Who Pays for Work-Related Injuries and Medical Bills?

Who should pay for your work-related injuries? Here’s what you need to know about workers’ comp coverage and third-party injury claims.

People can experience an injury at any time during their employment. Workplace injuries cost significant money in terms of either medical expenses, lost wages, or both.

Under the law, most employers are obligated to carry workers’ compensation insurance. If you suffered job-related injuries or illness, you can file a workers’ comp claim to receive reimbursement for your medical care and lost wages.

While you must initiate the workers’ comp claims process, your employer is responsible for providing you with the appropriate claim forms and notifying its insurance company of your injury.

If you were injured during the course of your work duties by someone other than your employer, you might have the right to bring a third-party claim against that party. Depending on the facts of the case, you may be eligible to bring the third-party claim in addition to your workers’ comp claim.

Employer Obligations After Workplace Injuries

It’s important to seek prompt medical attention after a workplace injury. You are not obligated to use your own health insurance to pay for medical care. Workers’ compensation insurance will pay the medical bills for employees who are hurt on the job.

Injured workers have to take the first step in initiating a worker’s compensation claim. After receiving medical care for your injury, you have to report your accident to your employer.

You should report your accident soon after it occurs.  Most state laws say that a worker has to report their injury within a specific period of time after it happens (for example, within three days of the date of injury). If a report is made after this time period expires, an injured worker may lose their chance to file a claim.

Notify your employer of your work injury in writing and keep a copy for your records. If you work for a small business, you might report your accident directly to the company’s owner. With larger operations, you may report your injury to a manager or human relations department.

Once a worker tells their employer about an injury, certain responsibilities fall on the employer. For example, when a report is made, the company has to provide the employee with a workers’ comp claim form.

To complete your portion of the form, you’ll have to provide details about your accident, the medical treatment you received so far, and the name of your treating doctor.

Once you complete your part of the form, return it to your employer. Your company will then complete its part of the form and then send it to its insurance company.

State laws require your employer to provide you with a copy of the complete workers’ comp form that it sends to its insurer.  If you don’t receive a copy of the completed form, make sure to ask your employer for one.

In most jurisdictions, within 14 days of receiving a workers’ comp claim form, the insurance company has to send a letter informing the injured employee of their claim status.

Workers’ Compensation Claims Eligibility

State laws require most employers to carry workers’ compensation insurance. Injured employees can then file a workers’ comp claim with their employer’s insurance company to get paid for work-related injuries.

The employer’s insurer will typically approve your workers’ comp claim provided you’re a covered worker and suffered an injury related to your employment.

Most workers qualify for workers’ comp benefits if they are full-time employees and working for a business with one or more workers. In some instances, workers can use FMLA in addition to workers’ comp.

Some state workers’ compensation laws exempt specific employees from eligibility for workers’ compensation benefits.

Examples of ineligible workers:

  • Independent contractors
  • Volunteers
  • Farmworkers
  • Maritime employees
  • Railroad employees
  • Seasonal or casual workers

There are also times when an insurance company will label an otherwise qualified worker as ineligible for benefits.

Circumstances that disqualify otherwise eligible workers:

Even if you’re a covered employee for workers’ comp purposes, you still won’t qualify for benefits unless you suffered a covered injury or illness on the job. “On the job” means that you were injured or suffered an illness as a direct result of your employment.

Common injuries covered by workers’ compensation:

  • Slip and falls at work
  • Back injuries from heavy lifting
  • Carpal tunnel from computer/keyboard work
  • Illnesses brought on by exposure to toxic chemicals
  • Injuries suffered in a car accident

When it comes to car accidents, workers’ comp will cover your injuries so long as you experienced them in the course of performing your work, regardless of your specific location.

For example, workers comp insurance will cover an employee that gets injured while driving from one job site to another. However, an insurer will not provide benefits to someone who is injured while using a company car to run personal errands.

A convenient aspect of workers’ compensation insurance is that it’s a no-fault insurance program, meaning a worker does not have to prove that an employer’s negligence caused or contributed to an injury. Workers only have to show that they were injured while on the job and performing work-related duties.

Types of Workers’ Compensation Benefits

Most states provide workers with four different types of benefits for workplace injuries.

Typical workers’ comp benefits include:

  • Medical benefits
  • Wage benefits
  • Vocational rehabilitation benefits
  • Death benefits

Medical Benefits

Workers’ compensation covers a worker’s medical expenses for their work-related injury.

This coverage includes medical costs for:

  • Emergency room care
  • Doctor fees
  • Hospital visits and treatment
  • Surgeries
  • Medications
  • Medical diagnostic tests
  • Physical therapy

Medical benefits also include reimbursement for the cost of necessary medical equipment, like crutches and wheelchairs.

Most workers’ comp laws state the insurer must pay for an employee’s expenses until they return to work or recover from their injury.

Some states may restrict coverage for alternative medical treatments and alternative care providers. For example, some may not cover your expenses for massage therapy, acupuncture, or pain therapy. Others may cover your expenses for these treatments but only pay for a certain number of visits.

Wage Benefits

Workers’ compensation coverage helps injured workers by providing money for lost wages.

Wage benefits usually fit into one of the following four categories:

  • Temporary Total Disability (TTD) Benefits
  • Temporary Partial Disability (TPD) Benefits
  • Permanent Partial Disability (PPD) Benefits
  • Permanent Total Disability (PTD) Benefits

Temporary Total Disability (TTD) Benefits

Insurers pay injured workers TTD benefits if their work injury renders them temporarily unable to return to work.

TTD benefits are most often paid as a percentage of your weekly wage. Most states use a percentage of 66 and two-thirds percent.

Consider, for example, a scenario where a person suffers a personal injury at work while lifting heavy boxes out of a truck. The injury results in the worker missing two weeks of work. Before the accident, the employee was making $2,000 a week. Given this amount, the worker would receive $1,333 in TTD benefits per week.

While this may seem like a big pay cut, keep in mind that workers’ compensation wages are generally not taxable.

Employees typically receive TTD benefits until they return to work, reach full recovery from their injury/illness, or state law says the benefits should expire. Many state laws limit temporary benefits to a certain number of allotted weeks.

Temporary Partial Disability (TPD) Benefits

The workers’ compensation system pays injured employees TPD benefits if they can return to work in a modified or light-duty capacity, but the available “light duty” position is at a pay grade lower than the position the worker filled before the injury.

TPD benefits, then, are intended to compensate you for the difference between your wages before your injury and your wages in your restricted capacity.

TPD benefits typically end when you return to work at your pre-injury wages, or state law dictates the benefits end because you’ve reached the maximum number of allotted weeks.

Permanent Partial Disability (PPD) Benefits

Workers receive Permanent Partial Disability (PPD) benefits if they’ve suffered a workplace accident that results in a permanent impairment but does not keep the worker from returning to the workforce.

Some injuries that may involve a permanent partial disability include:

  • Hearing loss
  • Vision loss
  • Loss of an appendage or limb

State laws differ in terms of the amount of a worker’s permanent disability benefits. Typically, though, the amount of these benefits increases with the severity of a worker’s injury.

Some states offer a lump sum based on the injured worker’s partial disability rating, as determined by the treating physician.

Permanent Total Disability (PTD) Benefits

Workers’ comp programs pay PTD benefits to workers who can’t return to the workforce in any capacity because of their work injury.

As with PPD benefits, the specific amount of permanent disability benefits often depends on a state’s laws. PTD benefits may be paid over time or in a lump-sum settlement. Many states reduce these benefits once you qualify for Social Security Disability.

Vocational Rehabilitation Benefits

Vocational rehabilitation benefits apply to workers that have to learn a new job to return to the workforce after suffering a work injury.

These benefits reimburse workers for things like:

  • Training programs
  • Tuition expenses
  • Professional certification fees
  • Vocational counselor services
  • Resume preparation

Death Benefits

Sometimes workers die from a workplace accident. If this occurs, most states provide death benefits to the worker’s surviving relatives. Surviving relatives are most often children and spouses who were financially dependent on the deceased worker.

Death benefits typically include compensation for funeral expenses and compensation for losing the deceased worker’s financial support.

Third-Party Claims for Work-Related Injuries

There are times when an employee gets injured by some third party while at work.

For example, a worker using a car to run a work-related errand may get hit by another motorist and suffer a back injury. The other motorist is referred to as the third party – the one responsible for causing the injury.

In these situations, the injured employee can still file a workers’ compensation claim and get all the appropriate benefits. But in addition to a workers’ comp claim, the injured worker can file a personal injury claim with the third party’s insurance company.

You can even file a lawsuit against the at-fault third party if the insurer won’t settle your claim for a fair amount.

In a third-party personal injury claim, you can get compensation for:

  • Medical expenses
  • Lost wages
  • Future lost earnings
  • Property damage
  • Out-of-pocket expenses
  • Pain and suffering

You can receive compensation for all your damages in addition to any benefits you receive under your workers’ comp claim. But if you settle or win your case against a negligent third party, you can expect the workers’ comp insurance company to put a lien on your settlement.  A workers’ comp insurer has a right to seek reimbursement for the medical expenses and wage benefits it paid on your behalf.

You don’t necessarily need a personal injury attorney to help file a third-party claim, provided that the facts of your case are relatively straightforward and you suffered minor injuries. For example, a car accident claim for a rear-end collision is usually an uncomplicated auto insurance claim when liability is clear.

Many work-related third-party claims can be complicated and expensive to pursue, for example in industrial accidents, when workers are injured by malfunctioning machinery or defective safety devices.

High-dollar and high-profile clams often require filing a lawsuit to get all the compensation the injured worker deserves.

If you suffered a severe work-related injury or illness, you’ll benefit from speaking with a workers’ compensation attorney to protect your legal rights, even if no third party is involved.

Most injury law firms provide free consultations, so you can get expert advice about your case without spending a dime.

Dustin Reichard, Esq. is an experienced attorney with 20 years of work in the legal field. He’s admitted to the Illinois State Bar and the Washington State Bar. Dustin has worked in the areas of medical malpractice, wrongful death, product liability, slip and falls, and general liability. Dustin began his legal career as a JAG... Read More >>