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.
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.
Workers’ compensation 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.
First, injured workers need to know when and how to file a valid workers’ comp claim. The next hurdle is getting their employer’s insurance company to approve the claim and begin paying benefits. The most difficult challenge can be proving the scope and severity of injuries, and getting fair compensation.
Here’s where we unpack what qualifies as a workplace injury, what you need to know about workers’ comp insurance, how to get help, and so much more.
What Qualifies as a Workplace Injury?
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.
Qualifying Criteria for a Workplace Injury Claim
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, the following criteria must be true:
- You were injured while legally employed and on-the-clock
- You were not injured while doing anything illegal
- You reported the injury as soon as possible to your employer
- You filed a workers’ comp claim prior to your state’s deadline
Not every 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 are Compensable Work Injuries? These are bodily injuries or illnesses that can be attributed to accidents that happen on the job or to working conditions like repetitive movements or chemical exposure.
What are Non-Compensable Work Injuries? 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.
What is a Work Injury Claim?
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.
- Here’s What to Do After an Injury at Work
- Can You Be Fired for a Non-Work Related Injury?
- Injured at Work and Employer Has No Workers’ Comp Insurance?
How do you file a claim for injury at work?
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 farm workers, are also exempt.
If you’re a federal employee, like a mail carrier, things are different. Find out how to file a federal workers’ compensation claim.
How long after a work-related injury can you claim?
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.
How long does a work injury claim take?
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.
How long do I have to see a doctor after a work injury? You must see a doctor and report the injury as soon as possible. Delaying medical care can seriously undermine your claim.
Do I get paid if injured at work? Yes. Workers’ comp wage benefits typically replace about 60 percent of your average pre-injury income.
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.
Where and how to file a work injury claim depends on the circumstances of your injury. Typically, you will report a workplace injury to your boss and get immediate medical attention. Then, you’ll file a claim with the workers’ comp 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. 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 has left you with a permanent total or partial 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.
- 12 Tips to Maximize Your Workers’ Comp Claim
- Does Your Work Injury Qualify for Pain and Suffering Compensation?
How long does it take to receive an offer of compensation? 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.
Is a workers’ comp injury covered for life? Depending on your state, workers who suffer a permanent total disability may qualify for lifetime benefits.
- Learn more about Permanent Partial Disability Benefits
Do you get full pay on workers’ comp? No. You can expect to get about two-thirds of your pre-injury wages. However, workers’ comp wage benefits are not taxable.
What Are Your Rights If You Get Hurt At Work?
Injured employees have certain legal rights under most state workers’ compensation laws, including the right to:
- File a workers’ comp injury claim
- Get prompt medical attention and treatment
- Receive disability compensation while unable to work
- Return to work after you’ve recovered
Can I Be Fired After Getting Hurt at Work? 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.
How do you prove an injury at work?
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 workers’ comp 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.
- Denied Workers’ Comp? Reasons Why and What to Do Next
- How to Handle an Independent Medical Exam
- Does Workers’ Comp Cover a Pre-Existing Injury?
- Employer Responsibilities for Injuries at Work
Who pays for a work-related injury?
Your employer’s workers’ comp insurance company should pay your medical expenses and wage replacement benefits. If your employer was not insured, you can file a lawsuit against them to pursue full compensation for your damages.
- Can You Sue Your Employer for a Workplace Injury?
- Filing an Employer Liability Claim vs Workers’ Comp Claim
- Does Your Employer Have to Pay for Work-Related Injuries?
- What to Do If You’re Injured by a Coworker
Wondering what happens if you’re injured outside of work or off-the-clock? Learn more.
In some cases, a third party may also be liable for your injuries. For example, let’s say you’re on the job 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.
Should You Get a Lawyer for a Work Injury?
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.
If your job injury or illness is being questioned by your employer or the workers’ comp insurance company, you’ll need an attorney. For example, if you’ve been hurt on the job and had a preexisting injury to that body part, or developed cancer caused by workplace exposure to toxins. Your attorney can help prove your condition qualifies as a workplace injury.
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.
What does a workers’ compensation attorney do?
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.
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 injuries on the job are also caused by vehicle accidents.
Top 5 most common workplace accidents and injuries:
- Back injuries from overexertion
- Work-related car accidents
- Slips, trips, and falls on the job
- Faulty equipment and machinery accidents
- Workplace violence
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.
Types of Injuries
How Much is Your Injury Claim Worth?
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Workplace Injury Questions and Answers
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