What is the Workers’ Compensation Program?

In the U.S., one of the most widely accessed entitlement programs is Workers’ Compensation. Workers’ compensation is a series of benefits that are paid to employees that are injured or become ill during and as a result of the performance of their jobs. Employers are required by law to provide this benefit to their employees and typically do so through a workers’ compensation insurance policy provided by a private carrier. Virtually every employee is covered by the Workers’ Compensation Act and benefits are paid to the employee regardless of who is at fault for the accident and/or injury.

The actual procedure for filing a workers’ compensation claim is generally straightforward and can be done by the injured party. However, the system has definite filing requirements and depending upon circumstances and documentation requirements, preparing the claim can become a complicated process and should not be attempted without a worker’s compensation attorney. States and cities may also have individual requirements regarding workers’ compensation, so it is important when choosing a worker’s compensation attorney to have representation from the proper state or jurisdiction. Attorneys who do not specialize in workers’ compensation law and are from outside the jurisdiction likely will not be able to properly represent your claim.

A workers’ compensation claim is similar to a claim against an auto or homeowner’s insurance company. It is a claim filed against the employer’s workers’ compensation insurance carrier and is not a law suit directed at the employer. In fact, the law provides that: (1) injured workers cannot sue employers for accidents occurring on the job and, (2) it is also illegal for employers to terminate workers for filing a workers’ compensation claim.

Under workers’ compensation, the main benefit categories are, but not limited to:

Payment of related medical bills;
Benefits paid when the worker temporarily cannot work due to the injury or illness. This is titled Temporary Total Disability (TTD) and is likely a series of ongoing payments until the worker can return to work.
Benefits paid when the worker is injured to the point that he/she cannot return to work at all. This is called Permanent Disability (PD). Based on the nature and extent of the injury, PD benefits are, very often, a lump sum settlement.
It must be understood that all insurance companies are actively reviewing cases for legitimacy and to minimize fraudulent claims and their cost of claims. Depending on circumstances and for any number of reasons, a worker’s compensation insurance carrier may deny benefit payments at the beginning of the claim or may be terminate compensation after initial benefits have been paid. Questions and positions regarding TTD and PD also are often contested as are charges of illegal firing due to the injury. Since the insurance company will employ experts in the workers’ compensation arena, in these situations, it is crucial to have an experienced workers’ compensation attorney who will advocate for you to get your legal benefits restored and the settlements to which you are entitled.

Navigating through the workers’ compensation benefit system can be a difficult task, especially if there are contested issues and/or special circumstances. It is a wise decision to engage the services of an experienced workers’ compensation attorney early in the claim to guide you and represent you through the process.

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