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Workers Compensation Eligibility and Benefits

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 work for a church pre school program and I have lost my job due to coronavirus. When I applied for unemployment in Texas it says that two does not except this employer as my last employer. I’ve been working there for 13 years. What do I do?

  2. Chad ….. how do I get thru when it wont accept my ID or my password. I change it 5 times and it still wont work. Calling is not working at any time when I spend and whole day calling back to back to get thru. why don’t they just help or force the employers ( company) to place they claims in for their workers like GM did……I NEED HELP…PLEASE.

    1. Chad,

      We understand this might be a difficult time for you. We’re anticipating a shortage of staff across unemployment offices due to the massive surge in UI applications considering the pandemic. We advise against calling or visiting the office, as you may not get a response instantly.

      Your state may have activated “Extended Benefits (EB)” authorized by the federal government. We recommend you apply for UI benefits online. For more information, please visit your state’s official Unemployment website.

  3. i live in ga…all the day cares have shut down my wife and i have full time jobs,,,but i have to leave my company which i have been there for over two years,to take care of our child….can i still collect unemployment…this covid virus is why i have to leave my job…

    1. Gary,

      We understand this might be a difficult time for you. We’re anticipating a shortage of staff across unemployment offices due to the massive surge in UI applications considering the pandemic. We advise against calling or visiting the office, as you may not get a response instantly.

      Your state may have activated “Extended Benefits (EB)” authorized by the federal government. We recommend you apply for UI benefits online. For more information, please visit your state’s official Unemployment website.

  4. are you kidding me my son lost his job on 10/17/2020 hes mentally challenged and cant file on his own because he doesn’t know how so I started going to sites trying to file for him and the residence inn Marriott promised to help him and have done zip . ive tried 10 different sites and I keep getting dropped wen I complete forms and push submit. 12 days now n still cant file a claim.

    1. Martin,

      There’s only one website you should be trying from. Please let us know your state and we’ll share the website information.

  5. I have submitted my forms EXACTLY as I was instructed too on line. Even though I have filled out the paperwork correctly I keep getting emails asking for me to fill out the form that I have done multiple times already. Remuneration – Claimant Questionnaire is the issue. I got online and requested a phone call. 3 days ago. I just need to know that you guys received everything and I don’t owe any more information.
    Nobody answers the 617-626-6800 number. Just get directed to the internet. Well, you can’t speak with the internet. I am getting mixed messages and I fret that this will delay any benefits.
    Could someone please give me a call.

    1. James,

      Please try finding answers online since there might be limited phone support due to the shortage of staffing. This is a private forum and we’ll not be able to arrange a callback.

  6. I work for a church that has grown it’s congregation over almost 40 years and we now have 26 mostly full time employees, most being here many years. Will our employees be able to file and receive benefits since we are an EXEMPT from paying unemployment industry? State of Florida

  7. My unemployment benefits ran out 3/1/2020 am I able to file for extended benefits ? I live in California and am 62 years old.

    1. Ariana,

      We understand this might be a difficult time for you. We’re anticipating a shortage of staff across unemployment offices due to the massive surge in UI applications considering the pandemic. We advise against calling or visiting the office, as you may not get a response instantly.

      Your state may have activated “Extended Benefits (EB)” authorized by the federal government. We recommend you apply for UI benefits online. For more information, please visit your state’s official Unemployment website.

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