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What is workers' compensation and what does it cover?

Worker's compensation, which is often called "workers' comp" is a system set up by the state to compensate workers who are injured or sickened on the job. Nearly all employees are covered, although there are separate systems for employees of the federal government and people in certain industries.

Most employers purchase workers' comp insurance, so an insurance company typically evaluates and pays claims. However, when disputes arise there are several levels of appeal available through state agencies and the courts.

The basic idea behind having a workers' compensation system is to avoid burdensome and unpredictable lawsuits when people are injured through an employer's negligence. In the average case, the worker essentially cannot sue their employer for negligence. In return, the employer has no option but to compensate employees for injuries and occupational illnesses that arise out of their work duties. The employee does not have to prove the employer was at fault in order to file a successful workers' comp claim.

In some cases, workers can file personal injury lawsuits against third parties who were involved in the incident from which the claim arose.

What conditions are covered by workers' comp?

Worker's comp covers injuries and illnesses that occur on the job. The condition can be physical or mental, and compensation may be available in situations where work activities made an existing condition worse. However, the injury or illness must have been caused by work activities.

In certain cases, injuries are covered simply because the worker is on the employer's premises when an accident occurs. At the same time, the worker doesn't have to be on the employer's premises to be covered as long as they were working. For example, a professional driver would typically receive workers' comp for a work-related traffic accident.

Some activities performed on the employer's premises can be excluded from compensation. For example, if an employee instigates horseplay or a fight and becomes injured, they may not receive compensation. However, not all employee wrongdoing defeats workers' comp claims. A worker's safety violations and intoxication, for example, may only reduce the weekly benefits paid.

What benefits can injured workers or their families receive?

Workers' comp typically covers partial wage replacement, necessary medical care, rehabilitation, and other benefits in these circumstances:

  • Temporary partial disability
  • Temporary total disability
  • Permanent partial disability
  • Permanent total disability
  • Death

There are special benefits for disfigurement, non-disabling toxic exposure, multiple injuries and certain other situations.

The workers' comp process has strict time limits and can be confusing, especially if your employer disputes your claim. You can hire a lawyer at any point in the process and many offer free case consultations.

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