What is Workers’ Comp, and Do I Qualify for It?

Workers Compensation

As I’ve learned from years of experience in biomedical engineering, taking care of your health needs can be difficult even in the best of times. Fortunately, if you’re experiencing healthcare issues due to workplace conditions, there’s a great resource that’s just for people in your situation. It’s called workers’ compensation.

Workers’ compensation or workers’ comp is a state-mandated insurance program that pays benefits to workers who suffer an on-the-job injury or illness. The vast majority of employers are required to purchase workers’ comp insurance to ensure injured workers have guaranteed benefits in the case of an injury, while preventing lawsuits against the employer.

While medical and wage benefits vary by state, workers’ compensation benefits both parties and offers fairly comprehensive benefits in the case of a covered injury or illness. Here’s how it works and who qualifies.

How Workers’ Comp Works

Workers’ compensation is a fairly straightforward program. Employers purchase workers’ comp insurance to cover employees in the event that they are injured. In exchange, the employer can’t be sued for a work-related accident or illness. Injured employees are guaranteed to receive benefits such as wage replacement and coverage for medical bills as long as they report the injury on time and make a claim. Employees must report the injury to their employer, sometimes using a specific form. If the employee does not report the injury on time, the ability to receive benefits may be lost.

One of the most important things to understand about workers’ compensation is that it is always a no-fault insurance program. This means injured employees give up the tort option of suing their employer and the requirement of proving negligence to receive benefits. Injured workers do not need to establish liability, a process that is often time-consuming and complicated.

What Does Workers’ Compensation Cover?

Workers’ compensation covers most types of illnesses and injuries sustained on the job. Workers’ comp doesn’t just cover physical injuries. It can be extended to include mental illness as well. The most important qualification for coverage is that the injury or illness was sustained on the job or the job contributed to the condition.

Workers’ comp can provide coverage for injuries that occur outside of the workplace as long as the employee was working within the scope of their job, such as a driver making deliveries who gets into a car accident. Employees can receive coverage for long-term illnesses and injuries as well as repetitive stress injuries, heart conditions, chronic back pain, and mental illnesses related to the job.

Workers’ Comp Benefits Can Include Coverage for:

  • Medical and hospital expenses
  • Rehabilitation
  • Disability payments to replace about 2/3 of your regular wages while you are unable to work
  • Retraining
  • Death benefits for employees who are killed on the job

Who Qualifies for Workers’ Compensation?

Qualifying for workers’ comp requires meeting only a few basic eligibility requirements. You must be an employee with an employer that carries workers’ comp insurance. You must also have a work-related illness or injury and meet state deadlines for reporting your injury and filing a claim. Figuring out all of these conditions on your own can be difficult, especially in your moment of crisis, so hiring a compensation lawyer can be pretty useful.

There are only a few exceptions to workers’ comp coverage. It typically won’t cover injuries that occur when the employee is using illegal drugs or alcohol, self-inflicted injuries, injuries sustained while committing a crime, injuries that occur when the employee violates company policy, and injuries that happen when the employee is not on the job.

Simon Greenberg

Simon is a health tech enthusiast who believes information technology can bring major improvements in healthcare cost and quality. He is currently working on ways to improve how we can connect and interact with our healthcare system. You can find him on and .

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