What Exactly is Workers’ Compensation and How Does it Work?


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Workers’ Compensation

What is workers’ compensation? On the surface this may seem like a very simple question to answer, right? For most of us, it actually is not. Sure, the common answer is that it’s a way for employees to have their medical bills covered if they get hurt while on the job. 

But what if it was due to negligence of the employee? What if an injury doesn’t manifest itself for a few months? What if an employee doesn’t have insurance with the company?

Suddenly, answering the original question isn’t as simple.

What Exactly is Workers’ Compensation?

If you want a lengthy but specific definition, you can find that by just searching for it on any internet search engine. But since you’re here and probably don’t want to take the time to do that, workers’ compensation is basically an insurance that employers pay for to cover the medical costs or pay out cash after a workplace incident. 

In these situations, it does not matter if there was reasonable negligence by the employee, unless under the influence of drugs or alcohol. The money does not come out of an employee’s check and there are even options for situations where an employee is no longer able to do their job (typically two-thirds pay). 

On the flip side, an employer has the right to fight the claim and essentially blame an employee for either faking or purposefully harming themselves to get a benefit. 

How to File Workers’ Compensation

Typically, in most states, you have up to two years to file a claim. However, the longer that you wait, the stronger of an argument an employer has to claim that perhaps it was not a workplace incident. 

For that reason, you want to make a claim as soon as possible and not wait weeks or months to see if a ‘sore back’ just goes away or if the daily headaches that started after you got hit in the head subside. 

The first thing you need to do is document everything. Obviously, if you break a leg or get knocked out at work, then the process is pretty straightforward. However, if you slip on water and hurt your hip but can still walk, it can be easy to brush it off and think you will be just fine. 

Don’t do that. Write it down, take a picture of the water, and then keep notes of how you feel the next few days. If things don’t improve, you’ve got evidence and can make an easier claim. 

To make a claim, all you need to do is approach your employer and tell them. Legally, they have to give you paperwork to fill out. The paperwork then goes to an insurance agency and denies or approves the claim. 

If You Win

If you win, the reward is normally equal to or more than all of the medical bills, wages lost, disability, and in extreme cases, death. Most of the time, the reward also includes a two-thirds wage if you are unable to return to work, at least until new employment is found. 

Hopefully this never applies to you. However, if it does, then in a best-case scenario, this is how everything plays out. Unfortunately, other times the claim is denied, or is denied to a certain extent. 

If You Lose

Sorry, if you get to this point it can be hard, but not all hope is lost. If you lose your claim, it is important to look at the reasoning that the denial gives. Different reasons can include that there wasn’t enough evidence to prove the injury was work-related or that the conditions weren’t accurate. 

Appealing the decision is an option, and it may be in your best interest to get an attorney involved. Unlike you, attorneys deal with this kind of situation all the time and know how to make your case strong. They know how to word an appeal and which areas to focus on to help present a strong case. 

Going at this alone is tough since your arguments and strategy to present your case likely won’t be any different the second time around and insurance agencies may not be as thorough as when an attorney is coming at them. 

The bottom line is that if you are injured at work, there are options, and even if denied the first time, you need to fight for the compensation that you deserve. 


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BSV Staff

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