Best Standard Workers' Compensation Coverage

What coverage does workers’ compensation provide?

Workers’ compensation insurance reduces a company’s liability for work-related injuries and illnesses. Without coverage, an employee can sue his or her company to help pay for their medical expenses, lost wages, ongoing care costs, and funeral expenses. For medical expenses, workers’ compensation can include emergency room visits, necessary surgeries, and prescriptions.

Workers’ comp can also cover repetitive injury on the job. Injury like carpal tunnel syndrome, for instance, can develop over months or years. In that case, workers’ comp can help cover ongoing care bills and other costs. In addition, workers’ comp coverage can provide benefits to employees who are temporarily or permanently disabled on the job, to help pay for medical bills and replace lost wages.

How does the workers’ compensation coverage claim process work?

Workers’ compensation claim process varies from state to state, but regardless of your location, it is crucial to begin claim processing immediately following a work-related illness or injury. Important requirements for each company to know are to ensure injured or sick employees receive immediate medical care; employees should notify employers about work-related injury or illness immediately; and employers need to contact workers’ comp providers to submit a claim (and, depending on your state, notify state-run workers’ compensation board). Afterward, the company’s provider reviews the claim and approves or denies benefits.

Typically, states have a timeframe when a worker can report a work-related injury to his or her superior – usually 30-90 days – and time limitations for when an employer can report a workers’ compensation injury to their insurer.  

What is the average settlement for workers’ compensation?

A variety of factors dictate how much money an employee will receive in a workers’ compensation settlement. The average workers’ comp settlement amount is $20,000, but settlements can range from $2,000 to $40,000. While that seems like a wide range in possible payout amounts, injuries that qualify for workers’ comp settlement are also wide ranging, as are the amounts required to cover fees and lost wages.

Most often, employees who fill out claims will get a reimbursement – and there are specific approaches that can help employees receive larger settlements across the board. An employee, once offered a settlement amount, has the option to negotiate the workers’ comp terms and payout amount. Typically, if the employee accepts the first offer, he or she will receive much less than countering for a higher amount. Even starting negotiations, in many instances, can compel insurance companies to significantly increase the workers’ comp payout amount.

What does workers’ compensation not cover?

Workers’ compensation does not cover all work-related injuries. Typically, injuries or illnesses sustained while a worker is drunk or using illegal drugs, for instance, do not get covered. Coverage may be also denied due to self-inflicted injuries, i.e., if a worker starts a fight; injuries suffered while an employee committed a crime; injuries suffered while a worker was off the job; and injuries suffered when a worker violates company policy. However, an employee will be covered while traveling for work, conducting an errand for work, or attending a social function for an employer.

How long does it take to reach a settlement for workers’ compensation?

From filing a claim to receiving payment, the entire settlement process can take anywhere from 12-18 months, depending on the details of the case and whether the employee has legal representation. If the employee does not have legal representation, does not have a permanent disability, and does not wind up negotiating a settlement, the timeline reduces slightly to roughly 12-14 months. The settlement process typically takes longer with a lawyer, from roughly 17-18 months, or 20% longer – but with a more favorable outcome.

Do you get a lump sum from workers’ compensation?

The two different ways that a workers’ compensation claim can be settled are as a structured settlement or as a lump sum. For lump-sum settlements, the worker would sign a settlement agreement ending the case and, in return, they would receive a payment from his or her company or the insurance company. Employees would get payments over an agreed timeframe in structured settlement agreements.

However, it is important to understand the workers’ comp settlement process. Occasionally, an injured worker may refuse the initial offer and choose, instead, to hire a lawyer and pursue a larger settlement.
If this is possible, then why doesn’t every injured employee do this to get more money for the injury? Answer: if the employee decides to pursue a workers’ comp settlement, the chance also exists that they could be awarded less than what was initially offered by the insurer.

What happens if you get caught working while on workers’ compensation?

It is important to remember that an employee must report his or her earnings if they are working while collecting workers’ compensation. Otherwise, an example of workers’ compensation fraud is when an employee misrepresents his or her job status while receiving disability benefits.

An injured worker may be able to continue working a second job or take a separate job while collecting workers’ compensation – if neither will aggravate the employee’s injuries. For instance, if a worker was injured when doing physically demanding work, he or she may be able to take a less physically demanding job. In that case, taking an employee’s added income into account, the insurer will adjust his or her workers’ comp benefits.