Many people aren’t sure whether or not they may qualify for workers’ compensation benefits if they’re hurt or sick on the job. Below, we’ll address some of the most frequently asked questions with answers that should apply to everyone, regardless of individual state laws.
Top 5 Workers’ Compensation FAQs, Answered
1. What factors might help me qualify for workers’ compensation benefits?
Unless you’re a federal government employee, workers’ compensation laws and eligibility guidelines vary from state to state. However, there are a few general factors that help determine if you’ll qualify, including:
- Your injury or illness occurs while performing your usual job duties in the workplace.
- The incident occurred as a result of your employer’s negligence. (For example: You slipped in a wet spot from leaking equipment that doesn’t meet OSHA safety standards.)
- You got sick or hurt during regular work hours (or on your scheduled shift). If you’re a restaurant worker eating there while off the clock and someone burns you, it won’t qualify for workers’ compensation. But if hot oil splatters in the kitchen and burns you during your regular work shift, you’ll likely qualify.
- Your injury or illness forces you to stop working for at least 3-7 days while you recover. This rule varies depending on where you live, but in most cases, there’s a mandatory waiting period before you can qualify for workers’ compensation benefits.
- You incurred medical expenses specifically due to a workplace injury or illness. We strongly recommend seeking medical attention any time you’re hurt or sick on the job. If you slip and fall, you may not realize you’ve sustained a concussion until hours or days later, for example.
- You’re unable to return to work immediately and lose wages as a result of your workplace illness or injury. This ties directly into #4 and #5 listed above.
2. What injuries typically qualify for workers’ compensation benefits?
Not sure if your injury might qualify for workers’ compensation? Check out the most-approved injuries for workman’s comp benefits in our interactive infographic below. Important: For the first time, exposure to harmful environments and transmissible illnesses that affect the whole body ranked #1 in 2020. This is due to the number of claims filed when people got sick with Covid-19 from workplace exposure.
3. What’s the best way to seek medical treatment if I’m planning to file a workers’ comp claim?
You absolutely should seek immediate medical care in order to qualify for workers’ comp benefits. However, many states allow you to choose which doctor treats your injury or illness immediately after your accident. If your employer’s policy requires you to see their preferred healthcare provider instead, that information should be readily available to you at work. In some cases, your employer’s insurance company will ask you to to come in for a follow-up exam with a doctor of their own choosing. If this happens, don’t skip your exam! And if your injury takes weeks or months to heal, you may need to attend additional medical exams every 60 days or so. That doctor’s diagnosis plays a key role in whether your workers’ compensation claim gets approved or denied. If you have any concerns about your medical exam or provider, it’s best to consult an experienced workers’ comp attorney.
4. What should I do if my employer asks about my injury/condition while I’m at home recovering?
When your employer contacts you at home to ask how badly you’re hurt and when you’ll return to work, consider that a red flag. If this happens to you, we strongly recommend contacting a workers’ comp lawyer immediately. Answering without getting legal advice first that applies to your specific situation could put your workers’ compensation claim at risk.
5. How long does it usually take to get workers’ comp benefits after filing my claim?
Again, the usual payment timeline varies from state to state (unless you’re a federal employee). However, if your claim’s approved, your employer’s insurance provider should notify you when to expect payment. In many states, you can start getting workers’ comp payments in as little as 30 days after approval.
If you’re a federal employee filing a workers’ compensation claim, your review time may take longer. According to current OWCP data, workers’ comp claims typically take 3-6 months for review and approval. The SSA may approve your benefits claim in as little as three months. However, most claims require workers to undergo a second medical exam. These follow-up exams could make your individual case review time stretch out to six months or longer. If that happens to you, your first workers’ compensation benefits payment may arrive closer to the six-month mark after filing your claim.
Lori Polemenakos is Director of Consumer Content and SEO strategist for LeadingResponse, a legal marketing company. An award-winning journalist, writer and editor based in Dallas, Texas, she's produced articles for major brands such as Match.com, Yahoo!, MSN, AOL, Xfinity, Mail.com, and edited several published books. Since 2016, she's published hundreds of articles about Social Security disability, workers' compensation, veterans' benefits, personal injury, mass tort, auto accident claims, bankruptcy, employment law and other related legal issues.