Workers’ compensation is designed to protect employees who get injured on the job, covering medical bills, lost wages, and other related expenses. But while the system sounds pretty straightforward, it’s usually more complicated. Many employees assume they’re automatically covered or that their claim will be a simple process – only to find out later that it’s anything but.
If you think you know everything about workers’ compensation, here are five things you need to know.
- Workers’ Comp Doesn’t Cover Every Injury
Many employees assume that workers’ compensation will automatically cover their injuries if they get hurt at work. However, that’s not always the case.
To qualify for workers’ comp benefits, your injury must meet specific criteria. Generally, your injury must:
- Occur while performing job-related duties
- Be reported within the required timeframe
- Not be the result of intoxication, “horseplay,” or intentional self-harm
For example, if you’re injured in a slip-and-fall accident in the office break room, you’re likely covered. But if you got hurt while messing around with a coworker or doing something outside your job responsibilities, your claim could be denied. Additionally, pre-existing conditions and repetitive stress injuries may not be covered unless you can prove they were worsened by your work.
- You Have to Report Your Injury Quickly
One of the biggest mistakes injured workers make is waiting too long to report their injury. Every state has strict deadlines for notifying your employer and filing a workers’ comp claim. If you miss these deadlines, you could lose your right to compensation.
Some states require you to report the injury within just a few days, while others may give you up to 30 days. Regardless of the specific deadline, it’s always best to notify your employer as soon as possible. Even if your injury seems minor at first, it could develop into something more serious over time.
- Workers’ Compensation Might Not Cover All Your Expenses
Another common misconception is that workers’ comp will fully cover every cost related to your injury. Unfortunately, that’s not always true. While it does cover medical bills and a portion of your lost wages, there are limits to how much compensation you can receive.
“Many injured workers assume that workers’ compensation is a guarantee and that it will cover all the costs of their injuries,” Query Sautter & Uricchio, LLC explains. “These assumptions may surprise injured workers when they learn that they can actually miss out on the full compensation they deserve.”
For example, workers’ comp typically covers only a percentage of your lost wages, meaning you may not receive your full paycheck while you’re out of work. Additionally, certain treatments, such as experimental procedures or alternative therapies, may not be covered.
In some cases, if your injury was caused by negligence from a third party (such as a defective piece of equipment), you may have the option to file a separate lawsuit to recover additional damages.
- You May Be Required to See an Employer-Selected Doctor
When you file a workers’ comp claim, you might assume you can visit your regular doctor for treatment. However, in many states, your employer or their insurance provider has the right to require you to see a designated doctor for your initial evaluation.
This can sometimes create conflicts of interest. If the doctor is closely associated with your employer’s insurance company, they may downplay your injuries or push you to return to work sooner than you should.
If you’re unhappy with the doctor’s assessment, you may have the right to seek a second opinion – but this depends on your state’s workers’ comp laws. In some cases, you may need to follow specific procedures to switch doctors.
- Your Employer Can’t Retaliate
Fear of retaliation keeps many employees from filing workers’ comp claims. Some worry they’ll be fired, demoted, or treated differently if they pursue the benefits they’re entitled to.
However, it’s illegal for an employer to retaliate against you for filing a legitimate workers’ compensation claim. Retaliation can take many forms, including:
- Termination or sudden layoffs
- Reduced hours or demotions
- Hostile work environments
- Negative performance reviews that seem unjustified
If you believe you’re being retaliated against, document every interaction with your employer and speak with an attorney as soon as possible.
What to Do If You’re Facing Challenges with Workers’ Comp
If you’ve been injured on the job and are struggling with the workers’ compensation process, don’t try to navigate it alone. Here are a few steps to take if you run into problems:
- Document Everything: Keep records of your injury, medical treatment, and any communication with your employer or insurance company.
- Follow Medical Advice: Stick to your treatment plan and follow all medical recommendations to avoid giving the insurance company a reason to deny your claim.
- Know Your Rights: Research your state’s workers’ compensation laws or consult with an attorney to ensure you’re receiving the benefits you’re entitled to.
The bottom line is that workers’ compensation exists to help employees recover from workplace injuries. However, it’s not always as simple as filing a claim and getting paid. With limitations on coverage, strict reporting deadlines, and other potential obstacles, you may need to work with an attorney.
