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Workmen's Comp

Learn about various workmens' comp benefits and the process of filing a claim.

Workers' comp helps avoid lawsuits between employees and employers. [©Jupiter Images, 2009]
©Jupiter Images, 2009
Workers' comp helps avoid lawsuits between employees and employers.

Despite the fact that the rate of workplace injuries continues to decline, accidents happen, and workmen's comp benefits can help an individual or family get through tough economic times. According to Cornell University, workers' compensation is monetary assistance paid by the employer's insurance company, or in some cases the federal government will pay compensation (if the injured worker is a federal employee) when employees suffer lost wages and expenses due to a work-related disability or death. Workers' compensation helps to avoid lawsuits between employees and employers by providing the injured employee with compensation and medical expenses while off work.

Each state has its own workers' compensation program that establishes and enforces the laws that protect both injured employees and co-workers. Employers are also protected under the law because their liability is limited to providing only the benefits required in their state. The state law determines which employers are required to have workers' compensation insurance. Subcontractors, the self-employed and those in certain employment situations may not be included within a state's eligibility requirements. Federal compensation programs offer coverage for government employees only. A workers' compensation claim form must be submitted to the employer to be eligible for benefits.

Types of Workers' Comp Benefits

According to the National Academy of Social Insurance, state workers' compensation laws provide eligible injured individuals with the following benefits:

  • Payment of immediate and long-term medical expenses related to the injury
  • Temporary disability payments while the injury heals
  • Permanent disability payments for partial or total injuries that prevent future employment
  • Vocational rehabilitation (job training) for workers who must pursue another career due to the injury

 

Workers' compensation also provides payments to financially-dependent family members of a worker who dies in a job-related accident. For example, in the state of New Jersey, the surviving spouse and children under the age of 19, as well as full-time students up to age 23, are considered dependents. The benefit is likely to be 70 percent of the deceased employee's salary. Benefits may also cover funeral expenses up to $3,500.

The Office of Workers' Compensation Programs (OWCP) oversees the following workers' compensation programs for federal employees:

  • The Black Lung Benefits Program gives miners affected by black lung and their families monthly benefit payments.
  • The Energy Employees Occupational Illness Compensation Program provides payments to former employees of the Department of Energy and/or surviving family members.
  • The Federal Employees' Compensation Program provides wage replacement and health benefits for federal employees (including postal workers) in the case of injury or death.
  • The Longshore and Harbor Workers' Compensation Program assists federal workers who are injured on the job or who catch a disease because of the nature of their jobs working in American waters.

Making a Workers' Comp Injury Claim

To be eligible for workers' compensation, the injury must be the result of an accident that happened while working on the job, and qualify under a set of guidelines as laid out by each state. Any attempt to fire someone for submitting a workers' compensation claim could result in the payment of lost wages as well as legal action against the employer.

The worker should complete a workers' compensation claim form, make a copy and present the original to the employer in person or by certified mail. The form should be submitted as soon as possible after the accident; some states request the form be completed within 30 days of the accident. The form is available from the employer or the compensation office of most states. The United States Department of Labor provides links to the workers' compensation divisions for each state. Federal employees can download the necessary forms at the Division of Federal Employees' Compensation Web page. Workers' compensation benefits can also provide coverage for a long-term injury, such as repetitive strain. The claim should be filed as soon after a diagnosis as possible.

Taking the time to fully document every aspect of the claim, including the events surrounding the initial injury and the subsequent health problems and treatment, will increase the likelihood of successfully receiving benefits. The employee should bring witnesses to employer meetings and avoid talking to other company employees about the injury and claim.

Processing the Workers' Comp Claim

After receiving the claim, the state requires that the employer authorizes payment of medical expenses within 24 hours. The employer or insurance company handling the claim may require the employee to see a particular doctor for treatment. The employer should complete the "employer" section on the form, provide a copy to the employee, and send it to the insurance company within the timeframe required by state law. Employees who do not hear from the insurance company within the required timeframe should contact the insurance company. The employee should call the workers' compensation division if the insurance company is not responding to the claim, or the employer refuses to file the claim form and/or chooses not to authorize the payment of medical treatment.

Returning to Work

After an injury has been treated and healed, the individual will be able to return to work if the injuries aren't permanent. Work duties may change temporarily or permanently to help the worker adjust. In some cases, a return to the previous employment will be impossible due to the injury and/or legal disputes with the employer. In many states, part of the workers' compensation division's job is to assist individuals in returning to work safely or seeking a new place of employment. Workers should check with their state's compensation division for this type of assistance.

Dealing With a Permanent Disability

Sometimes a long-term claim turns into a permanent disability. If there is no reason to believe that the worker will return to work after sustaining a work-related injury, the worker can apply for Social Security benefits. The worker becomes eligible for Social Security benefits after five months of disability and for Medicare after 29 months.

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