Who Pays for Workers Compensation

Workers Compensation
Workers comp is an important financial benefit and, if you ever need it, you may want to know who pays for workers compensation.

Most U.S. employers must purchase workers compensation insurance. Unfortunately, workers comp insurance doesn’t cover all workers. If you’re an independent contractor, an agricultural worker, or a domestic worker, your employer might not provide workers compensation insurance.

It’s important to file a workers comp claim if you’re injured at work. Alerting your employer to unsafe work environment conditions and practices can help the company prioritize safety for workers in the future.

Job-Related Injuries and Illnesses

Workers in some industries experience more job-related injuries and illnesses than others. For example, construction workers and nursing assistants suffer a higher than average number of work-related injuries and illnesses.

If you lose a toe packing boxes in a warehouse, take a tumble from a broken office desk chair and get a concussion, or develop a medical condition because of job duties, workers compensation is intended to cover medical costs and compensated you, the injured victim, for lost wages.

Workers Comp Coverage

To qualify for workers comp coverage, an employer-employee relationship must exist and an accidental injury must occur while you’re performing the job, get sick because of the job, or become exposed to toxic substances, such as asbestos because you’re employed by a business that renovates old buildings.

If you’re injured at work, it doesn’t mean the employer must automatically provide workers comp benefits. For instance, if a co-worker’s spouse arrives at the office to shoot her cheating husband, she’s not the cause of a work-related injury.  If the spouse tries to shoot her husband and accidentally shoots you instead, you might be covered under workers comp.

Workers compensation insurance is complex. If you’d like to know more about workers comp because a work-related injury has caused financial stress in your life, remember the following ten tips.

Ten Things You Must Know about Workers Comp

#1: Report any illness or injury your doctor says is work-related. Advise the company’s Human Resources department right away. Request an incident report form, then complete it. HR should make recommendations about next steps. If additional forms or paperwork don’t follow your incident report submission, follow up with your supervisor.

#2: Choose an appropriate medical provider. If you became injured in a work emergency, the ambulance driver will take you to the nearest hospital. If the injury occurs in a non-emergency scenario, the employer may suggest a certain doctor, health clinic, or hospital.

  • It’s important to comply in this situation. If you go to a private doctor, the employer might not agree to cover bills under workers compensation insurance.
  • If you decide to see your personal physician anyway, ask if he or she is certified to evaluate workers compensation claims (and has therefore agreed to the state workers compensation provider pay schedule).

#3. Let the doctor or hospital know you were injured at work. As you fill out paperwork in the doctor’s office or in the hospital, make sure to tick off the box that asks if the injury occurred at work. This step directs medical bills related to your injury to the workers comp insurer or to your boss and not to you.

#4: Check your medical records to ensure the work-related injury is accurately reported. Medical records must mention the circumstances and history of the illness or injury and should identify every part of your body that’s involved. Unfortunately, workers comp doesn’t pay for treatment of body parts that the doctor doesn’t list in your records.

#5: Learn more about workers comp coverage. The company’s HR department probably has a leaflet to explain the firm’s workers comp program. Read it. As a next step, determine the location of the state workers comp office. Review information about the workers comp office online.

#6: Your boss might lie to you about coverage. Unfortunately, this is true. Paying too many workers comp claims will raise its insurance premiums:

  • If the boss or HR department mentions you’re not covered by their workers comp policy because you caused the accident or event that injured or disabled you, remember that workers comp insurance is no-fault.
  • Regardless of who caused the accident or injury, you are covered. However, in some states an accident or injury that results from horseplay at work might not be covered.

#7: Don’t take drugs or drink alcohol on the job. This may seem like an obvious thing to remember at work. Let’s say you enjoy a beer with a co-worker at the loading dock and then you suffer an injury. Some workers ask for a drug test after an injury or accident and, if drugs or alcohol are identified in your bloodstream, you won’t get workers comp benefits.

#8: You might not need a disability attorney but don’t assume it’s okay to go it alone. Each state establishes workers compensation values or payouts. For instance, in some states a lost thumb is equal to 75 weeks’ wages. The workers comp doctor may say your thumb is only 10 percent disabled after a work-related accident. In that case, you receive 7.5 weeks’ disability pay.

There isn’t a lot of wiggle room in what your disability is worth in your state of residence. However, a disability attorney can be invaluable when your employer or its insurer denies your claim for workers comp.

An experienced workers comp lawyer is paid 20 percent or more of the settlement. If you believe the employer or insurance company is shortchanging your permanent disability or it won’t cover medical bills, hire a lawyer.

#9. Don’t expect a big workers comp payout. For example, Texas pays a maximum workers compensation benefit of just USD 725 per week. Depending on your pre-injury or accident compensation, workers comp benefits are intended to help the injured disabled workers pay for the basics of life.

#10.Cheating on workers comp is fraud. Potential fraud is a major issue for workers comp investigators. Expect the insurance company and/or employer to make at least one home visit, perform surveillance, or investigate your current earnings on workers comp. Don’t plan to work while on workers comp. If you’re caught, workers comp fraud can entail jail time.

Workers Compensation Lawyer

Now you know that your employer pays for workers comp. In most cases, workers comp benefits are there if you need them. If you’re injured and disabled because of a work-related accident, injury, or illness, a qualified workers comp lawyer can help.