Understand your legal options when you get injured at work — including the process of filing a workers compensation claim and what to do if your employer asks you not to file a claim.
As per the Bureau of Labor Statistics, employers reported 2.8 million workplace injury or illness cases in 2022 (an increase of 7.5% from 2021). Out of them, over 5,400 were fatal injuries in 2022.
Employers are required to make workplaces safe for people. However, workplace injuries are inevitable.
Rest assured, when you get injured at work, you have the right to file for compensation for job injury – known as workers’ compensation. And, if someone tries to snatch your rights, you can take legal action against them, too.
What is Workers’ Compensation, and How Does it Work?
Also called workers’ compensation, it’s a type of employer insurance coverage that benefits employees injured while doing their jobs, ill, or disabled.
It’s a government-mandated program that covers:
✔ Cost of injuries
✔ Additional healthcare costs like physical therapy
✔ Vocational rehabilitation
✔ Cash benefits
If an employee is injured and cannot work, the program also helps cover part of their lost wages.
Most of the time, workers’ comp is funded by private insurance companies through premiums paid by businesses. Each state manages its program through a Workers’ Compensation Board, which helps resolve disputes.
Special federal workers’ comp programs are available for federal employees, dock workers, and energy sector workers. The Black Lung Program is another federal initiative that benefits coal miners and their families in cases of illness or death due to working conditions.
| Important Note: Workers’ compensation rules differ by state; not every employee is covered. For instance, some states don’t require small businesses to provide this coverage. |
Benefits of Workers’ Compensation
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Medical Cost Coverage
The workplace injury compensation program usually covers medical bills for injuries sustained during an accident. For example, if construction workers fall off scaffolding at work, they’re covered.
| Important Note: Injuries like a car accident on the way to work wouldn’t qualify for workers’ compensation injury. |
Sometimes, if someone is too injured to work, they receive payments like sick leave. Unfortunately, if the injured/sick employee passes away, their family will receive compensation benefits.
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Salary Repayment
The compensation is usually about two-thirds of an employee’s usual salary, generally less than their full pay. These benefits are not typically taxed at the state or federal level, helping to make up for the lost income.
| Important Note: If someone is also getting money from Social Security Disability or Supplemental Security Income, they might have to pay some taxes. |
Types of Workers’ Compensation
These can be classified into two categories:
- Coverage A
- Coverage B
Coverage A is for employees who get sick or injured at work. The benefits include part of their salary, medical treatment, rehabilitation, and, if necessary, death benefits. Almost every state offers these benefits, but the specifics can differ greatly from one state to another, and some workers might not be eligible.
On the other hand, Coverage B provides benefits beyond the basic requirements of Coverage A. These additional benefits are given after an employee successfully sues for employer negligence or other misconduct.
What’s the Cost of Workers’ Compensation, and Who Pays Insurance Premiums?
Employers cover the cost of workers’ compensation insurance premiums, which don’t come from employee paychecks like Social Security. By law, employers must pay these benefits according to the rules set by each state.
The price of workers’ compensation insurance and its benefits differ from state to state. Costs also vary based on the job’s risk level, with higher rates for more dangerous roles.
| Important Note: The insurance fee may vary, depending on a company’s payroll numbers. |
How To Apply for Workers’ Compensation?
The application process for workers’ compensation injury and rules differ by state. Generally, if you’re injured or become ill due to your job, you should:
✔ Document the injury or illness thoroughly, including photos and names of any witnesses if possible.
✔ Notify your employer about the incident. They will handle filing the claim with their insurance provider.
Check-in with your employer’s insurance company to ensure your claim is being processed.
| Important Note: If your claim is rejected, you can challenge the decision with your state’s Workers’ Compensation Board. |
When Do You Need a Workers’ Comp Lawyer?
If you’ve suffered a serious injury at work, you may be entitled to permanent disability benefits. It is when you need to calculate the amount and benefits you deserve while focusing on your health.
In this case, a workers’ compensation attorney can greatly help. The lawyer assists in
✔ Handling Calculations
✔ Negotiations
✔ Settlement of the claim can be complex if you go it alone.
Suppose your initial claim was denied, preventing you from receiving compensation for time off work or medical expenses. In that case, it’s wise to consider hiring a lawyer to help get your claim approved.
Conclusion
Employers must provide workers’ compensation insurance. However, the specifics can vary widely as each state sets its own rules, leading to numerous exceptions and exemptions.
If you’ve been injured or fell ill due to your work and don’t know how to proceed, come to Swartz & Swartz. Call us at +1 (617) 742-1900 for free consultation.
About the Author: James Swartz
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