Workers' compensation provides two benefits. First, workers' compensation provides access to medical care when workers acquire an injury on the job. It also provides payment for injured workers' expenses during recovery. Second, workers' compensation typically protects the company from employee litigation. Since it is no-fault insurance, it is not necessary to determine who is to blame for the injury, simply that it occurred on the job.
Learn more about the types of workers’ compensation benefits below and why you need one.
Why Do You Need A Workers Compensation Insurance
If you are an employee, workers’ compensation insurance, also known as workman’s comp or workers’ comp, provides you with benefits if you get injured or become sick due to your job. These benefits can help:
- Cover medical care and medical treatment
- Replace most of lost wages if you have to take a leave from work for recovery
- Provide disability benefits
- Provide other benefits, such as death benefits
Although state laws governing workers' compensation benefits and coverage differ, most require that companies with employees have it.
As an employer, this insurance not only protects the welfare of your employees but also reduces your liability for work-related injuries and illnesses. Moreover, workers’ compensation benefits for some employers also include liability insurance coverage. This basically means that workers' compensation may assist in covering your legal expenses if injured employees or their families sue your company.
What Injuries Are Covered By Workers’ Compensation
Generally, if an employer has workers’ compensation insurance, any injuries their employees suffer while performing within the "course and scope" of their employment — whether on company property or elsewhere — are covered.
For instance, if an employee is still en route to work in their own car or the company’s official vehicle and suffers a driving accident, that would not be recognized as a valid reason for a workers’ comp claim. Accidents that occur when driving to and from work are not covered.
However, if an employee was hit by a falling object in the workplace or suffered a muscle strain while working, the employee will be granted workers’ comp benefits (provided the employee submits all requirements).
Additionally, according to the Insurance Information Insitute (III), workers’ compensation covers injuries that employees could sustain from other events such as workplace violence, terrorist attacks, and natural catastrophes.
Certain illnesses and occupational diseases (as specified by state statutes) acquired as a result of an employee’s work are also covered by workers’ compensation insurance. For instance, employees constantly exposed to toxic chemicals may file for a workers’ comp claim if they get ill or develop a condition.
What Are The Benefits Provided By Workers’ Compensation
There are four types of workers' compensation benefits you may be entitled to if you acquire injuries or illnesses in a workplace. These include medical coverage, wage replacement benefits, vocational rehabilitation, and death benefits.
Medical Coverage
All required work-related work-related injury or illness treatments are part of your medical coverage under workers’ compensation. In general, these claims are not constrained by a specific dollar amount, and the compensation should also cover all deductibles and copays.
Medical coverage may include payments for prescription drugs, hospitalization, nursing care, medical supplies — like wheelchairs or walkers — as well as other types of treatments. Also, you should consider any potential future or long-term medical care needs, such as physical therapy, when deciding how much medical coverage to seek. More than that, you should take into account the travel costs of going to and fro the hospital for your treatment or the pharmacy for your prescriptions.
It is important to remember that you can only receive compensation for any injuries you sustained while performing your work duties. Injuries or illnesses that occur outside of the workplace are not covered.
Eligibility Requirements:
- Must be a full-time employee of the company
- Must have received treatment from an authorized medical provider (e.g., managed care organization [MCO] or health maintenance organization [HMO])
- Injury or occupational disease must be work-related or a result of employment duties
- Must not be under the influence of illegal drugs or alcohol at the time of the incident
- Injury or occupational disease is not a result of going against written company policy
How To Apply:
- Report your injury to your employer as soon as possible
- Request for a workers’ compensation claim form.
- Submit official claim paperwork within the specified amount of time
Wage Replacement Benefits
Wage replacement benefits provide weekly compensation to employees who are unable to work, either permanently or temporarily, due to their work-related injury or illness. These are also known as disability benefits.
The extent of your injuries, how they will affect your ability to return to work, and the workers' compensation rules in your state will determine what you receive and for how long. However, the normal compensation is 60% to 75% of the employee's average weekly income. The employee's salary for 52 weeks prior to the injury, including overtime pay, is examined to calculate the average weekly wage.
Eligibility Requirements:
- Must be a full-time employee
- Must be out of work for at least 3 days (excluding the day of injury)
- Loss of earnings must be greater than 5% of total wages at the time of injury
- Must have a medical certification that the loss of earning capacity is due to work-related injury or occupational disease
How To Apply:
- Fill out a report of injury
- Request for a workers’ compensation claim form
- Submit a medical certificate
Vocational Rehabilitation
This benefit provides services that return an employee to, or as close as possible to, his or her prior earning capacity as determined by the employee's average weekly income. The amount of money you made each week before your accident is your average weekly wage (AWW).
Vocational rehabilitation may involve job training, career counseling, and assistance in finding new employment, according to the National Rehabilitation Information Center (NARIC).
Eligibility Requirements:
- Must be an injured worker in receipt of compensation payments (or will likely receive compensation payments) as a result of a work-related illness or condition
- Unable to return to work due to a permanent disability
- Appropriate return-to-work opportunities are present in your area
How To Apply:
- You or your compensation lawyer can request services by contacting a local claims examiner. If your work injury prevents you from returning to your previous job, your employer or insurance provider may recommend a vocational rehabilitation office in your area
Death Benefits
Workers' compensation would offer death benefits if an employee passed away due to injuries sustained at work. The spouse, kids, or employee dependents will be given these benefits. If there are no eligible dependents, the benefits go to the deceased’s estate (as required by most states).
Death benefits often involve payment for funeral and burial costs as well as an amount to compensate the employee’s family for their loss.
Eligibility Requirements:
- Deceased worker must have worked as a full-time employee
- Deceased worker’s death must be considered work-related or occupational
How To Apply:
- Since the application process varies from state to state, it is best to contact the deceased worker’s employer or insurance company for assistance. You may also speak with a workers’ compensation lawyer
- If you qualify, file your claim for death benefits one or two years from the date of death or the last payment of wage replacement benefits
If you wish to find out what medical conditions qualify for social security disability, check out this article by Disability Help.
