Workers’ compensation insurance offers much-needed assistance to people who have suffered injuries in the workplace. When you suffer an injury at work, you likely have the right to file for workers’ compensation regardless of what caused your accident. Workers’ comp helps many injured employees cover their expenses while recovering from their workplace injuries.
What exactly does workers’ compensation cover, and for what expenses should you expect to receive compensation? Read on for more information.
Coverage for Immediate Medical Treatment
Medical treatment for severe injuries or illnesses related to workplace incidents, from broken bones to repetitive stress injuries, can prove expensive and take years or perhaps never heal. While a severe injury needs prompt medical attention, lesser injuries sometimes go ignored. In fact, some people may choose to forego, or temporarily forego, medical treatment when they start to see minor signs of repetitive stress injuries or suffer a minor workplace injury.
As part of a workers’ compensation claim, however, you can claim coverage for your immediate medical treatment, whether you head to an emergency room or an urgent care center. Sometimes, your workplace may have a specific clinic or provider that you need to visit for minor injuries. That clinic may provide immediate treatment for your injuries or send you on to a larger medical care facility or more specialized provider. If you have to leave your workplace and proceed immediately to an urgent care provider or hospital because of the extent of your injuries, your workers’ compensation insurance should cover those costs.
Payment of Ongoing Medical Expenses
Following a serious workplace injury, or a severe illness sustained because of your work, you may have immense medical expenses. For example, you may have to have surgery, go through long-term physical therapy, or even require in-home care to aid you in your recovery.
Many people worry about the extent of those medical bills and how to manage future finances. Workers’ compensation can make managing those expenses much easier, since workers’ comp covers the cost of those medical bills. Unlike traditional personal injury claims, you will not have to wait for a settlement to arrive, either. Instead, your workers’ compensation provider will take care of those medical costs for you.
However, that coverage does come with a challenge that many accident victims may struggle to contend with. You may have to get approval through workers’ compensation before you can move forward with the treatment you need for your injuries, and workers’ compensation may deny the treatments your doctor recommends.
When Workers’ Compensation Denies Your Medical Procedures
Workers’ compensation may throw some roadblocks in your way as you try to get the medical procedures you need to recover from your accident.
You may have to use less-expensive options—even if they do not typically prove as effective in dealing with your injury—first.
Workers’ compensation may require you to try a less expensive procedure first, even if your doctor recommends a different one. For example, your doctor may recommend that you have surgery to treat your injury, but workers’ compensation may require you to try physical therapy first, even if it rarely has the desired outcome. Other times, the workers’ compensation program may pressure you to avoid expensive procedures until you have tried other options, even if your doctor feels that those expensive procedures will have the best odds of helping you make a full recovery.
You may have to use a specific medical provider chosen by the workers’ compensation program, rather than the provider that you would prefer to use to treat your injuries.
Many workplace injury victims find that workers’ compensation dictates which providers they can use. Unlike some health insurance companies, workers’ compensation may not offer a broad network of providers you can choose from. In some cases, you may have relatively few options. Workers’ compensation may even try to insist that you use a specific provider to treat your injuries, even if that provider does not meet your specific needs. Typically, workers’ compensation insurance will make a deal with a specific provider, and that provider will offer better deals on the procedures that workplace injury victims must receive. However, those providers might not fully fit your needs.
The providers available to you might prove geographically inconvenient, especially if you live some distance from your workplace. They might not have expertise in the specific field you need to treat your injuries. They might just not offer a good personality fit for you. You may still, however, have to use those providers.
Delays in Workers’ Compensation Approval
Sometimes, workers’ compensation will approve your claim, but you may have a long road to getting the approval you need for the procedures recommended by your doctor. In fact, many people feel that workers’ compensation drags the recovery process out longer than necessary, since some injured individuals may not get to undergo the procedures they need until long after a doctor recommends them.
You may have to have specific procedures or visits approved in batches.
Your medical care provider, for example, may recommend that you have physical therapy for several weeks or even months while you recover from your injuries. However, your workers’ compensation insurance may require you to have those sessions approved in batches: for example, you might only get approval for 12 sessions at a time. If you need to have three sessions per week, you may quickly run out of sessions, and you may have a delay before you can go back for further therapy. As a result, you may miss out on progress you could otherwise have made toward your recovery.
It may take time to get specific procedures approved.
You may have immense challenges related to getting specific procedures, especially expensive ones, approved by your workers’ compensation provider. In some cases, those claim delays can interfere with your overall recovery or make it difficult for you to manage the symptoms of your injury.
If you do suffer delays in workers’ compensation approval, working with an experienced workers’ compensation attorney can help you learn more about your legal rights and what you should do if your workers’ compensation insurance company refuses to cover the treatments or procedures you need to recover promptly.
Compensation for Your Lost Income
While you recover from your injuries, you might not have the ability to work. Frequently, after a workplace injury, especially a repetitive stress injury, your company will want you to take time off work while you recover. In the meantime, however, you may still need a source of income to support yourself and your family.
Workers’ compensation helps provide a source of income during your recovery. It does not, however, replace your full income. In Nevada, you can recover a maximum of two-thirds of your income while you remain out of work due to on-the-job injuries. Nevada also establishes a cap of $966.24 per week. You will start drawing workers’ compensation after you fill out Form C-4, which will establish your need to remain out of work and your right to compensation under Nevada law. If you do not fill out that form within 90 days of your accident, you may not receive workers’ compensation assistance for your injuries and your lost wages.
If you filed a personal injury claim, payment for your lost income would occur when you settle your claim. Workers’ compensation, however, pays the relevant percentage of your salary each week, rather than a lump sum at the end. You can continue to draw workers’ compensation as long as you remain out of work because of your injury.
In some cases, you may continue drawing workers’ compensation benefits until you turn 70, if your injuries permanently prevent you from returning to work. However, you should consult with an attorney as soon as possible to learn more about your rights, including how long your employer should pay out compensation for the injuries you sustained.
Sometimes, you can return to work within a few weeks or months of suffering even a relatively serious injury. You may bounce back from your injuries and go back to earning a normal income. Some injuries, however, may result in permanent disability. If your injuries prevent you from working altogether, you may have the right to draw permanent disability for your injuries. Your employer may also work out a settlement that will allow you to draw a lump sum payment. However, that usually occurs at your employer’s discretion.
If you suffered permanent disability because of your injuries, you should consult an attorney to learn more about your rights, including the value of your claim and how you should pursue maximum compensation given your specific circumstances.
When Can You Claim Workers’ Compensation?
To claim workers’ compensation coverage, you must suffer an injury at work or while completing your usual job responsibilities. Workers’ comp injuries may include:
Injuries that occur at your usual workplace or worksite while on the clock.
Most employees report to work at a specific location. If you suffer an injury at your place of employment while on the clock, you have the right to claim workers’ compensation for the injuries you sustained. You can also potentially claim compensation if you suffer an injury on your way to clock in at work or as you leave the building after clocking out.
Suppose, for example, that you suffer a slip and fall accident while leaving the store where you work at the end of your shift: you might still have the right to claim workers’ compensation.
On the other hand, suppose that you stayed after your shift to shop in your store. You slipped and fell while browsing the aisles, not while completing any type of work duty.
In that case, you might not have the right to claim compensation for a workplace injury. You might, however, have the right to file a personal injury claim if your injury occurred as a result of negligence on the part of your employer, like a spill that employees on the clock at the time of the incident did not clean up.
Injuries that occur while off-site, but still while completing work duties.
If you drive in the daily course of your job, and you suffer injuries due to your work responsibilities, you might have the right to claim workers’ compensation. Suppose, for example, that you work as a delivery driver. If you have a car accident on the way to work, regardless of how your accident occurred, you may have the right to claim workers’ compensation to cover the costs of those injuries.
Injuries that occur for any reason, regardless of who committed an act of negligence.
Workers’ compensation, unlike other types of personal injury claims, provides coverage regardless of who caused the accident. Suppose, for example, that you suffered injuries at work because of the negligent actions of a customer.
Your employer could have done nothing to prevent those injuries, but you can still claim workers’ compensation benefits because the injury occurred at work while taking care of regular work responsibilities. Likewise, if your employer committed a minor act of negligence, like failing to send someone to clean up a spill, you may have grounds for a workers’ compensation claim.
Many employees also find it important to note that if their own negligence inadvertently caused an injury, they still have the right to claim workers’ compensation. Suppose, for example, that you climbed up on an unsafe chair to grab something off of a high shelf in your office, rather than using a step stool or finding a taller coworker. If you fall and suffer injuries, you may have grounds for a workers’ compensation claim.
On the other hand, if you deliberately cause your injuries to get out of work, you will not have grounds for a workers’ compensation claim.
Do you have questions about the compensation you may have the right to recover and how to pursue it after a workplace accident? Contact an attorney to learn more about your legal rights and options.