People often have a lot of workers’ compensation questions, how it works, and what it covers and doesn’t cover. 

Workers’ compensation or workers’ comp provides wage and medical benefits for people who get sick or hurt at work. Each state mandates the coverage, and the benefits vary depending on the state as a result. It’s considered social insurance, and business owners are protected from civil liability if their employees get hurt at work. 

There are limitations to the benefits of workers’ comp for both employers and employees though 

All states, with a few exceptions, require businesses with non-owner employees to purchase workers’ compensation for those employees. If a business is required to have workers’ comp coverage and they don’t, it can lead to expensive consequences. 

An employee doesn’t have to be on work property to get coverage—they do have to be acting within the scope of their employment. For example, if someone is making a work delivery and they get into a car accident, this could make them eligible for coverage from workers’ comp. 

Once a claim is filed and processed, the sick or injured employee can be paid if the employer and the insurance company agree it’s a work-related injury or illness. If an employer doesn’t think the illness or injury was caused by work, then the claim can be disputed. 

If an employee is hurt or becomes ill, they have to report it to their employer in a timely way to be eligible for benefits. 

Once they report their illness or injury, the employee will get the required paperwork and forms from their employer. When an employee returns the completed paperwork, the employer files the claim with the insurance company. The employer may also have to notify the state agency or board about the illness or injury. 

Depending on what the outcome is, an employee may appeal it. 

The things that workers’ compensation generally doesn’t cover include:

To go back to our original question above, you can’t get workers’ compensation for pain and suffering. You can, however, get these benefits for psychological symptoms related to conditions like PTSD. If you want to seek damages for pain and suffering, you have to file a personal injury lawsuit. 

The big objective of workers’ compensation is to keep courts from being clogged up by injuries related to work and to make sure workers get expedited compensation for injuries. There is a tradeoff because employees can get compensation without proving fault, but the downside is the inability to win non-economic damages, including not only pain and suffering but emotional distress, loss of enjoyment of life, and mental anguish. 

In certain circumstances, you could be able to file a personal injury lawsuit.  One is if your employer intentionally hurts you by deliberately ignoring safety issues or physically assaulting you, for example. 

If your workplace accident is the fault of a third party, you may also be able to file a personal injury lawsuit. In these cases, it’s a good idea to work with an experienced personal injury attorney when exploring your workers’ compensation questions because it can be challenging to calculate pain and suffering damages. 

Again, it’s important to emphasize that every state has its own set of laws as far as workers’ compensation goes, so while most are similar, you may see some differences in specific issues depending on where you live. 

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