FAQ

Who pays workers' compensation benefits?

In most states, employers are required to purchase insurance for their employees from a workers' compensation insurance company -- also called an insurance carrier. In some states, larger employers who are clearly solvent are allowed to self-insure or act as their own insurance companies, while smaller companies (with fewer than three or four employees) are not required to carry workers' compensation insurance at all. When a worker is injured, his or her claim is filed with the insurance company -- or self-insuring employer -- who pays medical and disability benefits according to a state-approved formula.

Are all on-the-job injuries covered by workers' compensation?

Most are. The workers' compensation system is designed to provide benefits to injured workers no matter whether an injury is caused by the employer's or employee's negligence. But there are some limits. Generally, injuries caused because an employee is intoxicated or using illegal drugs are not covered by workers' compensation. Coverage may also be denied in situations involving:

• self-inflicted injuries (including those caused by a person who starts a fight)
• injuries suffered while a worker was committing a serious crime
• injuries suffered while an employee was not on the job, and
• injuries suffered when an employee's conduct violated company policy.

Does an injury have to have a definite date of onset in order to be covered?

Not necessarily. Your injury does not need to be caused by an accident -- such as a fall from a ladder. Many workers, for example, receive compensation for repetitive stress injuries, including carpal tunnel syndrome and back problems, that are caused by overuse or misuse over a long period of time. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions -- for example, heart conditions, lung disease and stress-related digestive problems.

Are You Covered by Workers' Compensation? Most workers are eligible for workers' compensation coverage, but every state excludes some workers. Exclusions often include: business owners independent contractors casual workers domestic employees in private homes farm workers maritime workers railroad employees, and unpaid volunteers. Check the workers' compensation law of your state to see whether these exclusions affect you. Federal government employees are also excluded from state workers' compensation coverage, but they receive workers' compensation benefits under a separate federal law. In addition, about one-third of the states do not require workers' compensation coverage from employers having fewer than a designated number of employees -- three to five, depending on the state. So, if you work for one of these employers, you may be excluded from the state program.

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Disclaimer

This publication and the information included in it are not intended to serve as a substitute for consultation with an attorney. Specific legal issues, concerns and conditions always require the advice of appropriate legal professionals.