- Workplace compensation provides financial assistance to injured workers and keeps disputes out of the courts.
- Workplace compensation covers salary replacement for lost wages, reimbursement of healthcare costs, and survivor benefits if a workplace injury or illness is fatal.
You’ve no doubt heard the term, but there’s a difference between understanding the concept of workers’ compensation and navigating the claims process. Most employees only ever confront it after having sustained a workplace injury themselves. Digging through the vast sea of information online is more than just encouraged, it’s essential to easing your anxiety levels and preparing for the path ahead.
Understanding the fundamentals of workers’ compensation benefits is a great first step. This article sets out to break down the various types of workers compensation benefits available to you, the important rights you have as an employee, and how to find professional representation should you need it.
VectorMine / ShutterstockWorkers’ Compensation Benefits Defined
Workers’ compensation, workmans’ compensation, and workers comp are all different names for the government-mandated support provided to workers who have sustained an injury or have become ill on the job or due to the nature of the job.
The program is designed to protect both businesses and their employees from long and costly litigation proceedings by keeping disputes out of the courts. This heavily regulated system is there to provide financial assistance to injured workers, healthcare reimbursement, and a lot more. The particulars can vary depending on the state in which you work. Despite the specifics, there are consistencies that cross state lines.1
Who Qualifies for Workers’ Complication Benefits?
States and specifics can determine much, but workers’ compensation benefits are generally made available to employees that sustain an injury or develop an illness while at work, or as the result of the work that they performed. Fault is not a factor either. A negligent employee that got themselves hurt at work can still qualify.2
Workers’ compensation isn’t available to independent contractors or freelancers. This system is designed to protect salaried workers. There are countless exceptions to these rules depending on the location of the business too, so be sure to research the laws in your area or consult a local professional for more specifics.
Salary Replacement
As a primary element of the workers compensation suite of benefits, salary replacement is there to reimburse an injured or ill worker for wages that their malady led them to miss. The amount of income protection benefits an employee is eligible to receive can vary, but some can see as much as two-thirds of their salary replaced.
This type of workers compensation is called many things including salary replacement, wage reimbursement, and disability benefit. Each claim falls into one of four categories depending on the severity of the injury and the length of coverage. They are:
- Temporary total disability;
- Temporary partial disability;
- Permanent total disability, and;
- Permanent partial disability.
Healthcare Reimbursement
The shortlist of workers compensation types is highlighted by healthcare reimbursement benefits. Sustaining an injury at work is hard enough without having to stress about financing a lengthy recovery.
Healthcare reimbursement benefits are issued to cover the cost of medical expenses that result from the specific injury that the employee filed a claim for. The financial support can extend past the initial hospital visit. Furthermore, workers’ compensation benefits may reimburse a claimant for the cost of occupational therapy and rehabilitation.
Survivor Benefits
Workers’ compensation insurance policies usually include coverage for fatal workplace injuries. These are called survival or death benefits and are designed to step in and support the deceased employee’s family.
Survivor benefits may include the reimbursement of funeral and burial costs. Additionally, these benefits may cover financial assistance for the victim’s family.
Waiving the Right to Sue
When an injured or ill employee agrees to receive workers’ compensation benefits, they are inherently agreeing to forgo their right to sue their employer for negligence in relation to the injury or illness sustained.
Workers’ compensation is far from a one-sided system. It works because it brings both parties to the negotiating table in a systematic and governable way. It protects employers from lengthy litigation, and it provides employees with a straightforward avenue towards reimbursement.
Appeals
Although fault is not a factor in determining whether an injured employee receives workers’ comp, there are several reasons a claim might be denied. Pre-existing medical conditions, clerical errors, intentional neglect, and horseplay are just a few potential obstacles.3
You do have the right to appeal any claim denial. Again, the process can vary by state, but expect to present your case to an independent appeals board. You can also expect the process to take between two to four months, though each case is unique and could take more or less time depending on the individual circumstances.4
Third Party Lawsuits
Accepting benefits doesn’t waive your right to legal recourse entirely. Should your injury come as the result of third-party negligence, you are free to sue them. If the injury or illness was the result of a faulty or defective piece of equipment, for example, the manufacturer could be considered a third party and is eligible to be sued.
Third party lawsuits are not processed through the workers’ compensation process though. Instead, a civil lawsuit would need to be filed through either the federal or state court systems.5
Seeking Legal Council
Whether you’re planning to launch a civil lawsuit against a negligent third party or just searching for guidance, know that legal representation is your lawful right — regardless of which state you work in.
Professional legal advice is only ever a few keystrokes away and can work wonders in easing your concerns and lowering your stress levels. When choosing a legal representation, always review their experience, ask about their success rate, and inquire after their references.
Conclusion
Navigating the pitfalls of workers compensation benefits can be frustrating, but understand that you’re merely at the beginning of this journey. The step you took to educate and protect yourself and your family doesn’t have to end here.
Instead, keep reading, learning, asking questions, and eliciting guidance. The more you understand, the more ready you’ll be to confront a workers’ compensation benefits claim or aid a loved one in need.
