When you slice off your finger working within the deli, fall off your executive chair and crack your skull, or develop an illness due to your job, workers’ compensation is supposed to cover your medical costs and pay you for any days of labor you miss. Almost all employers need to buy workers’ compensation insurance. But workers’ comp doesn’t cover everyone on the work. Agricultural workers, domestic workers, and independent contractors are among those that are sometimes excluded.
To be covered by workers’ compensation, you want to be an employee and be accidentally injured while doing all of your jobs, or get sick from doing all of your jobs, like being exposed to asbestos from ripping out ceiling tiles while doing renovation work.
“Just because an injury happens at your job doesn’t mean you’re automatically entitled to benefits,” says Rebecca Shafer, President of Amaxx Risk Solutions, a workers’ compensation consulting company in Hartford. How are you able to confirm you get the workers’ compensation you deserve? Here are 10 things to know:
1. Report every injury or illness
Always report any work injury or illness your doctor says is thanks to your job. “It’s not enough to report it to the guy working next to you,” says Tricia Kagerer, a workers’ comp expert and vice-chairman of risk management for Jordan Construction in Dallas.
Report the injury or illness to the HR department, your supervisor or the risk-management department when it occurs, she says. “You should get an event report back to fill out, and that they should assist you to obtain medical treatment,” she says.
If you don’t get paperwork or a call from an insurance adjuster, something is wrong. Follow up together with your boss.
2. Visit the right medical provider
If your injury is an emergency, you’ll go where the ambulance takes you. during a nonemergency, your employer may direct you to a specific hospital, clinic or doctor. Go where your employer tells you or your bills might not be covered by workers’ compensation, Shafer says.
3. Tell the doctor or hospital employees you were injured on the job
When you’re filling out the paperwork at the hospital or doctor’s office, check the box that asks if your injury happened at work. That gets your medical bills sent either to the workers’ compensation insurance firm or your employer, instead of to you.
If you select your own doctor, make sure she’s approved or certified to try to workers’ compensation claims and has agreed to the workers’ comp pay schedule.
4. Make sure your medical records include everything about your injury
Your medical records should mention the history and circumstances of your injury or illness and list every one part involved -- workers’ compensation won’t pay to treat body parts that aren’t listed, says Ed Scheine, a Hauppauge, New York, workers’ compensation attorney.
5. Ask your employer to explain its workers’ comp coverage
Your employer most likely features a brochure explaining the workers’ compensation program. Get it and read it. Next, find your state’s workers’ compensation office and inspect the knowledge on its internet site, says Bryan Thomas, CEO of Cannon Cochran Management Services, a Danville, Illinois, risk management, and claims administration firm.
6. If your employer says you’re not covered because your accident was your fault, it might be lying
Workers’ comp is no-fault insurance, so you’re covered even when the accident is your fault. “If you’re at work and you slip and fall on a banana skin, they can’t deny your claim because you ought to have seen the peel,” Kagerer says.
However, there's a limit to how stupid you'll be. If horseplay is involved -- say, a coworker dares you to leap out the window and you break your leg doing it -- workers’ compensation won’t cover you in some states.
7. Stay sober at work
In a similar vein, if you get high on your thanks to working then slice your finger off later that day, you’ll be paying your own medical bills. Most employers require a drug test after an accident; if you test positive, your claim is going to be denied.
8. You may not need an attorney to get what you’re owed
States set workers’ compensation payouts, so there’s not tons of leeway for you to urge more (or less) than you deserve. In NY, for instance, a thumb is worth 75 weeks of pay. If your thumb is 10 percent disabled during a workplace accident, you get 7.5 weeks of disability. “The value system is made into the law, and therefore the doctor decides how permanent your injury is,” Scheine says.
A workers’ compensation attorney will take a minimum of 20 percent of your settlement, so don’t hire one unless you think that you’re being shortchanged over a permanent disability, have a posh claim or were unfairly denied coverage of your medical bills.
Even then, most states have a workers’ compensation ombudsman who can assist you get what you deserve from the system.
9. Big payouts are rare
In Texas, the maximum workers’ comp benefit for lost pay is $725 a week, Kagerer says. That’s fine for a minimum-wage worker, but it doesn’t come close to replacing a chief financial officer’s salary.
10. (Most) cheaters eventually get caught
Cheating is so common in workers’ compensation that there’s a term for it -- malingering -- also as fraud divisions to seem for it. “[Malingerers] get caught because insurers and employers make home visits, do surveillance and see if other companies are contributing to your Social Security,” Shafer says. “It may take a while, but the likelihood is that pretty good you’ll get caught, and if you are doing get caught, it can mean jail time.”
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