In the United States, “Workers Compensation” also known as workers comp, workmans comp or workmen’s compensation, generally refers to a type of insurance program that governs the rights and claims of workers and employers in the case of an employee injury while they are performing their job duties. In most states the amount and types of coverage and the conditions under which an employee can make a claim under a workers comp policy are determined by state laws.
In its most general sense, workmen’s compensation pays employees in-full or in-part for their wages and medical costs resulting from a disability, illness or injury related to their job. In some cases workers comp can also be expanded to include any other benefits paid by the employer for the employee while the employee is ill or not able to work because of an on-the-job injury.
Why is Workers’ Compensation important?
Workers Compensation was started to ensure that injured workers received fair financial treatment from their employers. In fact, this is one of the oldest nationwide insurance programs in the United States, beginning as early as 1911 in some states. The intention of workmen’s compensation is to balance the employer’s wish to minimize costs with the employee’s need to receive an income while they are unable to work due to job-related illness or injury.
If not for workman’s compensation, an employee would have to sue his employer to receive compensation for medical expenses and lost wages. This could take years, and would require proof of employer negligence or liability in many cases. However, by accepting workers comp benefits instead filing a lawsuit, a worker can receive immediate payments for medical bills and lost wages without the time and expense of going to court and without a formal proof of liability.
At the same time, employer saves money by not having to pay the costs of defending against a lawsuit. And the court system as a whole is not overburdened with worker disability, illness, and injury claims.
Understanding the Types of Workmens Compensation Coverage
There are two main types of workers compensation coverage. Single event coverage refers to coverage that pays for injuries that arise from a one-time accident, like a slip or a fall. For example, if an employee fell on a wet floor and broke their leg, the injury would be covered under single event coverage. Likewise, if an item fell off a shelf and injured a worker, this would also be a single event. Or if an assembly line worker was injured by a malfunctioning machine that cut his hand, this would again be a single event. Single events can be identified because they happen once, on a specific date and time.
On the other hand, cumulative event coverage covers injuries that arise over time on the job. For example, if a worker develops knee problems as a result of carrying heavy loads for years at work, that would be a cumulative injury. Or if a worker suffers from mesothelioma cancer because of continually being exposed to asbestos at work, that would also be a cumulative injury. Or if an office worker has carpel tunnel syndrome from constant typing at her job, that again would be a cumulative injury.
Who pays for a Workers Compensation policy?
Payment for a workers comp policy varies depending on the location and sometimes even on the particular employer. In some states, employees are covered under policies that are issued by the state and paid for by their employer. In other areas, employees are covered by private insurance policies purchased by their employer. And some union members are covered by policies paid for by their union dues. You should always consult your employer’s Human Resources or Benefits office, or your union representative, to learn more about the policy that applies in your case.
What does Workman’s Compensation pay for?
Workers’ compensation usually replaces lost wages while an employee is sick or unable to work because of a work-related injury. Usually the employee will receive a benefit which is less than or equal to his normal rate of pay before the illness or injury happened. Payments usually start from the time the injury occurred and was reported, and they generally last until the employee is able to resume his normal duties at his normal payrate.
In some cases, depending on severity of the injury, the worker may never be able to do his old job properly again, and may need to be retrained to do other kind of work in order to accommodate his disability. And in cases where the injury is very serious, workers comp benefits may be paid out throughout the workers life time, and may even continue after his death until the death of his spouse.
How do I file a Workers Comp claim?
Filing a workmen’s compensation claim can be a complex process. The first thing to do is to notify the proper people about your injury or illness as soon as it happens. If you are member of trade union or guild, first notify your union representative and ask them what steps you should take to ensure your eligibility for benefits. Follow their instructions carefully so that your claim will be processed as quickly as possible and so that you will not do anything that might cause your claim to be denied.
If you are not a member of union, then immediately notify your employer of any injuries or illnesses related to your job. You may need to talk with your the human resources department or local labor department in order to start the claims process, depending on your location.
Does It Matter Whose Fault the Injury Is?
Unlike other types of insurance coverage or a lawsuit, workers comp usually does not require that an employee prove that the employer was negligent or responsible for the accident in order to receive benefits. As long as the employee wasn’t deliberately being negligent, or acting recklessly, or trying to injure himself on purpose, he should be eligible to receive benefits through a workmen’s compensation claim.
Can I get fired if I file a Claim for Workmans Compensation?
In most cases an employer cannot fire an employee after the work related injury. However, it is always best to get information about a specific case from an attorney with experience in workers comp law.
Can I sue my employer and also file a Workers Compensation claim?
In many states, workmen’s compensation is the only claim an injured employee can make against his employer.
In other states, an injured employee can choose between suing the employer or filing a workers comp claim. It is important to remember that if an employee has a choice, he can decide to either sue or to file for workers compensation, but he cannot do both. Once an employee has made the choice to file a workmen’s compensation claim, he cannot also sue his employer for his work related injuries or illness.
However, it is important to remember that in most cases a “Third Party”, such as an equipment manufacturer, can be sued by employee even if the employee decides to file a workers comp claim. A Third Party means someone who is not the employer or the employee. So, for example, if an employee’s arm was injured because a machine he was using did not work correctly, the employee could usually sue the machine’s manufacturer even if the employee also filed a workmen’s compensation claim with the employer.
What happens after I file a Workers’ Compensation claim?
Claims can be handled in several ways, so you should always find out what the proper procedures are in your case. However, typically you will be examined and treated by a doctor approved by the insurance company that issued the workers comp policy that covers you. After examining you, the doctor submits the proper documentation regarding your injury and the treatment and costs associated with it to the insurance company. You employer will also submit a report about the accident along with statements from any witnesses.
If the claim is accepted, then you will shortly begin to receive your benefits. You should talk with your claims representative to be sure that you fully understand what benefits you will be receiving. Will you receive enough funding to replace all of your lost wages, or only part of them. Are there any medical expenses that will specifically not be covered? Are there any restrictions about which doctors or which hospitals you can be treated at? How long will your benefits continue to be paid? Will your benefits cover any expenses for re-training you if you will not be able to resume your former job?
In some cases, even if you think that you have a legitimate claim, you may be denied benefits. If that happens, you usually have the right to appeal the denial, though you may need to go to court depending on the laws that apply in your area. In that case, you may need to consult an attorney or lawyer to properly pursue your claim and ensure that you do eventually receive any benefits that you are entitled to.
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