How Does Workers’ Comp Work?

If you are injured at work or develop a work-related illness, you may have the right to workers’ compensation benefits. Workers’ comp is a government-mandated program that covers your medical expenses and a portion of your lost wages when you cannot work because of an on-the-job accident or illness.

The majority of employers must carry workers’ compensation insurance. Filing for benefits is not always simple, however. An insurance company might delay or deny your claim unfairly, which makes it hard to access the assistance you need and deserve.

For help with filing a workers’ comp claim or appealing a denial, you can consult an attorney. At Pond Lehocky Giordano, our team of workers’ compensation attorneys has been helping injured people throughout the United States for more than a decade. Schedule a consultation to learn how workers’ compensation works and why you may need a lawyer to help you.

Who Is Covered by Workers’ Comp?

From the first day of employment, most employees are covered by workers’ compensation insurance. This includes part-time, full-time, and seasonal workers. Regardless of your previous medical history, this insurance should cover all of your medical expenses and some of your wages after a work-related illness or injury.

A workers’ compensation claim hinges on a valid employment relationship. This means that most private contractors are not eligible for benefits.

How Do You Know if Your Injury Is Covered by Workers’ Comp?

The injury must occur within the scope of your employment. Thus, injuries that happen while you are carrying out job duties or tasks are eligible. This applies even to incidental accidents.

For example, if you trip and fall while walking from your boss’s office to your desk, you would be eligible for benefits. Repetitive work injuries are also covered. If you develop carpal tunnel syndrome due to your data-entry job or have knee issues from frequently bending over at your warehouse job, for example, you can apply for workers’ compensation.

What if You’re on a Break When You Get Hurt?

If your injuries occur while you are taking a break, these injuries usually qualify for benefits because the worker is still available to the employer. If you stepped out to go to lunch, however, you would not be covered — unless the lunch is work-related.

You may also be eligible to receive workers’ compensation even if you were clocked out but were on-site when the injury occurred, although these cases are more complicated. If you get hurt in your employer’s parking lot while walking to your car, for example, your injury could be covered by workers’ comp.

In most cases, commutes are not covered. However, workers’ comp may apply if a car accident happens while you are driving a company car, driving between work sites, or running a work-related errand.

Can You Still Work While on Workers’ Comp?

Although it is possible to continue working while on workers’ comp, you have to follow certain regulations so that you do not forfeit your benefits. For starters, you must accurately declare your income to the insurance company.

It is also important not to take on a second job. Your workers’ comp benefits cover you because you are not able to perform your usual duties. If you can take on a second job, the insurer might see this as a sign that you are well enough to keep working.

For How Long Does Workers’ Comp Pay Out?

The duration of your workers’ comp benefits will depend on the length and severity of your injury. For instance, injuries or illnesses that are temporary but prevent you from working can get up to 66% of your wages for up to 90 days.

If you are considered to be more than 50% disabled, you can continue receiving full disability benefits. If the evaluation shows that you are less than 50% disabled, you can receive partial disability benefits. Typically, this means that you will receive 500 more weeks of lost wages before the benefits end.

How Do You File a Workers’ Comp Claim?

Immediately after suffering an injury or becoming aware that you have developed a work-related illness, you need to let your employer know. You must do this within 120 days to be eligible for compensation. It is always a good idea to communicate this information in writing.

Get medical care from someone on your employer’s approved providers list as soon as possible. Your employer will file a First Report of Injury, which lets the insurer know that it needs to look into a claim. The insurer has 21 days to assess the claim and make a decision.

Can I Appeal if I Get a Decision I Do Not Like?

Yes, you can appeal the insurance company’s decision. The appeals process is complex, and you will likely need to provide substantial evidence.

Since you are likely focused on recovering from your work-related injury, the last thing you need is to try to handle legal processes alone. Workers’ compensation attorneys can help.

At Pond Lehocky Giordano, our team understands the claims and appeals process, and we know what evidence can make the most difference. We will work tirelessly toward a fair workers’ comp settlement.

Contact Us Today for a Free Case Evaluation

If you have suffered a work-related injury or illness, you may have the right to receive workers’ compensation benefits. At Pond Lehocky Giordano, we can guide you from the start of the claims process and handle any appeals. Our team fights for injured workers in all 50 states.

You can also turn to us for help applying for Social Security disability insurance or employee-provided short-term disability benefits. We understand how workers’ comp can influence these benefits and advise you on the right strategies. Call our team to schedule a free consultation.