Workers’ Compensation Benefits: Claims for Work Related Injuries

By / October 26, 2016 / Workers Compensation / No Comments

Find out how Workers Compensation Benefits can replace your lost wages and healthcare benefits if you’ve suffered a work-related accident or illness.

Have you been injured and/or disabled on the job, in the workplace or while traveling on company business as part of your job? Did your employer’s working conditions cause or aggravate an illness? Are you a dependent of someone who recently died because of a work-related accident or illness?

If so, you may be eligible for Workers’ Compensation benefits — a lump sum or paid over time — eliminating the need for you to take legal action against your employer. Benefits will cover your medical expenses, prescriptions, physical therapy and more. It will also provide payment of a percentage of your lost wages. However, if your claim is contested or denied, legal services will be helpful to attain benefits, or if a third party was involved, legal assistance in suing them for damages.

Individuals working for private companies, or for state or local government agencies, can ask the Workers’ Compensation agency in their state for details regarding eligibility, assistance and filing procedures.

An Overview of Workers’ Compensation Benefits
Workers’ Compensation is an insurance program that provides employers a means to bypass time-consuming, expensive lawsuits and speed payments to workers who are injured or develop work-related illnesses on the job.

Workers’ Compensation benefits ill and injured employees two ways: It provides coverage of medical expenses required to treat, heal or cure the work-related issue, and it pays a percentage of lost wages while the employee is not able to work.

Coverage details vary from state to state. In some states, companies with less than five employees are not required to have coverage. Many states exclude volunteers, farm workers and/or domestic workers from coverage.

Workers’ Compensation is not a program for the self-employed, independent contractors working for one or more customers/clients, those who own or are part-owners of a business, or so-called casual employees (e.g., those hired to remove snow or mow the lawn).

Even if the company you work for classifies you as an independent contractor, and therefore not eligible for Workers’ Compensation (and other) benefits, you may actually be considered an employee under the law. If you’re unsure about this, it might be wise consult with an attorney, and to file a claim anyway. Then it will be up to your employer to prove that you are legally an independent contractor, rather than an employee.

How Workers’ Compensation Differs From Social Security Disability Benefits
Under Workers’ Compensation, your disability must be work-related in order to receive benefits, which include coverage of your medical costs, prescriptions, rehabilitative therapy and other services that will help you get back to work as soon as possible. It also provides for you to receive a percentage of your wages while you are recuperating. If you are not expected to recuperate from your illness, Workers’ Compensation continues to pay for your medical care and a percentage of your lost wages. The insurance premiums are paid by your employer.

Under Social Security Disability Insurance (SSDI), your ailment or injury must be disabling to a point where you will not be able to work for at least 12 months, or if your condition is expected to result in death. If you qualify, SSDI provides a limited amount of income during that time. You may get medical assistance from Medicare if you qualify.

If you have paid premiums for Social Security coverage, usually through payroll deductions, and have enough credits (based on your income and amount of time worked), you may be eligible for Social Security Disability Insurance (SSDI) benefits — if you cannot work for at least 12 months due to an injury or illness. Temporary disability is not covered by SSDI.

It is possible for you to qualify for both SSDI and Workers’ Compensation at the same time, assuming your claims are valid and you meet the criteria. However, the total benefits you receive from both programs cannot be more than 80% of your average earnings prior to becoming injured or ill. If you receive Workers’ Compensation benefits, your SSDI benefits may be reduced accordingly.

Some states allow disabled workers to collect Workers’ Compensation benefits and unemployment benefits (if eligible) at the same time. To find out if this applies to you, file claims for both and they will let you know.

If you are also covered by a private disability insurance program—with you and/or your employer paying the premiums—you might also receive benefits from the private program even if you are receiving Workers’ Compensation benefits… unless the private program specifically excludes such benefits. Read the fine print of your policy or ask your employer for details.

A Brief History of Workers’ Compensation Benefits
During the second half of the 19th Century, as the United States became an industrial nation, an ever-increasing number of men, women and even young children were employed in factories, processing plants and other mass-production facilities (many with unsafe machinery, procedures, ventilation, etc.). As their numbers grew, so did the number of work-related injuries, illnesses and deaths…and the number of lawsuits seeking damages.

To reduce the need for litigation, while easing the requirement that injured workers had to prove that their injuries were the fault of their employers’ working conditions, Workers’ Compensation laws were enacted—first in Maryland in 1902, followed by Wisconsin in 1911, and then by the other states.

In general, Workers’ Compensation laws are a compromise. They guarantee medical care to injured workers, along with a measure of payment for lost wages, on a no-fault basis, without employees having to file lawsuits.

At the same time, they help employers avoid frequent lawsuits that could be disruptive and extremely costly, and place limits as to how much money or reimbursement their injured workers can receive.

In most states, employers obtain Workers’ Compensation coverage through private insurance companies, while in a few states this coverage is provided by a state government agency. The premiums that employers pay are based, in part, by their industry’s classification, with those in hazardous industries paying more than those in safer industries.

Only in Texas, employers are not required to have Workers’ Compensation insurance or self-insurance, but they can purchase coverage from private insurance companies.

Although the Workers’ Compensation program has proven to be very effective, there are challenges. There are the ever-increasing premiums for employers, and (at times) slow claims processing for employees. There is always the need to involve doctors to verify the claims, and attorneys hired to prove or disprove claims, to help injured workers obtain the benefits they’re entitled to, in the shortest possible time frame.

How Federal and Certain Other Employees Are Protected
Federal employees and certain other groups are not protected by individual states, but by these Workers’ Compensation programs of the U.S. government:

Federal Employees’ Compensation Act (FECA)
This act provides coverage to some 3 million federal and postal workers throughout the world, for job-related injuries and occupational diseases.

It also covers other employees of the United States (except those paid from non-appropriated funds), including the Peace Corps and VISTA volunteers; federal petit jurors and grand jurors; volunteer members of the Civil Air Patrol; Reserve Officer Training Corps cadets; Job Corps, Neighborhood Youth Corps, and Youth Conservation Corps enrollees; and non-federal law enforcement officers under certain circumstances involving crimes against the United States.

Benefits include wage replacement, payments for medical care, and (where necessary) medical and vocational rehabilitation assistance in returning to work.

For simple occupational illness cases, a decision may take up to 90 days, or as long as six months if it’s a complex case. For traumatic injuries, allow up to 45 days, or more if it’s complex.

Claims for loss of wages are usually handled within two or three weeks.

Energy Employees Occupational Illness Compensation Program
This program provides benefits to employees of the Department of Energy (DOE), its contractors or subcontractors, and atomic weapons employees who have radiation-induced cancer due to their worksite (under certain conditions).

Longshore and Harbor Workers’ Compensation Act (LHWCA)
This act provides medical benefits, compensation for lost wages, and rehabilitation services for longshoremen, harbor workers, and other maritime workers who are injured during the course of employment or who suffer from diseases caused or worsened by employment conditions.

Also covered are workers engaged in the extraction of natural resources of the outer continental shelf, employees on American defense bases, and workers under contract with the U.S. government for defense or public works projects outside of the continental United States.

Black Lung Benefits Act (BLB)
In cooperation with the relevant states, this act provides benefits to coal miners who are totally disabled due to pneumoconiosis, and to the surviving dependents of miners whose death was due to this disease.

Types of  Workers’ Compensation Benefits Claims:
Injury — When you think of a job-related injury, you probably picture a worker falling off a ladder, or being injured by some factory machine, or some other incident involving physical violence. These types of injuries—and far worse ones— take place all the time throughout the country, in workplaces of all types and sizes.

Work-related injuries may also be caused by repeated physical motions (e.g., lifting or carrying heavy cartons, tools or children), exposure to airborne chemicals or other fumes, psychological stress (e.g., constant harassment; coping with assembly line speeds), or other physical or mental hazards.

Generally speaking, Workers’ Compensation covers damages that occur in the course of employment at a worksite or while making service calls.

Since it’s a no-fault system, you may be covered even if the injury was due to your own carelessness, as long as your behavior was otherwise acceptable.

Occupational Illness — Any illness or disease can be classified as an occupational illness when job conditions increase the chances of suffering from that illness or disease. In some states, certain illnesses (e.g., heart attacks; hernias) are presumed to be covered for high-stress occupations (e.g., police officer; firefighter) if there is a direct connection between the work and the illness,

However, claims investigators from the insurance carriers may check to see if there are any non-work factors (e.g., drinking; smoking; poor diet; lack of exercise) that are present to negatively affect a particular condition, in an effort to weaken your claim that the illness was strictly work-related, and deny payments.

In recent years, the courts have increasingly recognized emotional illnesses, stress-related digestive problems, and other such illnesses as the gradual result of unhealthy work conditions and often consider them valid claims.

Prompt Medical Care, along with additional care if required, for a work-related injury or illness is usually covered by Workers’ Compensation. The question is: Who provides that care?

In most states, you are allowed to go to the doctor of your choosing, so long as they are authorized by the Workers’ Compensation Board. To protect your right to choose a doctor, some experts suggest that you send a letter to your employer (and keep a copy of it) informing them that if you are ever injured on the job, you would prefer to be treated by your regular doctor (unless emergency treatment is needed immediately). Otherwise, they say, your employer or their insurance company may have you examined by a doctor of their choice, who might provide a conservative diagnosis of your injury, thereby jeopardizing your Workers’ Compensation claim.

Therefore, if you are treated by a doctor chosen by your employer or their insurance company, get a second opinion from your own doctor, even if you have to cover the cost yourself. Even if you go to an approved doctor of your own choosing, the insurance company may ask you to go for an Independent Medical Examination. You are trying to get the best possible care, but you also need to document your condition to prove your injury occurred while working or you illness was caused by your work conditions. Even if you are not terribly hurting immediately after an accident, or at the time of your diagnosis, your condition may worsen over time.

If your claim is approved, the insurance company would be responsible for all related medical expenses.

Death — Almost always, when employees are killed on the job due to a work injury or illness, their spouse, children or other dependents are eligible to receive Workers’ Compensation benefits. Rarely do the courts consider the possibility of murder or suicide, unless there is evidence suggesting it as the cause.

 

Workers Compensation Benefits by State
Use the list below to contact the agency in your state for more information on filing or appealing a Workers’ Compensation claim:

Alabama
Workers’ Compensation Division
Department of Industrial Relations
Industrial Relations Building
649 Monroe Street
Montgomery, AL 36131
Telephone: 334-242-2868 or 800-528-5166
Website: https://labor.alabama.gov/wc/workers-compensation.aspx

Alaska
Department of Labor Division of Workers’ Compensation
P.O. Box 115512
Juneau, AK 99811
Telephone: 907-465-2790
Website: http://labor.state.ak.us/wc/home.htm

Arizona
State Compensation Fund
3030 N. 3rd Street
Phoenix, AZ 85012
Telephone: 602-631-2300 or 800-231-1363
Website: https://www.azica.gov/divisions/claims-division

Arkansas
Workers’ Compensation Commission
324 Spring Street
P.O. Box 950
Little Rock, AR 72203
Telephone: 501-682-3930 or 800-622-4472
Website: http://www.awcc.state.ar.us

California
Department of Industrial Relations
Division of Workers’ Compensation
1515 Clay Street, 17th Floor
Oakland, CA 94612
Telephone: 510-286-7100 or 800-736-7401
Website: http://www.dir.ca.gov/dwc/dwc_home_page.htm

Colorado
Department of Labor and Employment
Division of Workers’ Compensation
633 17th Street, Suite 400
Denver, CO 80202
Telephone: 303-318-8700 or 888-390-7936
Website: http://www.coworkforce.com/dwc

Connecticut
Workers’ Compensation Commission
21 Oak Street
Hartford, CT 06106
Telephone: 860-493-1500
Website: http://wcc.state.ct.us/index.html

Delaware
Office of Workers’ Compensation
4425 N. Market Street
3rd Floor
Wilmington, DE 19802
Telephone: 302-761-8200
Website: http://dia.delawareworks.com/workers-comp

District of Columbia
Office of Workers’ Compensation
64 New York Avenue, NE
2nd Floor
Washington, DC 20002
Telephone: 202-671-1000
Website: http://does.dc.gov/page/workers-compensation-does

Florida
Division of Workers’ Compensation
200 E. Gaines Street
Tallahassee, FL 32399
Telephone: 850-413-1600 or 800-742-2214
Website: http://www.myfloridacfo.com/division/wc

Georgia
State Board of Workers’ Compensation
270 Peachtree Street, NW
Atlanta, GA 30303
Telephone: 404-656-3875
Website: http://www.sbwc.georgia.gov

Hawaii
Department of Labor & Industrial Relations
Disability Compensation Division
830 Punchbowl Street, Room 209
P.O. Box 3769
Honolulu, HI 96813
Telephone: 808-586-9161
Website: http://labor.hawaii.gov/dcd

Idaho
Industrial Commission
317 Main Street
P.O. Box 83720
Boise, ID 83720
Telephone: 208-334-6000
Website: http://www.iic.idaho.gov

Illinois
Workers’ Compensation Commission
100 W. Randolph Street
Suite 8-200
Chicago, IL 60601
Telephone: 312-814-6611 or 866-352-3033
Website: http://www.state.il.us/agency/iic

Indiana
Workers’ Compensation Board
402 W. Washington Street, Room W-196
Indianapolis, IN 46204
Telephone: 317-232-3809 or 800-824-2667
Website: http://www.in.gov/wcb

Iowa
Division of Workers’ Compensation
1000 E. Grand Avenue
Des Moines, IA 50319
Telephone: 515-281-5387 or 800-562-4692
Website: http://www.iowaworkforce.org/wc

Kansas
Division of Workers’ Compensation
800 SW Jackson Street
Topeka, KS 66612
Telephone: 785-296-2996 or 800-332-0353
Website: http://dia.delawareworks.com/workers-comp

Kentucky
Office of Workers’ Claims
657 Chamberlin Avenue
Frankfort, KY 40601
Telephone: 502-564-5550, ext. 4423
Website: http://www.labor.ky.gov/workersclaims

Louisiana
Office of Workers’ Compensation Administration
1001 N. 23rd Street
P.O. Box 94040
Baton Rouge, LA 70804
Telephone: 225-342-7555
Website: http://www.laworks.net/workerscomp/owc_mainmenu.asp

Maine
Workers’ Compensation Board
27 State House Station
Augusta, ME 04333
Telephone: 207-287-3751 or 888-801-9087
Website: http://www.maine.gov/wcb

Maryland
Workers’ Compensation Insurance
8722 Loch Raven Boulevard
Towson, MD 21286
Telephone: 410-494-2000 or 800-264-4943
Website: http://www.wcc.state.md.us

Massachusetts
Workers’ Compensation Advisory Council
600 Washington Street
Boston, MA 02111
Telephone: 617-727-4900, ext. 378
Website: http://www.mass.gov/lwd/workers-compensation/injured-workers

Michigan
Workers’ Compensation Agency
7150 Harris Drive
1st Floor, B Wing
Dimondale, MI 48821
Telephone: 517-322-1106 or 888-396-5041
Website: http://www.michigan.gov/wca

Minnesota
Department of Labor & Industry
Workers’ Compensation Division
443 Lafayette Road N
St. Paul, MN 55155
Telephone: 651-284-5005 or 800-342-5354
Website: http://www.dli.mn.gov/workcomp.asp

Mississippi
Workers’ Compensation Commission
1428 Lakeland Drive
Jackson, MS 39216
Telephone: 601-987-4247 or 866-473-6922
Website: http://www.mwcc.state.ms.us

Missouri
Division of Workers’ Compensation
3315 W. Truman Boulevard
Room 131
P.O. Box 58
Jefferson City, MO 65102
Telephone: 573-751-4231 or 800-775-2667
Website: http://labor.mo.gov/dwc/injured_workers

Montana
Workers’ Compensation Court
1625 11th Avenue
Helena, MT 59624
Telephone: 406-444-7794
Website: http://wcc.dli.mt.gov/whoweare.asp

Nebraska
Workers’ Compensation Court
Capitol Building
P.O. Box 98908
Lincoln, NE 68509
Telephone: 402-471-6468 or 800-599-5155
Website: http://www.wcc.ne.gov

Nevada
Division of Industrial Relations
400 W. King Street
Suite 400
Carson City, NV 89703
Telephone: 775-684-7260
Website: http://dir.nv.gov/WCS/Home

New Hampshire
Workers’ Compensation Division
95 Pleasant Street
Concord, NH 03301
Telephone: 603-271-3176 or 800-272-4353
Website: https://www.nh.gov/labor/workers-comp/workplace-injuries.htm

New Jersey
Division of Workers’ Compensation
P.O. Box 381
Trenton, NJ 08625
Telephone: 609-292-2414
Website: http://lwd.dol.state.nj.us/labor/wc/wc_index.html

New Mexico
Workers’ Compensation Administration
2410 Centre Avenue, SE
P.O. Box 27198
Albuquerque, NM 87125
Telephone: 505-841-6000 or 800-255-7965
Website: http://www.workerscomp.state.nm.us

New York
Workers’ Compensation Board
20 Park Street
Albany, NY 12207
Telephone: 866-750-5157 or 877-632-4996
Website: http://www.wcb.ny.gov/content/main/Workers/Workers.jsp

North Carolina
Industrial Commission
4340 Mail Service Center
Raleigh, NC 27699
Telephone: 919-807-2501
Website: http://www.ic.nc.gov/claimants.html

North Dakota
Workforce Safety & Insurance
1600 E. Century Avenue
Suite 1
Bismarck, ND 58503
Telephone: 701-328-3800 or 800-777-5033
Website: http://www.workforcesafety.com/workers

Ohio
Bureau of Workers’ Compensation
30 W. Spring Street
Columbus, OH 43215
Telephone: 800-644-6292
Website: https://www.bwc.ohio.gov/worker/default.asp

Oklahoma
Workers’ Compensation Court
1915 N. Stiles Avenue
Oklahoma City, OK 73105
Telephone: 405-522-8600 or 800-522-8210
Website: http://www.owcc.state.ok.us

Oregon
Workers’ Compensation Division
350 Winter Street, NE
P.O. Box 14480
Salem, OR 97309
Telephone: 503-947-7810 or 800-452-0288
Website: http://wcd.oregon.gov/Pages/index.aspx

Pennsylvania
Bureau of Workers’ Compensation
Department of Labor & Industry
1171 S. Cameron Street
Room 324
Harrisburg, PA 17104
Telephone: 717-772-4447 or 800-482-2383
Website: http://www.dli.pa.gov/Individuals/Workers-Compensation/Pages/default.aspx

Rhode Island
Division of Workers’ Compensation
1511 Pontiac Avenue
Building 71-1, 1st Floor
P.O. Box 20190
Cranston, RI 02920
Telephone: 401-462-8100
Website: http://www.dlt.ri.gov/wc

South Carolina
Workers’ Compensation Commission
1333 Main Street, Suite 500
P.O. Box 1715
Columbia, SC 29201
Telephone: 803-737-5700
Website: http://www.wcc.sc.gov/Pages/default.aspx

South Dakota
Division of Labor and Management
Department of Labor
Kneip Building
700 Governors Drive
Pierre, SD 57501
Telephone: 605-773-3681 or 800-332-2667
Website: http://dlr.sd.gov/workerscomp

Tennessee
Workers’ Compensation Division
220 French Landing Drive
Nashville, TN 37243
Telephone: 615-532-4812 or 800-332-2667
FAX: 615-532-1468
Website: http://www.tn.gov/workforce/section/injuries-at-work

Texas
Division of Workers’ Compensation
7551 Metro Center Drive
Suite 100
Austin, TX 78744
Telephone: 512-804-4000
Website: http://www.tdi.texas.gov/wc/employee/index.html

Utah
Industrial Accidents Division
160 E. 300 S, 3rd Floor
Salt Lake City, UT 84114
Telephone: 801-530-6800 or 800-530-5090
FAX: 801-530-6390
Website: http://laborcommission.utah.gov/divisions/IndustrialAccidents/WCClaimsProcess.html

Vermont
Workers’ Compensation Division
Department of Labor
5 Green Mountain Drive
P.O. Box 488
Montpelier, VT 05601
Telephone: 802-828-2286
Website: http://labor.vermont.gov/workers-compensation

Virginia
Workers’ Compensation Commission
1000 DMV Drive
Richmond, VA 23220
Telephone: 877-664-2566
Website: http://www.vwc.state.va.us

Washington
Department of Labor and Industries
P.O. Box 44000
Olympia, WA 98504
Telephone: 360-902-5800
Website: http://www.lni.wa.gov/claimsIns/claims/default.asp

West Virginia
Workers’ Compensation
P.O. Box 50540
Charleston, WV 25305
Telephone: 304-558-3386 or 888-879-9842
Website: http://www.wvinsurance.gov/WorkersCompensation/Forms(WC).aspx

Wisconsin
Workers’ Compensation Division
201 E. Washington Avenue
Room C100
Madison, WI 53703
Telephone: 608-266-1340
Website: https://dwd.wisconsin.gov/wc

Wyoming
Workers’ Safety & Compensation Division
1510 E. Pershing Boulevard
Cheyenne, WY 82002
Telephone: 307-777-7441
Website: http://www.wyomingworkforce.org/businesses/workerscomp

Workers’ Compensation Benefits: Claims for Work Related Injuries
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