Workers compensation is an essential insurance system that provides vital benefits to employees who are injured or become ill due to their job or job responsibilities. However, as with many other social programs, workers comp can be a tricky system to navigate.
Take a look at some of the most common workers comp-related questions below.
What Types of Injuries or Illnesses do Workers Compensation Cover?
Workers compensation covers physical and mental injuries or illnesses caused or aggravated by your job or workplace. These illnesses can include invisible conditions like carpal tunnel syndrome or hearing loss, stress-related conditions such as anxiety, or physical injuries, including limb loss or broken bones.
How Do I File a Workers Compensation Claim?
To file a claim, you must notify your employer and submit a claim form to your state’s workers compensation board. Your employer will review your claim, then take the opportunity to accept or deny your claim. If your employer accepts your claim, you’ll begin receiving benefits shortly. However, you can appeal the decision if your employer denies or disputes your claim.
How Will I Access Medications?
Most companies have a pharmacy benefit manager, or PBM, that handles all medication-related concerns. The top PBMs help employers find rebates and negotiate prescription costs to help employers and employees access the best prices for their medications.
Who Is Eligible for Workers Compensation?
Any employee who is injured or becomes ill as a result of their job can file a workers compensation claim. Eligible claimants include full-time, part-time, and seasonal employees. The only employees who usually aren’t covered are independent contractors or freelance workers.
What if My Employer Doesn’t Have Workers Compensation Insurance?
If your employer does not have workers compensation insurance, you may still be able to receive benefits through your state’s workers compensation program. A second, often less savory, option is to file a lawsuit against your employer directly.
What Benefits Am I Entitled To?
The type and amount of benefits you’re entitled to will depend on the severity of your injury or illness and how long you are unable to work. Standard benefits include medical expenses, income replacement, job retraining assistance, and death benefits for your dependents.
Are There Any Situations Where I’m Not Eligible for Workers Compensation?
There are a few situations where you may not be eligible for workers compensation benefits. For example, your employer will likely deny your claim if you were injured while engaging in illegal activities or if your injury was self-inflicted. In addition, if you instigate a physical altercation, your employer could deny your claim.
How Do I File if My Injury Happened in Another State?
You’re still eligible for benefits if you travel for work and receive an injury or contract an illness out-of-state. However, if your employer’s benefits are insufficient, you can look into extraterritorial coverage, which you’d receive from the state where you were injured.
Will My Employer Be Notified That I’m Receiving Workers Compensation Benefits?
In most cases, your state workers compensation board will notify your employer that you’re receiving workers comp benefits. However, there are some circumstances when you can request your employer not be notified. For example, if you’re receiving treatment for a mental health condition, you can request that your claim remain confidential.
Can I Return to Work While I’m Receiving Workers Compensation Benefits?
Employees can return to work before their workers comp claim is complete. Doctors often encourage returning to work because it can speed up your recovery and help you transition back into your pre-injury role. However, you should only return once your doctor clears you, as certain activities can exacerbate injuries.
How Can I Be Certain I’m Eligible for Workers Compensation?
When you’re unsure whether you’re eligible for workers compensation, the best thing to do is contact your state’s workers compensation board. The board can answer any questions about eligibility requirements and the claims process in your state.
What if My Claim Gets Denied?
You have the right to appeal the decision if your claim is denied. However, the appeals process can be complex, so it might be wise to consult an attorney with workers compensation experience. An attorney can help you gather the evidence you need to prove your case and get the benefits you’re entitled to.
Final Thoughts on Workers Compensation
Workers compensation is essential to ensuring workers have a fair and safe workplace. However, the system often leads to many questions that are hard to answer. Hopefully, the answers provided in this article will help make your claim process run more smoothly.