How Does Workman's Compensation Work?

How Does Workman's Compensation Work?

There are many instances of workers getting injured or ill during any on-job task. This guide will tell how does workman's compensation work? in order to make labor force aware of their basic rights in such cases.

In extreme cases, a worker can get badly injured or sick that can stop him/her to either continue job or stay home for time being until recovery. To recompense the wounded labors workers' compensation insuranceplays a vital role by lowering the pain of suffering workers through offering a wide range of benefits that can greatly help them in this tough time.

Covered Employees in Workers' Compensation Benefits

In the USA each state has its own criteria for the selection of workers/firms who can avail compensation benefits. Each state forms its own factors about when an enterprise can obtain such protection. Also, few of the USA states have a law concerning the minimum number of workers that a firm needs to have in order to gain workers' compensation insurance. Other states have their own set of rules for providing such benefits in case of injury or illness caused at the workplace.

In addition, some states exclude certain kinds of industries from this coverage. For instance, most states do not cover farm workers, local workers, independent contractors, and seasonal workers in this benefit. What if such workers get harmed or sick on the job? These labors can claim compensation under a Tort theory of liability, but cannot apply for workers' compensation program.

Since federal workers are covered in the federal workers' compensation benefits program, thus they cannot get state provided such programs. It is necessary for workers and equally firms to know about the benefits they can avail and the way in which workman comp work.

How Does Workman's Compensation Work?

Workers who face a workplace injury or illness must immediately inform his/her firm's responsible person about the situation. Every state in the USA (or around the world) has their own incident reporting deadline after which the workers cannot apply for a compensation claim. So be careful about this aspect and inform about the accident or sickness in time.

After reporting the incident, firm and workers must take the following steps to understand how does workman's comp work:

  • Firstly, visit the most trusted health care expert. This is because it is necessary for wounded or sick workers to seek immediate medical assistance as any delays greatly put their health and linked benefits at stake. The doctor will create and issue a report containing all health details to file the compensation claim.
  • Receiving health report begins the claim process. Firms are usually given the duty of providing suitable information concerning the claims process. Moreover, they are also given the responsibility of providing claim forms and contact information of the insurance company to workers.
  • After filling the form, the worker is required to file the claim in the next step. The suffering labor must file a claim with the firm's suggested insurance company while ensuring to give attention to all details. All necessary reports must be attached with the form before submission.
  • Finally, receive reimbursement. As the insurance provider accepts the compensation claim then the worker will start to get workers' comp benefits. Benefits comprise of coverage for the worker's health expenses and disbursement of two-thirds of their salary till they are unable to work and rehabilitation costs.
  • Return back to work. A wounded worker might return to work on a reduced schedule or full time, depending on the recommendation of the treating physician. Employers should make appropriate adjustments to support that worker during their way back to work, and give them safety training to make sure that the same thing does no repeat in future.

According to stats, (presented in Table 1) gathered by the New Jersey's Department of Labor and Workforce Development, a large number of compensation claims is reported in the state and very few of them have filed the claim. This is because worker comp process can be tiring for people. DOL OWCP provides further information on this process, containing all necessary details concerning filing the claim.


Table 1: Statistics for compensation claim in New Jersey

YEAR # of Reported Accidents (FROI) # of New Claim Petition Filings # of Re-openers
1990 219 500 53 637 2 309
1991 197 300 50 910 2 671
1992 239 300 54 164 2 996
1993 219 900 47 393 2 984
1994 237 200 48 810 2 866
1995 178 200 45 823 3 125
1996 157 700 48 548 3 347
1997 146 246 44 823 4 379
1998 119 269 42 410 3 799
1999 109 728 40 794 3 974
2000 139 139 44 227 4 097
2001 170 307 39 720 3 991
2002 * 41 667 3 909
2003 185 708 40 960 3 971
2004 184,680 ** 39 212 4 274
2005 175,873 ** 37 248 4 393
2006 156,289 ** 35 041 4 412
2007 179,591 ** 35 566 4 773
2008 160 277 35 469 5 252
2009 149 688 34 489 5 400
2010 137 055 33 246 5 691
2011 148 791 34 810 5 893
2012 144 535 32 740 5 901
2013 129 867 35 452 6 274
2014 139 029 34 798 5 982
2015 134 580 34 500 6 250

Source: https://www.nj.gov/labor/wc/content/stats.html#Benefit-Rates

What Types of Benefits Does Workman Compensation Cover?

Workers comp offers five most vital benefits to the labors being subjected to on-job injury or sickness. It is a necessary part of the process of how does workman's compensation work. These benefits include:

  • Medical Care: Medical care comprises of all the treatment cost that will be incurred due to injury or illness caused by on-job activity.
  • Long-lasting Disability Benefits: This includes payments till the worker cannot recover completely.
  • Short-term Disability benefits: Payments for wage loss because of injury which prevent the worker from coming to office.
  • Death Benefits: Payments to the immediate family members in case of death of the worker due to job injury or illness.

These five are the benefits that are covered by most of the USA firms. This kind of insurance motivate the affected worker to recover speedily and act as the last hope for them. Thus, every firm is needed to conform to these benefits.

Exempted employees from worker compensation

Many worker groups are protected by worker's compensation insurance but there are certain workers which are excluded from this benefits. This is because they either do not need any compensation or are self-owned workers or might not come under the definition of the state's employee. These workers are as follows:

  • Independent contractors.
  • Volunteers.
  • Farmworkers.
  • Labors working in private homes
  • Business owners
  • Railroad employees
  • Casual workers
  • Maritime employees

How Does Workman's Comp Work for Businesses?

No workplace is totally protected. Even though businesses have broad safety guideline but they are unable to completely eliminate the dangers associated with the work. As per the data for work-related injury by the U.S. Bureau of Labor Statistics, the private sector has witnessed approximately 892,270 injuries or illness in the year 2016 because of on-job task. As a result, on an average basis, employees have missed their eight working days.

Hence, firms are held accountable for any of the staff member's injury and require carrying worker compensation coverage. A firm that does not have proper compensation coverage can be subjected to major cost, in this regard, as they will be giving reimbursement benefits without any criteria. To avoid such losses, the companies must benefit themselves by taking suitable insurance policy for worker compensation.

Conclusion

Workman compensation offers a great amount of benefits to the labors that somehow gets harmed or sick due to on-job injury or illness. Thus, it is essential for the workers to know how does a workman's comp work. The guide has highlighted the five steps i.e. getting a medical report, fill out a compensation claim form, file claim, receive benefits, and return back to work that is needed to be followed by the worker to gain reimbursement.

Also, major benefits include medical care, long-term and short-term disability benefits, and death benefits. There are certain workers such as volunteers, independent contractors, etc. that are excluded from worker compensation benefits. Finally, since workman compensation has an appropriate criterion for providing benefits so it can be advantageous for the employer to adequately give such benefits to the workers.

ClaimFight.com - Shayyan  - author / writer

Shayyan has completed his master in Law from University of Melbourne along with a year of experience as a law professor in Melbourne. He is very opinionated and believes in the saying that a pen is mightier than a sword. Since his early life, he has served greatly to make the world a better place by writing worthy articles regarding political, legal, and social problems. During his leisure time, he loves to travel and learn about new cultures, languages and societies

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