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Workers Compensation Eligibility and Benefits

Author : Ray

Updated : June 12th, 2019

Workers’ compensation, also known as Workman’s comp, is a state-mandated insurance program that is administered by the federal government for federal and certain other types of employees. Each of the 50 states has its own customised programs for its citizens.

An employee with a work-related illness or injury can get workers’ compensation benefits regardless of who was at fault. In exchange for these guaranteed benefits, employees usually do not have the right to sue the employer in court for damages for those injuries.

The Department of Labor’s OWCP (Office of Workers compensation programs) administers disability compensation programs for workers (or their dependents) who are injured at work or have acquired an occupational disease. A wide range of categorical benefits are extended to workers in need.

  • Wage replacement benefits
  • Medical treatment
  • Vocational rehabilitation
  • Other benefits

Eligibility Criteria

Three vital and basic requirements must be fulfilled to become eligible for compensation benefits.

  • The company you are/were working for must carry workers’ compensation insurance or be legally required to do so.
  • You must be on rolls of that person or company.
  • The nature of injury or illness must be related to the work and not a personal ailment.

In addition, there are some special regulations for domestic workers, agricultural and farm workers, leased or loaned workers, casual or seasonal workers, and undocumented workers.

Types of Benefits

Workers’ comp benefits can include medical care, rehabilitation expenses, and disability coverage to compensate for lost wages. If you’ve been injured on the job or become ill through your work, you may have already been told that you can receive some or all of these benefits through your employer’s workers’ compensation insurance.

If you are a dependent family member of someone who was killed on the job, you might be entitled to death benefits through workers’ compensation.

Medical Care

Medical benefits available through workers’ compensation include hospital and medical expenses. Workers’ compensation generally covers doctor visits, medication and surgeries and other related expenditure. In some instances, workers’ compensation will also cover services like counselling, pain therapy, and acupuncture.

Rehabilitation

Rehabilitation benefits cover medical and therapeutic care (such as physical therapy) necessary to help you cope with and recover from your injury or illness. They also cover the care and training necessary for you to regain the skills and abilities you need to return to work.

Disability

The role of disability benefits for unemployed workers is to compensate you for wages lost while your injury or illness makes it impossible for you to work. Disabilities fall into one of four categories.

A temporary total disability is one that prevents you from working at all, but only for a limited amount of time. In other words, you can’t work now, but you will be able to work some day. The vast majority of workers compensation disabilities fall into this category.

A temporary partial disability is one that prevents you from doing some of the duties of your job for a limited amount of time. In other words, you can do parts of your job now, and someday you may be able to do all of the duties of your job, just as you did before your injury.

A permanent total disability is one that prevents you from ever returning to work. You don’t need to be totally helpless or medically incapacitated to fall into this category, just unable to work at your job or a similar one.

A permanent partial disability occurs when the damage is permanent, but it only partially impairs your ability to work.

Death

Most states’ workers’ compensation programs provide death benefits to people who were related to the deceased worker (for example, a spouse, child, parent, or sibling) and were financially dependent on that person. Although most states provide funeral and burial expenses as part of this benefit, the main purpose of the benefit is to compensate dependent family members for the loss of financial support.

Filing a Claim

Get immediate medical care if your injury requires it. You must then inform your employer of your injury as soon as possible. This is a tricky part of processing a workers’ comp claim, since states have wildly different limits on the number of days you have to notify your employer; in most states, the limit is one month, but the range is from a few days to two years.

Your employer will have claim forms for you to fill out and submit or can obtain a form quickly. It then becomes your employer’s responsibility to submit the paperwork to the relevant insurance carrier.

If your injury is not permanent and does not cause you to lose income, getting payment for your medical bills will probably be the extent of your claim. If you are temporarily unable to work because of your injury, you will also begin receiving checks to cover your wage loss—typically within a week or two after your claim is approved. Your employer will notify the insurance company to stop sending you wage-replacement checks as soon as you recover and return to work.

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  1. I am in a unique situation. I would like to know if even though I work for a church that does not pay into unemployment, I have only been here a year and my job previous did pay into unemployment. Would I be eligible for unemployment benefits if I were laid off? This is in the state of Nevada. If so, how long do I have before that is NOT the case? In other words, I know that benefits usually go back 18 months. Would it be the same in this case?

    1. Leslee,

      As much as I am aware, church employees do not qualify to receive UI benefits. Please call the Unemployment Office for clarification.

  2. The unemployment office in Nevada doesn’t answer the phone. They have a recording that says they only take new claims on Monday, and Tuesday, from 8am to 4pm. But if you call at 8am, they tell you that the “Que is already full for the day.” How can that be possible if they don’t start accepting calls until 8am? No wonder unemployment in the United States is DOWN! They don’t accept phone calls after they tell you online that you “have to call to confirm your information” and then they don’t take the calls.

  3. I have called as soon as they open and they just say please call on the next business day I DID and you still didn’t answer

  4. Could you please provide a reference for the following statement in your article – please see below. Thanks.
    “You may also be qualified for unemployment benefits if:
    …You entered Commission-Approved Training and the job is not considered suitable under Section 20 relating to your availability for work, active search for work or refusal to accept suitable work”.

  5. If I exhausted all my benefits last year 2019 and my new benefit year starts back up in Jan. 2020 can I reapply? I still should have money in other quarters from my previous job.

    1. Yvette,

      The E.U.C(Emergency Unemployment Compensation) remains expired. There is no extension available. Please inquire further with the labor authorities in your state by calling them.

  6. Can i receive unemployment if my car broke down and i couldnt work cause i work outta my car and i couldnt afford to get it fixed so i ended up not working there anymore cause the car situation

    1. Willie,

      I can understand your situation. However, I am not sure if you can claim for voluntary reasons. Please call the Unemployment Office for clarification.

      1. Hello,

        I have been unemployed since this past July. My regular unemployment benefits are running out. Can I apply for Emergency Unemployment Benefits after this claim expires? What can I do?

        Thank you,D. ANDERSON

  7. I filed my first bi-weekly claim today but it only took my first week. Are there only certain weeks I can file 2 weeks worth of unemployment?

    1. How strict are they on the school program being less than 2 years for CTB training extension? I have an interview next week for a Training Extension. I started school this week, I am set to finish just a few months over the 2 year mark. Finishing in May 2022.

  8. What if it’s an employer that is threatening over it being personal home life and nothing to do with work or the work place??

    1. Kelly,

      You can be eligible to claim if you resign due to hostile working conditions. Please make sure to check with the Unemployment Office before making a decision.

        1. Paula,

          A copy should be available on the department’s website. You will be able to download after logging in.

  9. I finally start new job on Monday. My work hours are 6;30-6:30pm.
    How can I file my last two weeks if I’m working

    Can I. Call Tuesday? What number?

      1. Hello, I live in the state of Pennsylvania, for reference. I was told on 1/9/2020 I am being let go because of financial issues my employer and office is having. With that, my employer said I can work for the next two weeks to give me time to find another job and if circumstances change they will call me back to work. My question is, Where do I go to figure out my quarter dollar amount earnings for my highest 4 out of 5 quarters. I’ve been with this employer for 7 months, started June 2019. Before that I was unemployed for 5 months and before that I was employed for years up until Feb 2019.

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