Work Injury Claim Guide: What to Do and How to Get Fair Compensation

Find out what qualifies as a workplace injury, how to protect your rights, if you need an attorney, and how to file a workers’ compensation claim.

Every year, at least 2.8 million American workers suffer non-fatal injuries on the job,¹ and more than 5,000 workers die from work-related injuries.²

Workplace injuries can be devastating to workers and their families, physically, emotionally, and financially.

Fortunately, most employers are required by law to protect their employees with workers’ compensation insurance, also known as workers’ comp.

Workers’ comp gives injured workers immediate help with medical expenses and wage replacement. But the process can be complicated and doesn’t always have the best outcome for the employee. With a little knowledge, you can greatly increase your chances of getting the compensation you deserve after an injury at work.

Here we unpack what qualifies as a workplace injury, what to do after an injury at work, what you need to know about workers’ comp insurance, how to get fair compensation, and much more.

What Is Workers’ Compensation Insurance?

Workers’ compensation insurance is a type of “no-fault” coverage for eligible workers injured on the job. Workers’ comp covers an injured worker’s medical expenses and a portion of their wages until they can return to work.

Workers’ comp insurance is required almost everywhere in the United States. It provides benefits to workers who become injured or sick from their job, without having to prove the employer was at fault. However, the injured employee is not allowed to sue their employer except in extreme circumstances.

Workers who may not be eligible for workers’ comp benefits include volunteers, independent contractors, agricultural workers, and domestic workers. The rules vary by state.

Get answers to the Top 20 Frequently Asked Workers’ Comp Questions here.

More Questions about Workers’ Compensation:

If you are hurt at work or become sick from your job, your medical condition will usually qualify as a workplace injury. The legal definition of a workplace injury states:

“Any injury or illness is considered work-related if an event or exposure in the work environment caused or contributed to the condition, or significantly aggravated a preexisting condition.”

Some workplace injuries arise from abrupt and dramatic events, like slip and falls, burns, and crushing injuries. Other work-related injuries, like carpal tunnel syndrome or black lung disease, can develop over time.

A work injury claim seeks medical and income replacement benefits while you recover from a work-related injury. You file the claim with your employer’s workers’ compensation insurance carrier.

With a work injury claim, the victim doesn’t have to prove the injury was caused by their employer’s negligence. A claim is valid even if the worker made a mistake that led to their own injuries, so long as they were acting in the course of their duties.

When, where, and how your injuries occur will determine if you have a valid work injury claim. To qualify as a valid work injury claim, these criteria must be met:

  1. You were injured while legally employed and on-the-clock
  2. You were not injured while doing anything illegal
  3. You reported the injury as soon as possible to your employer
  4. You filed a workers’ comp claim prior to your state’s deadline

Not every job injury or illness qualifies as a workplace injury, even if you get hurt or sick at work. For example, an employee who breaks a tooth in the lunchroom while eating a sandwich brought from home won’t get far with a workers’ comp claim.

On the other hand, if you fell and broke your wrist while away from the office on company business, it might count as a workplace injury.

What to Do After a Work Injury

If you’ve recently been injured at work, here’s what to do:

Step 1. Get Medical Treatment

The first step after any type of injury is to get prompt medical treatment. Even if you don’t think it’s an emergency, it pays to see a doctor. Adrenaline at the moment of injury can mask symptoms. Getting treatment quickly can prevent an injury from getting worse. Furthermore, establishing a medical link between your work activities and the injury is necessary for a successful claim.

Step 2. Report the Injury to Your Employer

As soon as possible after seeking medical attention, report the accident to your employer. Your report protects your claim for benefits. If you wait too long to report your injury you may lose the chance for compensation.

Most state laws say a worker has to report their injury within a specific period of time after it happened. This time period is usually within a few days of the accident, or within a “reasonable time” after the accident.

Step 3. File a Workers’ Compensation Claim

While reporting your work injury to your employer is a good start, the act alone is not the same thing as filing a claim. Once you tell your employer about an injury, you should be given a workers’ comp claim form. You must complete the “Employee” section of this form to start a workers’ comp claim.

You’ll generally have to provide details about your accident and the treatment you received for your injuries. Make sure to sign and date the form, and make a copy for your records. Once completed, return the form to your employer.

To file a workplace injury claim, start by checking with your employer’s Human Resources department. If you work for a small business without an HR department, report the injury to your supervisor and request a workplace injury report form and a workers’ comp claim form.

In many states, you can also file a claim online. Each state has forms and filing instructions for workers’ compensation claims. Find your state’s workers’ compensation official here.

Most employers are required to have workers’ compensation insurance, although companies with very few employees may be exempt. Some types of workers, like some farmworkers, are also exempt.

It’s best to file your workers’ comp claim immediately after your injury, or as soon as you are diagnosed with a work-related condition.

Reporting a work injury to the boss is not the same as filing a claim for workers’ compensation. You may lose your right to workers’ comp benefits if you miss your state’s deadline for filing a claim.

You must see a doctor and report the injury as soon as possible. Delaying medical care can seriously undermine your claim.

How Does Workers’ Compensation Work?

Many injured employees are confused and stressed, and don’t know how workers’ compensation works.

Where and how to file a work injury claim depends on the circumstances of your injury. Typically, you will report an injury to your boss and get immediate medical attention. Then, you’ll file a claim with your employer’s insurance company by using forms provided by your employer or filing your claim online.

Throughout your recovery, the workers’ comp company will keep close tabs on your medical condition. If they suspect your injury is not as severe as you assert, they may start a claim investigation. Here’s how to respond to a workers’ comp investigation and prove your claim.

After filing a claim, you’ll get partial wage benefits until you’re able to return to work. You must return to work as soon as the doctor says you’re able. You may be sent back to work with “light duty” restrictions before full recovery.

If your doctor determines that your injury left you with a permanent disability, you may be offered a lump sum settlement to resolve your workers’ compensation claim. When a worker is fatally injured on the job, benefits are payable to their next-of-kin.

More Questions About How Workers’ Comp Works:

You can expect the workers’ comp insurance company to respond to your claim very quickly. Most claims are straightforward and accepted immediately, especially if your employer is backing up your claim.

Claims that are questionable or more complicated might take longer to process.  These could take up to a year or more. The insurer won’t come right out and deny your claim, but they may need more information before releasing funds for medical care or income replacement.

Although some states don’t pay wage benefits right away, you should be entitled to coverage for all your medical costs from the date of injury.

Injured employees have certain legal rights under most state workers’ compensation laws, including the right to:

  1. File a workers’ comp injury claim
  2. Get prompt medical attention and treatment
  3. Receive disability compensation while unable to work
  4. Return to work after you’ve recovered

It’s easier to prove a workplace injury when you act quickly. If someone else witnessed your injury, get their name. Immediately report work injuries to your supervisor, including the names of witnesses.

Get prompt medical attention, and be sure to tell your doctor when and how you were hurt, and every affected body part, not just the area that hurts the most.

Most work injury claims are accepted by the insurance company without question, as long as the employer is on board. If your employer questions the nature of your injury, or asserts it’s not a qualified work injury, it usually falls on the employer to prove you wrong.

That said, you’re always better off having strong evidence proving your injury or illness is work-related.

Yes. In most states, an employer can legally terminate your “at-will” employment when you’re out because of an injury, so long as you aren’t fired in retaliation for reporting a workplace injury.

For example, you might legally lose your job if your absence creates a hardship for the employer. However, your workers’ comp benefits should continue until you’re medically released to work.

Should You Sue Your Employer?

There are many justifiable reasons to sue your employer. These include violations such as failing to carry worker’s comp insurance, wrongful termination, employer retaliation, discrimination, egregious conduct and sexual harassment, unsafe work environments, and more.

But if your injury is simply being questioned by your employer or the workers’ comp company, a lawsuit may not be necessary. The first step is to speak to an attorney. An attorney can help prove your condition qualifies as a workplace injury and get you the benefits you deserve, without filing a lawsuit.

It’s always a good idea to get personalized legal advice from a local attorney. If you only suffered a minor workplace injury like a muscle sprain, you can probably handle the claim yourself. But if you suffered a more serious injury, you’re better off consulting a personal injury attorney.

You might work for the best company in the world, but your claim will be handled by hard-boiled workers’ comp insurance adjusters. Your boss won’t have a say in how your claim is processed and paid.

Workers’ comp adjusters are trained to find reasons to reduce or terminate your benefits. When you’re hurting and out of work, you’re vulnerable to their tactics designed to make you give up and take whatever you’re offered. It’s a lot harder for the adjuster to take advantage of you if you’re represented by a reputable law firm.

Workers’ compensation adjusters won’t hesitate to make lowball offers to workers who suffered disabling injuries. If you’ve suffered amputations, hearing or vision loss, or permanent limitations from a workplace injury, an attorney can help you maximize your settlement.

A workers’ comp attorney can protect your legal rights, make sure your wage benefits are correctly calculated, help you get optimal medical treatment, and deal with the workers’ comp insurance company on your behalf. You won’t have to worry about making a paperwork mistake or missing a critical deadline.

Sometimes workplace injuries involve third parties other than your employer. Vehicle collisions, machine malfunctions, and safety equipment failure are examples of situations where an attorney can help you pursue full compensation for your pain and suffering, in addition to your workers’ compensation benefits.

What Does Workers’ Compensation Cover?

While each state has its own workers’ compensation laws, there are many similarities governing what workers’ comp covers and doesn’t cover.

Workers’ compensation normally covers:

  • Medical bills
  • Partial wage replacement
  • Disability lump-sum payout
  • Vocation training
  • Death benefits

Workers’ compensation normally does not cover:

  • Pain and suffering reimbursement
  • Injuries resulting from illegal activities, drug or alcohol use, horseplay, or violations of company policies

Yes. Workers’ comp wage benefits typically replace about 60 percent of your average pre-injury income.

These are bodily injuries or illnesses that can be attributed to on-the-job accidents, or to working conditions like repetitive movements or chemical exposure.

These are bodily injuries or illnesses that can not be attributed to accidents or conditions at work, or that the workers’ compensation provider will not accept as work-related.

If you can’t return to the job you had when injured, the insurer may offer a settlement after you’ve reached maximum medical improvement.

Depending on your state, workers who suffer a permanent total disability may qualify for lifetime benefits.

No. You can expect to get about two-thirds of your pre-injury wages. However, workers’ comp wage benefits are not taxable.

Work Injury Settlement Amounts

Average settlement amounts for work injuries vary widely. Payouts are affected by a variety of factors including the type and severity of the injury, level of disability, worker salary, and more.

The average work injury settlement can range from a few thousand dollars to many hundreds of thousands.

Who pays for a work-related injury?

If you’re wondering who pays for your work injury, chances are your situation is more complicated than a standard workers’ comp claim.

In a normal claim, your employer’s workers’ comp insurance company should pay your medical expenses and lost wage benefits. In some cases, a third party may also be liable for your injuries. A third party is someone other than you and your employer.

For example, let’s say you’re at work driving a company vehicle and get hit by another driver who ran a red light. Workers’ compensation will pay for your medical care and wage benefits, but you can also pursue compensation from the at-fault driver through their auto insurance liability coverage.

Common Workplace Injuries & Causes

Some of the most common workplace injuries are caused by overexertion and body reactions, slips or trip and falls, and contact with workplace equipment.³  A significant number of job-related injuries are also caused by vehicle accidents.

Top 5 most common causes of workplace injuries:

  1. Overexertion (lifting, pulling, etc.)
  2. Work-related vehicle accidents
  3. Slips, trips, and falls
  4. Faulty equipment and machinery
  5. Assaults at work

Overexertion injuries happen while lifting, pulling, and twisting. Body reaction injuries are caused by repetitive motion without exertion, like typing and scanning groceries.

Slip, trip, and falls result in a wide variety of workplace injuries, ranging from bumps and bruises, to broken bones, to fatal head or spinal cord injuries. Workplace falls can be same-level falls, like tripping over an extension cord, or potentially deadly high-level falls from a roof or collapsing structure.

Equipment-related injuries can be caused by a body part caught in machinery, flying objects, burns, abrasions, explosions, and vibrations. Failed safety equipment can also play a role in workplace injuries.

See statistics on workplace injuries here.

Workplace Injury Claim Questions