Workers' Compensation FAQs
Basic Workers' Compensation definitions
Q: What is workers compensation?
Answer: Workers compensation is a business type of insurance that most employers are required by law to carry. Workers compensation provides compensation to employees who have an illness or an injury that is related to their job. The federal government runs a workers compensation program for federal employees, as well as certain other kinds of employees. Although similar, every state has its own programs and laws in regard to workers compensation.
Q: What is the definition of "wages"?
Answer: Wages are a payment that is made by an employer to an employee for labor or services performed by the employee on behalf of the employer. Wages usually consist of a monetary payment according to contract on an hourly, daily or weekly basis or by what is known as a piecework basis. A fixed weekly or monthly wage is usually referred to as a salary.
Q: I work for a limited liability company, am I covered through workers comp?
Answer: Although laws vary from state to state, if you are an employee of a limited liability company, or LLC, you are covered by workers compensation. This is true regardless of whether you are a full time, part time or regular seasonal employee or a family member who is an employee.
Q: I got hurt as a volunteer, do I have workers compensation rights?
Answer: In most instances, because you were a volunteer and not an employee, you are not eligible to receive workers compensation benefits. However, some states allow organizations to have the option of providing workers compensation coverage to their volunteers.
Q: Is my employer required to have workers compensation insurance?
Answer: In every state except Texas, all employers, with few exceptions, are required by law to carry workers compensation insurance. Although the laws vary from state to state, some of the exceptions include sole proprietors and limited liability companies (LLC) with no employees. In some states in certain situations, employers with domestic workers, farm and agricultural workers, seasonal or casual workers, undocumented workers or loaned or leased workers are not required to provide workers compensation insurance.
Q: I'm only part-time, am I covered?
Answer: Yes, part-time employees are covered by workers compensation.
Q: I'm a volunteer firefighter, do I get workers compensation coverage?
Answer: In some states, volunteer firefighters are covered by workers compensation if you are injured during the course of your work as a firefighter. You need to check the workers compensation laws in your state to see if you are covered.
Q: What is the uninsured employers fund?
Answer: The uninsured employers fund is a fund that pays workers compensation benefits on a valid workers compensation claim that is filed by an employee who is injured while working for an illegally uninsured employer. When an injured worker files a valid workers compensation claim, the uninsured employers fund pays the injured worker's compensation benefits as if the uninsured employer had been covered by workers compensation insurance.
Q: What if I can only come back to work on light duty, does my employer have to oblige?
Answer: In most states, your employer is required to allow you to go back to the job that you had when you were injured or an equivalent job. However, this is true, only if such a position is available.
Q: What are the first steps my employer should take when I file a workers compensation claim?
Answer: Although the specifics of what an employer should do vary from state to state, there are some general first steps that your employer should take that are valid across the country. After making sure that you have received the medical attention that your injury requires, your employer should make sure that a First Report of Injury, or similar document, is filled out and sent to the company's workers compensation insurance company.
Q: I work for a very small business, 3 employees and the owner, am I covered for workers compensation?
Answer: In some states, you are covered by workers compensation insurance. In other states, you may not be covered. Your employer's responsibility to provide workers compensation insurance depends on the number of employees that are employed, the kind of business it is and the type of work you are doing. Certain kinds of workers are excluded in most states, which include domestic workers, farm workers and casual or seasonal workers.
Q: What if my employer says the accident was my fault?
Answer: Workers compensation is what is known as a "no-fault" type of insurance. Although there can be exceptions, what this means is when it comes to workers compensation, fault is not an issue. If you were injured in an accident while you were performing your job for your employer, you are eligible for workers compensation benefits; regardless of whose fault the accident was.
Q: I got hurt, but I'm just a contractor, what are my workers compensation rights?
Answer: If you are an independent contractor, you are not eligible for workers compensation benefits. However, some employers misclassify employees as independent contractors in order to avoid paying workers compensation premiums and payroll taxes for them. You need to check and see if you are really an employee.
Q: Can I get workers comp for any job injury?
Answer: Workers compensation covers most, but not all, job-related injuries. Injuries that are not covered by workers compensation include injuries that result due to an employee using illegal drugs, being intoxicated, being guilty of conduct that violates company policy, committing a serious crime, starting a fight or having self-inflected injuries.
Q: Does workers compensation cover future problems?
Answer: Workers compensation covers future problems if those problems stem from your job-related injury. There is no time limit for workers compensation medical benefits. As long as you need treatment for your injury, workers compensation will pay for that treatment. However, if you settle your claim for a lump sum, you may be giving up your rights to future medical benefits that you may need, especially if your condition gets worse.
Q: I wasn't injured at the office, but while on the clock
Answer: If you were doing something for your employer in the course of your employment, even though you were not in the office, you would be covered by workers compensation. However, if you were on your way to or from work, or you were away from the office for a purely personal reason that had nothing to do with your employment, you would not be covered by workers compensation.
Q: What is the first step I should take when I want workers comp?
Answer: If you have been injured on the job, the first step that you should take to get workers compensation benefits is to get the medical attention that you need for your injury. As soon as your injury will allow you to do so, you should let your employer's (supervisor, manager, boss, foreman) know about your injury. Depending on the state that you are in, you and/or your employer will have to fill a form out to send to your employer's workers compensation insurance company in order to file a claim for workers compensation benefits.
Q: I didn't realize I was injured until a few days after my accident, can I still make a claim?
Answer: Yes, you can still file a workers compensation claim. However, you should always report your injury to your employer as soon as you possibly can, even if you do not think that you were hurt. When you do not report your injury on the same day that it happened, you can lose or seriously hurt your rights to receive workers compensation benefits.
Q: What type of benefits are offered through workers compensation?
Answer: Although the details of what is covered varies from state to state, workers compensation benefits include paying for all of your necessary medical care as long as you need it and lost wages, which usually amounts to about two-thirds of your regular salary. In addition, workers compensation benefits include as needed; retraining, rehabilitation, partial and total, temporary and permanent disability, and death benefits for your loved ones (spouse, children, parents and/or siblings) in the event that you die on the job.
Q: Can I get workers compensation even if my injury was onset from a pre-existing medical condition?
Answer: Although details vary in each state, if your job-related accident accelerates or aggravates your pre-existing condition, you can receive workers compensation benefits. In other words, if your job-related injury makes your previous condition worse, you can get workers compensation benefits.
Q: What about legal action against my employer?
Answer: In exchange for receiving prompt workers compensation benefits, you are not allowed to take legal action against your employer. However, there are exceptions where an employee who has a work-related injury is allowed to sue their employer. For example, if your work-related injury is caused by your employer's reckless, intentional or illegal action, you have a right to refuse the workers compensation process and sue your employer.
Q: When is hiring an attorney recommended?
Answer: If your job-related injury is minor, and/or you know that co-workers have been treated fairly and have not had any problems getting the workers compensation benefits that they were entitled to when they were injured on the job, you probably do not need to hire an attorney. However, if your work-related injury is serious or your employer threatens you or has a reputation for trying to prevent workers compensation claims, you should hire a workers compensation attorney. Also, workers compensation laws can be a confusing maze of legal procedures and rules. So, it is a smart idea to have a workers compensation attorney on your side.
Q: How are attorney fees handled for workers compensation?
Answer: Attorney fees in workers compensation cases are handled on what is known as a "contingency" basis. What this means is that you do not owe an attorney any fees unless they win your case. The attorney is then awarded a percentage of what you receive, which varies from state to state, but is anywhere from around 10% to 35% of what you are awarded.
Q: Can I, as an employee, waive my right to workers comp coverage?
Answer: No. You are not permitted to waive your right to be covered by workers compensation insurance. Any waiver agreement that you enter into with your employer is invalid. You will still be covered by workers compensation insurance.
Q: Can my employer dispute my workers compensation claim?
Answer: Yes. Your employer can dispute your workers compensation claim. In fact, your employer may dispute a workers compensation claim that he or she knows is a valid claim.
Q: How much do I have to pay a lawyer to get my workers comp?
Answer: Workers compensation lawyers work on a contingency basis. This means that you do not owe any attorney fees unless the attorney wins your case. The lawyer is paid a percentage of what you are awarded. The percentage varies from state to state, but is anywhere from 10% to 35% of what you are awarded.
Q: How is my workers compensation filed?
Answer: Each state has its own specific procedure for filing a workers compensation claim. However, the procedure usually involves you and/or your employer filling out and filing a specific form with your employer's workers compensation insurance company and/or your state's workers compensation board or industrial commission.
Q: Do I have to go to a certain doctor for treatment?
Answer: This depends on the workers compensation laws of the state that you live in. In some states, you are required to go to a doctor that is chosen by your employer or your employer's workers compensation insurance company. In other states, you are allowed to use your family doctor or any doctor you choose that is within a network determined by your employer's insurance company, your employer or your state.
Q: How do I properly handle medical expenses?
Answer: You do not have to pay for any necessary and reasonable medical expenses, and there is no deductible. Your employer's workers compensation insurance company is responsible for paying all of your necessary and reasonable medical expenses for as long as you require medical care that is connected to your job-related injury. Also, if you require medical care in another city, you are permitted to receive reimbursement for your mileage expenses.
Q: Can an employer schedule me a medical evaluation?
Answer: Yes. Your employer or your employer's workers compensation insurance company has a right to schedule you a medical evaluation that is referred to as an independent medical examination (IME). If you do not go to an IME, you may forfeit your workers compensation benefits.
Q: Do I get paid for follow up medical appointments?
Answer: Although the details vary from state to state, you should be paid for follow up medical appointments. This is provided that they are in connection with your job-related injury and they occur during your regularly scheduled work hours.
Money and Expenses Questions
Q: Who is paying for my compensation?
Answer: Your employer pays for workers compensation insurance coverage. Your employer is not allowed to deduct the cost of workers compensation insurance from your pay. It is illegal if your employer does so. Your employer's workers compensation insurance company pays the workers compensation benefits that you receive when you are injured on the job.
Q: What about lost wages because I'm injured for a long time?
Answer: You are entitled to receive wage loss benefits for as long as you are disabled and unable to work. There is no time limit on wage loss benefits.
Q: I got hurt midway through my shift and went to hospital, do I get paid for the "entire" shift?
Answer: While the specific laws vary according to the state that you live in, your employer usually only has to pay you for the hours that you actually worked. If your employer does this, the day that you were injured is regarded as the first day of your disability. If your employer pays you for the entire shift, the next day is considered to be the first day of your disability.
Q: What if I get a medical bill that should be on workers compensation?
Answer: You should not receive any medical bill for medical care that is reasonable and necessary in connection with your work-related injury. However, should you receive medical care that is not approved by your workers compensation insurance company, you may be responsible for that bill.
Q: How much money will I get from workers comp?
Answer: Although it varies from state to state, the weekly wage loss amount that you receive usually amounts to around two-thirds of your regular salary. The amount of money that you get from workers compensation will depend on how long it takes for you to recover from your work-related injury and when you are able to return to work.