Workers Compensation Eligibility and Benefits
Updated : August 23rd, 2014
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
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 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 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.
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.
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.