What Is Workers’ Comp? | How To Exercise Your Rights

ByDanica Djokic
October 08,2021

Imagine getting a brand new job at, say, a library. You’re super excited, but on your first day of work, you trip over a bunch of books and break your arm. What are you supposed to do now? Besides getting a cast, you need to get your workers’ compensation insurance; our guide on how to act if an accident happens is here to tell you how.

If your first question is “What is workers’ comp?” we have to say the answer is far from simple. First, we’ll need to introduce some statistics, break down all those complex legal terms, and walk you through the application steps for workers’ compensation.

Work accidents happen even in the safest circumstances. Statistics tell us that the most common ones are: slips, trips, or falls on level ground (29%), handling, lifting, or carrying (20%), being struck by moving objects (10%), acts of violence (8%), falls from a height (8%). If any of these things happen to you, you’ll want to ask: “How does workers’ comp work?” 

Known as workman's comp until the name was changed to make it gender-neutral, workers’ comp is a system that protects both employees and employers. While workers can get medical and disability benefits if they get workplace injuries, employers get protection from occasionally fraudulent lawsuits.

The Claim Process

We’ll start with the assumption that your employer is supportive and aware that only happy workers are good workers. As such, they would have introduced you to the claim process in case of an accident. But you may still be wondering: “What is a workers’ comp claim?” In that case, you’ll need to go through our step-by-step guide:

  • First of all, you need to act in a timely manner. In most cases, that means reporting an injury or illness to your employer within 4 to 90 days of occurrence. Deadlines differ from state to state, but the general rule is: The sooner, the better.
  • File a written complaint with the state workers’ comp agency. Again, there’s a deadline, usually between one and three years. In case of an occupational disease or cumulative injury, the time starts from the date you first experienced disability, even if you hadn’t known your working conditions caused it.
  • “What is the cost of workers’ comp insurance?” you might ask. Fortunately, this shouldn’t be your concern. Just make sure your doctor is familiar with the fact you’re covered by workman’s comp insurance so that he can bill your employer or their insurance carrier.
  • Consult an attorney for help with legal terms and protecting your needs if your claim is denied.

A Disputed Claim

There’s always the possibility of having your claim disputed since both employers and insurance companies do everything in their power to deny workers’ comp claims and limit compensation. If there’s a dispute, you might be asked to undergo an IME with a supposedly neutral doctor. “What is an IME for workers’ comp,” you ask? It stands for “Independent Medical Examination,” and it’s a procedure often requested by insurance companies to validate your doctor’s decisions.

Judges often ascribe significant weight to IME reports, so the results might affect your case. Be well-prepared for the examination: You’ll be asked questions about how your injury happened and undergo some physical exams and tests. You can challenge the report legally if it’s limiting or cutting off your benefits, but make sure to contact a workers’ comp attorney for that.

A Denied Claim

Of course, what can be disputed can be denied as well, so asking yourself, “What do I do if my workers’ comp claim is denied?” is only natural. One option is to give up on the claim or even start job hunting. We wouldn’t recommend this, however, because there are still options for you to make good on your rights. Firstly, you have the right to contest the decision via an appeal. If the negotiations don’t work out, and you can’t reach a settlement, the next step is a summons to a formal hearing.

The hearing would be your final chance to fight for your rights and present your case. “What is a workers’ comp hearing like?” is the next question, right? The legal proceedings are pretty standard - you are trying to negotiate a settlement with the insurance company, but in court. That’s why you need to hire a lawyer and gather all the necessary evidence, such as medical records, doctor’s reports, and bills, to present to the judge. After testifying, the court will reach the verdict on whether you get workers’ comp insurance within 30 to 90 days.

You Got Your Workers’ Comp and Recuperated: Now What?

Even after your claim is settled and you’re all better, there are some legal things to get done. Once your condition is stable enough to get back to work, you’ve reached the MMI. What is the MMI in workers comp cases? It stands for “Maximum Medical Improvement” and means that you’ve reached the point where your health conditions are no longer expected to improve. From then on, the insurer is only obligated to pay for secondary medical services, and that for a limited time.

The Bottom Line

We would like to encourage you to ask your employer everything about workers' compensation terms and conditions during your onboarding process. Now that you know the answer to the question “What is workerscomp?” you’ll know what to look out for. The main thing to remember is that you have rights and you’re entitled to exercise them - just make sure you have the proper legal support, too.

Frequently Asked Questions
What Is Workers' Compensation?

This is a type of business insurance aimed at those who became ill or injured while working. The insurance money serves to compensate for medical care and wages from lost work time.

Who Pays for Workers' Compensation Benefits?

Your employer will be in charge of paying them. However, the insurance company, your state government, or a third-party administrator hired by your employer might actually cover the costs.

How Do I File a Workers' Compensation Claim?

First of all, make sure to read up all on the topic: What is workers’ comp? Then, report your injury or illness promptly, file a written complaint with the state workers’ comp agency, inform your doctor, and consult a lawyer, if need be.

Do I Have to Have Workers' Compensation Insurance?

Workers in most states are obliged to have workers’ compensation insurance, except for Texas. Unfortunately, business owners, volunteers, federal employees, independent contractors, dock workers, and railroad workers are not eligible for workers’ comp in its traditional form.

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