What Does Worker's Compensation Cover?

What Worker's Compensation Typically Covers

Worker's compensation covers medical expenses, lost wages, and rehabilitation costs when an employee is injured or becomes ill due to their job. It is a no-fault system, meaning the employee does not need to prove employer negligence to receive benefits. In return, the employee generally cannot sue the employer for additional damages. The specific coverage provided depends on state laws and the terms of the employer's insurance policy.

Medical Treatment

Coverage usually includes all reasonable and necessary medical treatment related to the workplace injury or illness. This can encompass emergency room visits, hospital stays, surgeries, doctor appointments, physical therapy, and prescription medications. In many cases, travel expenses for getting to medical appointments may also be covered.

Disability and Lost Wages

When an injury prevents an employee from working, worker's compensation provides disability payments to replace a portion of lost wages. These payments are typically classified as temporary total disability, temporary partial disability, permanent total disability, or permanent partial disability. The percentage of wages replaced and the duration of payments vary significantly by jurisdiction.

Rehabilitation and Death Benefits

Many policies cover vocational rehabilitation if an employee cannot return to their previous role, helping them retrain for a new occupation. If a workplace injury results in death, worker's compensation generally provides death benefits to dependents, which can include coverage of funeral and burial costs.

What Worker's Compensation Typically Does Not Cover

Worker's compensation does not cover injuries that occur while an employee is intoxicated, engaging in horseplay, or intentionally self-inflicting harm. It also generally excludes injuries sustained during a commute, unless the employee was traveling for work purposes. Independent contractors are usually not covered under a standard worker's compensation policy, though misclassification can sometimes lead to disputes about eligibility.

Filing a Claim

To access coverage, an employee must typically report the injury to their employer within a specific timeframe and file a formal claim with the state's worker's compensation board. Delays can result in a denial of benefits. Employers are required by law to carry worker's compensation insurance in most states, though the exact requirements and benefit structures differ from state to state.