Workers’ Compensation: What It Is and How to Make a Claim

Important: We updated this article in October 2023 to make sure all information below is correct. If you have a workplace injury or illness, you may qualify for workers’ compensation benefits. Keep reading to learn what workers’ comp typically covers, how to apply, appeal a claim denial, and other important information below.

Workers’ Compensation Basics: What Does It Usually Cover?

Every state has its own laws that define the workers’ compensation process. (The only workers who follow different rules for securing benefits are federal employees.) However, every U.S. state requires most private employers to provide some kind of insurance coverage for employees.

Each state’s workers’ comp program typically covers employees who experience:

1. Work related injuries. Workers’ comp insurance should at least pay medical bills for injuries from workplace accidents. Once you miss enough work, then you’ll also qualify for wage replacement benefits.
2. Occupational diseases. These are conditions you might develop over time that result directly from your job duties. Examples might include carpal tunnel/repetitive motion injuries, mesothelioma, or silicosis.

When Most Injured Employees Can Expect Paid Time Off

In most cases, your injury must force you to miss several work days before you qualify for paid time off. If your employer’s policy isn’t posted in a visible area (i.e., your break room), contact your Human Resources department. They can answer specific questions about your state’s workers’ compensation program, filing deadlines, waiting period before you’re eligible for paid time off, etc.

Most employers want injured employees to get medical treatment so they can come back to work again. Some people ease back into their job because the doctor gives them certain work restrictions. This might include limiting how much weight you lift, how long you can stand or other limitations during work shifts. Your employer’s policy might reference these restrictions as “light duty” work. Workers’ comp is designed to cover your medical bills and partial wages until you fully recover.

Workers’ Compensation Insurance Policies Vary From State to State

Each state has individual eligibility rules for hurt or sick employees filing workers’ comp claims. Three virtually universal requirements are:

1. The company you work for must have insurance coverage.
2. You must work for your employer before your illness or injury occurs.
3. Your illness or injury must be work-related and happen while you’re clocked in and doing your job.

Volunteers, seasonal or temporary employees, independent contractors, and domestic workers are often not covered. Ask your supervisor if your employer’s policy covers you before you apply for benefits.

6 Steps to Apply for Workers’ Compensation Benefits

The state you’re in has specific steps to apply for workers’ comp benefits. Below is a basic overview of how the process works:

1. Report your injury or illness to your manager, if possible, then seek appropriate medical treatment immediately.

Few state programs refuse to cover emergency medical care. (Connecticut is an exception, so ask first!)

2. Ask your supervisor if you must use the insurance company’s preferred doctor or if any provider can treat you.

Some states make injured workers choose from a list of previously authorized doctors. Others let you choose your physician from the first visit. Checking with your supervisor first ensures you won’t pay any surprise medical bills yourself.

3. Ask what paperwork you must complete to file for workers’ compensation.

You usually fill out and return a specific form to your employer. Otherwise, take an employer-provided form to your first doctor’s visit.

4. Keep copies of all related medical documents from your healthcare provider(s) for your records.

You don’t want the insurer to deny you benefits. Keeping copies of everything makes it less likely your treatment won’t get paid for in a timely manner.

5. Submit every required form on time, to the right person or department, and always keep a copy.

Every state has a specific deadline for filing claims. This is called the “statute of limitations,” and earlier is always better. Follow instructions exactly so you don’t miss out on lost wages or other benefits. Ask which forms you must file yourself, if any, and who those forms should go to. Do you need to send them via certified mail, for example? Or can you do it online? Employers should know this important information. If not, contact Human Resources!

6. Check the deadline to appeal if you’re denied benefits.

The insurer should notify you in writing within 30 days. This letter should list detailed instructions on how to resolve disputes and your deadline to appeal.

How to Get Free Expert Workers’ Comp Help

You might think you don’t need a workers’ comp attorney. However, people with preexisting conditions are much more likely to get denied workers’ compensation. Any time employers can avoid paying unexpected benefits, their own costs stay low. If you’re denied, an attorney can handle your appeal. That’s why we recommend talking to a workers’ comp attorney as soon as possible.

Workers’ comp attorneys work on contingency, so you’ll pay $0 for help unless you win. And if you win, then you’ll only pay one small fee after you’re paid first.

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