A Step-by-Step Guide to Workers’ Compensation

Understand what workers’ compensation is, whether you’re eligible, and how to claim compensation

Workers’ Compensation, also known as workers’ comp or workman’s comp, is something that every worker (and business) needs to be aware of.

The policy provides partial medical care and income protection to employees who are injured or become ill at work (and death benefits to families of workers’ who are killed on the job) – while simultaneously helping employers avoid the real cost of the injured person’s medical expenses and lost wages following a workplace injury or illness.

While it is unfortunate for an injury to occur at work, accidents do happen, and workers’ compensation can deliver a financial lifeline to an employee, as well as their family.

In this blog, we’ll be breaking down what occupational injuries are covered by workers’ compensation, how to report and file a claim, the benefits you may be entitled to receive, and what to do if your application is denied.

What injuries are covered by workers’ compensation?

Most injuries that occur on the job are covered by workers’ compensation insurance, including sprains and strains, bone fractures, repetitive strain or stress. For example, RSIs, such as carpal tunnel, tendonitis, rotator cuff injuries, hernias, back pain, slips, trips, and falls, cuts, lacerations, and punctures.

Not all types of injuries are covered by workers’ compensation. If the employee was under the influence, not on the job at the time of the injury, violating a law or company policy, or the injury was self-inflicted (for example, if the injured person started a fight with a co-worker), then workman’s compensation insurance would not provide coverage (please look at your short-term and long-term disability policy provided by HR for more information).

My injury/illness IS work-related, so am I eligible for workers’ compensation benefits then?

Not necessarily. You must have reported your work-related illness or injury in a timely manner. Typically, this must be accomplished within 30-45 days of the injury, but note that different states have their own, specific policies. Therefore, you are bound by the policy of your employer’s state, found in your employer’s policy manual. If you find yourself in this position, ask your HR department for your employee policy handbook. When you apply either by email or a formal letter, you will need to satisfy the following criteria:

*You must be an employee
*Your employer must have workers’ compensation insurance
* Your job must be the type that is covered by workers’ comp (this may rule out self-employed people, independent contractors, business owners, and the like).

What does workers’ compensation cover?

As with any form of insurance, the specific coverage provided by workers’ compensation varies from business to business, and also depends on the severity of the illness or injury. However, as a rule of thumb, the insurance policy covers the following:

*Medical care
*Disability and lost wages
*Survivor benefits
*Rehabilitation and physical therapy

How much does workers’ compensation pay?

It is usually around two-thirds of your weekly wage but there are a number of factors that affect exactly how much you’ll receive in workers’ compensation such as the following:

*The rules in your state
*Whether, and for how long, you’re unable to work
*The severity of your illness or injury

How do I file a claim?

The injured employee must report their work-related illness or injury in a timely manner to their employer, typically within 30-45 days, either via email or a formal letter.

The employer is then required to provide the injured or sick employee with the relevant paperwork and forms to file a workers’ compensation claim with the insurance company.

Upon completion and return of the documents, the employer will then inform the insurance provider of the incident and injury.

The insurance company will then choose a doctor to conduct an independent medical examination. The doctor will report the results to the insurance company, who will use this information to create a compensation offer.

If I am receiving workmans compensation, am I eligible for Social Security Disability Insurance (SSI/SSDI) benefits as well?

Employees receiving workers’ compensation income benefits are not automatically ineligible for SSI/SSDI.  SSI/SSDI benefits could be affected by workers’ compensation benefits.

For information and advice regarding eligibility for SSI/SSDI alongside workmans compensation, talk to a trusted lawyer at Sampson Dunlap LLP today. Please contact us if you expect to be out of work for twelve months or longer.

Unfortunately, over two-thirds of applicants for workers’ compensation (and SSI/SSDI) are turned down by the SSA on the first attempt.

At this point, many people throw in the towel. They are not aware that they can appeal a denial or do not have the confidence to take on the SSA.

But remember: You deserve to get the benefits of which you are entitled.

For the best chance at approval, contact Sampson Dunlap today and let us use our 30+ years of experience in this area to get your application approved.

How Sampson Dunlap can help
Workers’ compensation is complex with strict deadlines that vary from state to state. Trying to navigate it on your own when already dealing with an injury/illness, is not easy.

An experienced Sampson Dunlap attorney can assist you through the process. and help you keep on top of your deadlines.

You only pay our firm if we can get your case granted.

You don’t have to go it alone.  Let Sampson Dunlap put our extensive experience to work for you today.