How Does Workers Compensation Work?

Workers compensation is a type of insurance program which insures employees for injuries and illnesses that occur due to their job. It’s mandated by the state, with each state establishing different rules for when an employer must have this insurance. Employees benefit by getting access to medical care after sustaining a work-related injury or illness as well as receiving a portion of their wages while they can’t work due to that specific condition. The rate of compensation should an employee become permanently disabled or dies as a result varies depending on the state’s regulations.

The program began over a century ago, with the federal program the first to establish it, covering its civilian employees after an act was passed in 1908 to help workers who engaged in hazardous work. Less than a decade later, all federal employees were covered, and states soon followed. By 1921, nearly all states had workers compensation laws, and today, each one of the 50 states as well as the District of Columbia, U.S. Virgin Islands and Puerto Rico, have their own programs.

Some of the latest statistics, as reported by the Social Security Administration, show that state and federal workers compensation covered more than 135 million employees in 2015, and total wages paid to covered workers that year was over $7 trillion.

What Workers Compensation Can Cover, and What It Can’t

 

Generally, workers compensation coverage starts the very first minute you’re on the job, through any time you’re officially on the job performing a service for your employer.  A work-related injury may not have to be the result of a single incident, for example, an illness that results from continued exposure to a chemical or chemicals in the workplace, or a repetitive stress injury like carpal tunnel syndrome.

Workers comp doesn’t cover injuries that occur during a normal work commute or during unpaid breaks and mealtimes, or accidents that happen while taking part in recreational activities. If an injury results from the fault of your own, such as starting a physical fight, while being intoxicated or using illicit substances, it’s generally not covered.

How the Claims Process Works

 

There are several obligations that both employees and employers are required to meet for workers compensation to cover a work-related injury or illness. The employer must have workers compensation insurance, or it can be fined or face a lawsuit. The employee who becomes ill or injured must report the incident to their employer right away, and typically must fill out a specific form. If this is not done within the period of time specified by their state, they may lose their right to any benefits. Employers may be required to provide their employees with their specific rights and responsibilities, but if there is any confusion, the state agency responsible for administering the program can help.

What Happens When Problems Occur

 

Workers compensation claims don’t always go smoothly. If the employer did not have the required workers compensation insurance, or if it’s questionable as to whether the injury or illness is related to something that occurred on the job, affected employees may need to take further measures, such as hiring a Pittsburgh injury lawyer, or an injury attorney in the particular city in which they work or live.

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