TL;DR
Answers to the most common questions about workers' compensation — who is covered, what benefits are available, and what to do if your claim is denied.
Workers' Compensation FAQ: Your Questions Answered
Who is covered by workers' compensation?
Most employees in the United States are covered by workers' compensation. However, coverage requirements vary by state. Some states exempt employers with fewer than a certain number of employees. Independent contractors are generally not covered, though some workers misclassified as contractors may actually be employees entitled to coverage.
What injuries and illnesses are covered?
Workers' compensation covers injuries and illnesses that arise out of and in the course of employment. This includes:
- Accidents at work (falls, equipment injuries, vehicle accidents)
- Repetitive stress injuries (carpal tunnel, back problems from repetitive lifting)
- Occupational diseases (lung disease from chemical exposure, hearing loss from noise)
- Mental health conditions in some states (PTSD, stress disorders)
What benefits can I receive?
Workers' compensation benefits typically include:
- Medical benefits — All reasonable and necessary medical treatment
- Temporary disability — Wage replacement while you cannot work (typically 2/3 of your average weekly wage)
- Permanent disability — Compensation for lasting impairment
- Vocational rehabilitation — Job retraining if you cannot return to your previous work
- Death benefits — Compensation for surviving dependents in fatal cases
Can I sue my employer for a workplace injury?
In most cases, no. Workers' compensation is an exclusive remedy, meaning you cannot sue your employer for negligence in exchange for the guaranteed benefits of the system. However, you may be able to sue third parties (equipment manufacturers, contractors) whose negligence contributed to your injury.
What if my claim is denied?
If your claim is denied, you have the right to appeal. The appeals process varies by state but typically involves:
- Requesting reconsideration from the insurance company
- Filing an appeal with your state's workers' compensation board
- Appealing to a workers' compensation judge
- Further appeals to higher courts if necessary
An attorney can significantly improve your chances of a successful appeal.
Can my employer fire me for filing a workers' compensation claim?
No. Retaliation against an employee for filing a workers' compensation claim is illegal in every state. If you are fired, demoted, or otherwise penalized for filing a claim, you may have a separate retaliation claim against your employer.
Do I need an attorney for a workers' compensation claim?
For simple claims with clear liability and minor injuries, you may not need an attorney. However, an attorney is strongly recommended if:
- Your claim is denied
- You have serious or permanent injuries
- You are offered a settlement
- You are being pressured to return to work before you are ready
- Your employer is retaliating against you
Most workers' compensation attorneys work on contingency. Find one near you on NinjaLawyers.