like a lot but with a professional on your side, the benefits granted are likely to be the maximum possible which can be a lot more that you might get on your own.
Compensation to your attorney must be fair, and the workers compensation judge or panel must approve it.
If you have a solid case, feel free to negotiate. There is no minimum amount you must pay and a well-documented case that reduces the amount of work and time your attorney has to put in may allow you to negotiate a smaller fee.
Filing for Workmans Comp
Always get as much information from your employer as you can and make sure you record everything on paper. If the company you work for has no official form for accident reports and injuries, keep your files and make sure to visit a doctor. The more proof you have, the easier it is to get the benefits you deserve.
It doesn’t matter who is at fault or if the illness or injury you have has occurred over time. Workers’ compensation is there to help out any worker who was hurt or who had fallen in due to their job. It is also there to support the families of those that are harmed or killed due to their job.
No one wants something like this to happen, but it does. Whether the incident and its effects were major or minor, make sure you file. No one knows what might happen down the road and it’s better to avoid wondering if you are covered.