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Beginner’s Guide To Workers’ Comp Insurance

Injured man signing forms

If you are an employee who has been injured on the job, you are most likely eligible to collect workers’ compensation benefits. The following questions and answers provide some basic information about the workers’ comp claims process, and the benefits you may be entitled to receive. Our friendly agent is also happy to help.

What Types of Injuries Are Covered By Workers’ Comp

Workers’ compensation insurance covers only work-related injuries. The injury or illness must have been sustained in the course of your employment. If you have clocked out for the day and you are involved in a traffic accident on your way home, workers’ comp will not cover your injuries. If you trip and fall in the workplace, break your arm, or sustain another injury while performing the duties of your employment, you should be entitled to workers’ compensation benefits.

What If I’m At Fault for the Accident that Caused My Injuries?

Workers’ comp is a no-fault system. Even if your injuries resulted in part from your own failure to take the necessary safety precautions, you are still entitled to benefits in most cases. In return, you are precluded from suing your employer for injuries covered by workers’ comp insurance.

What Benefits Are Provided By Workers’ Comp?

After an on-the-job injury or illness, workers’ comp will pay for your medical care related to the injury and replace a portion of the wages lost as a result of your injury. Typically, wage replacement amounts to approximately two-thirds of the worker’s average wages, up to a specific fixed limit. Benefits may also include:

  • Compensation for any permanent disability
  • Occupational rehabilitation or retraining if your injuries prevent you from returning to your previous position
  • Survivor benefits for families of workers killed on the job

How Do I Apply for Workers’ Compensation Benefits?

The workers’ compensation claims process may vary somewhat from state to state. Generally, to collect workers’ comp benefits, you must notify your employer and the workers’ comp insurance carrier of your illness or injuries.

Ensure you have the necessary medical treatment right away. Then notify your employer in writing, complete an official claim form, and keep detailed records of your treatment. Make sure to notify your employer and file your claim within the required time frame, which can vary from state to state.

Are My Workers’ Compensation Payments Taxable Income?

In most cases, workers’ comp payments for wage replacement or permanent disability are not subject to state or federal taxes. However, a portion of this money may be taxable if you are also receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI).

What If My Workers’ Comp Claim is Denied?

If you file a claim for workers’ compensation benefits and your claim is denied, you still have recourse. The reason for denial should be explained in the denial letter. If you feel your claim was incorrectly denied, you may appeal the decision through your state’s workers’ compensation board. Common reasons given for denial include:

  • Insufficient evidence that the injury is work-related
  • Employer is disputing the claim
  • No medical treatment was received
  • Injury was not reported to the employer within the specified time limit
  • Claim for benefits was not filed before the deadline