Who Pays for Workers’ Compensation?
Workers’ compensation is a government-mandated insurance program meant to provide benefits to workers who are injured or become ill as a direct result of their work duties. Eligible workers can receive benefits to make up for lost wages, pay healthcare costs, or both. But who pays for workers’ comp benefits?
Workers’ comp benefits are paid by employers. Most businesses are required by law to provide workers with this type of insurance. Benefits can vary considerably from one state to another.
Keep reading to learn more about who is responsible for paying for workers’ comp insurance, how it works, and what to do when benefits are denied.
Understanding Workers’ Compensation
If you have suffered an accident at work, you could be entitled to workers’ compensation benefits that can include money for lost wages for the amount of time you are unable to work due to your injuries. Benefits may also cover healthcare, therapy, and medical equipment such as crutches or a wheelchair.
The cost of workers’ compensation insurance is covered by employers. Although it is important to note that not all workers are covered by this program. To qualify for workers’ comp benefits workers must meet the following requirements:
- The worker must be an employee and not a contractor.
- The business must have workers’ compensation insurance.
- The injury must have happened at work.
- The employee must report the injury or illness in a timely manner.
- The injured worker must adhere to a treatment plan.
There are two types of workers’ compensation coverage: Coverage A and Coverage B.
Coverage A covers lost wages as well as medical attention, rehabilitation, and death benefits for family members when the injury in question is fatal. Except for Texas, all states mandate these benefits for injured workers, although they can vary from state to state. Coverage B grants benefits that go over the minimums covered under Coverage A.
Although a workers’ compensation claim is usually granted to employees who met these criteria, things can go wrong. When a valid claim is turned down, the best thing to do is to contact a qualified attorney for help.
When are Workers not Covered by Workers’ Compensation?
Workers’ compensation insurance protects workers by providing benefits when they are injured while performing their job. However, some situations arise where workers are injured at work but are not covered by workers’ comp.
Some reasons for workers’ comp benefits being denied include where the accident occurred, horseplay, and intoxication.
Injuries while Coming or Going to Work
The most important factor when a workers’ comp claim is considered is where the employee was injured. If an accident occurs during working hours and specifically at work the claim should be granted. But does this cover going and coming from work?
According to the “coming and going rule” workers may or may not be covered while making their way to or from work. The specific circumstances will be the deciding factor here. For example, an injury would be covered if:
- The employee is out on a business matter.
- There is no fixed employment place such as an office.
- Special circumstances such as having management approval to be outside of the work area.
These situations can be interpreted differently depending on the circumstances. An experienced workers’ comp lawyer should be consulted when a claim that involves these situations is denied.
Quite often, work-related injuries are a result of horseplay. Even if your employer has not expressed that horseplay is not allowed at work, you should know that it isn’t and will lead to a claim not being approved.
However, if an employee who was not involved in horseplay is injured because of the actions of others, the claim should be approved. For example, if the horseplay of two employees causes a third (who was not involved) to be injured, workers’ comp benefits can be claimed by the third party.
Intoxication is something else that has no place in the workplace and can be the cause of injuries. If your employer or the insurance company suspects that intoxication was to blame for your injuries, you will not get workers’ compensation benefits.
Of course, there are cases where the insurance company claims that intoxication was involved but it was not. If you are unjustly accused of this, the best course of action is to present your case to an attorney for professional advice.
What to do After an Injury
Since employers are responsible for paying for workers’ comp insurance, you do not have to worry about any costs when you file a claim.
If you suffer an injury at work, the most important matter is to get immediate medical attention. Employers have approved medical facilities where injured workers are expected to go, but you can go to the nearest clinic or hospital if it is an emergency.
Once you have gotten medical attention, you have to notify your employer about your injury. Failing to do this promptly can be seen as fraudulent and lead to problems when trying to get workers’ comp benefits.
Most workers’ compensation claims are processed without any issues, but this is not always the case. Sometimes, claims can be denied either because someone unjustly suspects fraud or simply to save the insurance company money. When this happens, workers can dispute the decision by themselves but it is better to do so with the help of an attorney who knows how to deal with these cases effectively.
Getting Professional Assistance
Often, workers who are denied benefits after an injury will dispute without proper counsel and be unsuccessful. Some will simply leave the matter there thinking that nothing can be done. In most cases, and depending on the facts of the case, an experienced attorney can get much better results than workers going about this by themselves.
What’s more, an attorney who specializes in these cases will grant you a free consultation so you lose nothing by seeking professional assistance for a workers’ comp claim.
Most states mandate that employers pay for workers’ compensation insurance, although there are exceptions such as when a company has less than four employees.
Being injured on the job should make you eligible for benefits but some circumstances can lead to a claim being turned down. If this happens to you, you should consult a workers’ comp lawyer for help.
Call us at the Law Office of Robert E Frawley at (617) 523-2929 and we’ll help you get the compensation you deserve.