Every state, except Texas, requires most employers to carry workers’ compensation insurance to protect their workers.
If employees in Pennsylvania and most other states are injured on the job, the workplace insurance covers expenses like medical costs. Even though most job-related illnesses and injuries are covered by insurance, maximizing your workers’ compensation benefits is often a priority. After all, you don’t want to be stuck with injury or illness-related expenses.
So, how can you get the most out of your workers’ compensation benefits? The most effective way is to avoid making mistakes during the claim process. Here’s what all employees should know about filing a workers’ compensation claim.
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Workers’ Compensation Insurance Benefits
Before diving into workers’ compensation benefits, it helps to know a little about the insurance program. Workers’ compensation is required by every state except Texas. This doesn’t mean companies in Texas aren’t carrying workers’ comp coverage, only it’s not a requirement to operate a business in the state.
Okay, with that being said. The benefits are typically supported by private insurance companies. Your employer pays the premium to the private insurers who provide coverage for employees if they’re injured on the job. Workers/ comp benefits also cover illnesses and diseases contracted through work.
Workers’ compensation benefits are in place to support employees’ recovery after an accident or disease diagnosis. These benefits typically include:
- Medical costs which can include diagnosis and treatment
- Rehabilitation costs
- Long-term and lifetime care for injuries resulting in a temporary or permanent disability. If the illness/disease requires extended treatment, workers’ compensation typically covers all prescribed medical care.
- Reimbursement for partial lost wages. If your illness or injury is preventing you from returning to work, the insurance can cover some of your lost income. If the injury results in a disability preventing you from earning an income, you may qualify for permanent disability support. Something to note is that workers’ compensation payments are usually not taxable. Even though it’s reimbursing you for lost wages, income taxes rarely apply.
Unfortunately, fatalities can occur whether from disease or injury. Workers’ compensation benefits can also cover funeral and burial expenses. The insurance also covers the deceased’s medical expenses. Eligible family members of the deceased may also be able to claim lost income.
If you’re wondering who’s eligible to receive wrongful death benefits through workers’ comp, it’s typically limited to surviving spouses, children, or parents. Only one person can claim wrongful death benefits for the same individual through workers’ compensation.
Filing a Workers’ Compensation Claim
Before you file a workers’ compensation insurance claim, there’s something to consider. If you file a claim and it’s approved, you’re giving up your legal right to sue your employer for damages.
Once you accept a settlement from workers’ compensation, your case is considered closed, meaning that you can’t file a personal injury lawsuit against your employer in civil court.
If you’re ready to go ahead with a workers’ comp claim, you need to follow a few basic steps. This helps ensure you’re meeting all of the requirements and minimizing your chances of your claim being denied.
Determine Your Employer’s Coverage
Business owners can typically carry either workers’ compensation insurance plans A, B, or both. The type of coverage your employer carries can help maximize your benefits.
Coverage A is required by most states, and this type of insurance plan covers medical costs, and lost wages, and provides wrongful death benefits. The primary difference between plans A and B is coverage amounts. Plan B can pick up where coverage A leaves off. However, if your employer isn’t carrying Plan B, you can’t apply for these benefits.
Plan B has another catch. You can usually only take advantage of these benefits if you file a lawsuit alleging negligence by your employer. Even though we mentioned accepting a workers’ comp settlement negates your right to file a lawsuit, some states are reinstating employees’ right-to-sue laws.
If this applies in your state, if your employer’s negligence is the cause of your injury or illness, you may be able to file a lawsuit regardless of the type of workers’ compensation insurance. This is also true if you accept the workers’ comp settlement offer.
Document the Accident
If your injuries require immediate medical attention, don’t worry about documenting the accident scene. Your health takes priority. However, if possible, take pictures of the accident scene. For example, if you slip and fall on an unmarked wet floor, get pictures of the spill and lack a caution sign.
Don’t forget to take pictures of any visible injuries. You also want to jot down your actions leading up to the accident. This information is required in your workers’ compensation form and it’s best to write everything down while it’s fresh in your mind.
Note if there are any witnesses or security cameras in the area of your accident. Witness statements can help support your claim, along with any video footage.
Notify Your Employer
Chances are, if an ambulance shows up at work, your employer will know. However, you still need to notify your employer about the accident or your disease diagnosis. Yes, you alert your employer instead of contacting the insurance company. Your employer will file the claim, but you still have paperwork to file out.
Prove Your Claim
The insurance adjuster will want details on how the injury occurred. If your claim involves an illness, you’ll need to show its cause is directly related to your job. Witness statements and security camera footage can help back up an accident claim.
Medical records provide proof of injury and illness. A good rule to follow throughout the workers’ compensation claim process is to save everything relating to your case. You never know what the insurance adjuster may request.
Maximizing Workers’ Compensation Benefits
Most workers’ compensation claims move through the process without any major hiccups. However, sometimes insurance adjusters balk at paying out benefits.
If you’re trying to maximize your workers’ comp claim, talk to an experienced attorney. They can help you through the claims process, even if it involves filing a lawsuit against your employer.
