Worker's Compensation Claim Information 

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Employee Information:
What is workers' compensation insurance?
Suppose I am injured at work, what do I have to do to collect benefits?
How long can I get benefits?
How is workers comp different from health insurance?
What kind of benefits can I receive?
Will I be compensated for pain and suffering?
What do I do if I believe I'm wrongly denied benefits?

Employer Information:
Checklist for handling worker's compensation claims 
Warning signs of worker's compensation fraud

What is workers' compensation insurance?

Workers' compensation insurance is a form of no-fault insurance that most states require employers to carry. The main objective of the workers' compensation program is to provide medical expense benefits, rehabilitative benefits, and cash benefits to employees who are injured or disabled as a result of a job-related illness or accident. Loss-of-income benefits are also payable to a surviving spouse in the event of an employee's death. Currently, workers' compensation laws cover approximately 90% of all employees in the United States. Certain kinds of employment are generally excluded from workers comp laws, such as agricultural and domestic workers and those who work for religious organizations. The most common types of injuries that lead to workers compensation claims are back injuries, usually the result of heavy lifting or falling. Other common workplace ailments are back problems and repetitive stress injuries, like carpal tunnel syndrome, that develops over time.

Suppose I am injured at work, what do I have to do to collect benefits?

The workers' compensation program is based on the legal principle of strict liability. This principle holds employers liable for any losses that an employee suffers due to an occupational injury or disease, no matter who was at fault. Therefore, employees do not have to prove their employers acted negligently to collect benefits. The system is designed to reduce litigation costs and to provide for the prompt payment of benefits to the injured worker. If you have an accident or suffer from an illness that is job-related, you should contact your employer and/or your benefits counselor to file a claim. It is not necessary to hire a lawyer and undertake an expensive legal campaign to collect workers' compensation benefits.

How long can I get benefits?
If your work injury is severe, you may receive benefits for the rest of your life. But that is less likely today because medical advances are helping to get people back to work quicker, and of course managed care is guarding the purse strings with respect to medical benefits.

How is workers comp different from health insurance?
You get benefits under workers comp only if you are injured on the job or develop an occupational disease.

What kind of benefits can I receive?
Workers comp insurance covers medical care, dismemberment, disability, and death (with each state defining a benefit level that employers must meet). Essentially, the medical benefits are the same as those you would get with health insurance. But, unlike with health insurance, you also get compensated for lost wages as long as you are considered partially or permanently disabled.

Also, the goal in your medical treatment is slightly different. It is the job of the doctor who treats you under workers' comp laws to assess what percentage of disability you have and when you are fit to work again. This is in addition to the usual treatment responsibilities.

Will I be compensated for pain and suffering?
It is tricky to make generalizations about compensation for pain and suffering because it depends on the state. Payment for pain and suffering is sometimes a part of a lump-sum settlement. There is a controversy over whether physical pain can be measured, and many jurisdictions don't compensate for mental anguish. But if the workers compensation jurisdiction takes a holistic approach in assessing eligibility for benefits — including an analysis of the worker's ability to perform the tasks of daily living — then pain and mental anguish payments may be included.

What do I do if I believe I'm wrongly denied benefits?
In some cases, you may have to resort to litigation if you have been wrongly denied workers comp benefits. But there are usually other ways to handle the dispute. Some states have an ombudsman who explains workers' rights, and the services of the ombudsman may be enough to resolve the claim. For example, if an employer has told an employee that he or she has to go to a doctor chosen by the employer, when in fact state law entitles him to use a doctor of his choosing, an ombudsman will inform him of that right. Other states use mediators to resolve disputes.