How Workers Comp Claims Work

Worker’s compensation or worker’s comp is an insurance policy that was created to protect business owners and their workers. Thanks to this policy, employees who sustain injuries on the job can receive compensation to help cover expenses including medical costs, lost wages, therapy, and more. Employers also benefit from having an all-inclusive worker’s compensation package because it protects their business from covering out-of-pocket expenses. It also protects businesses from possible lawsuits taken by the employee. Workers comp claims can sound scary and be somewhat overwhelming if you do not have knowledge about what it is and how it works. Fortunately, this article will help you understand the factors to consider and steps to follow in navigating it.

Workers’ compensation: How Does it Work?

Workers’ compensation insurance benefits employees by providing them with compensation in case of work-related illnesses or injuries. Workers comp claims provide coverage for the medical expenses of injured or sick workers. The compensation can also cover salary or income from lost work time.

Workers’ comp insurance is intended to protect not only workers, but companies and business owners as well. Workers comp insurance was made to:

  • Help and protect companies in different industries.
  • Encourage safety of employees at work
  • Help workers get back to work or transitional work
  • Give workers access to training for new skills

Many states require companies to carry worker’s compensation insurance for their employees. It should be noted, however, that requirements for workers’ compensation vary from state to state.

Once a workers comp claims are filed, the injured or sick employee must accept it. Employees are qualified for workers’ compensation insurance regardless of whose fault the injury or illness was—as long as it happened or was caused by work.


Workers and Employers Both Benefit from Workers Compensation

Workers’ compensation claims and insurance is meant to protect employers and employees alike. Below are some of the ways workers compensation benefits both parties:

Benefit for Employees

For sick and/or injured employees, workers comp claims benefits depends several factors such as type of injury or illness, state requirements, and specific policies. Employees also get access to other benefits such as compensation for permanent injuries, vocational rehabilitation, and survivor’s benefits.

Benefit for Employers

Workers compensation insurance policies help protect business owners and managers. Without this, they’ll end up being financially responsible for employees who get injured or sick for work-related reasons.

For instance, let’s say you’re a business owner and one of your employees slips and falls and hits their head while carrying a heavy box. He’s immediately taken to the hospital via ambulance. At the hospital, it is discovered that they sustained a broken arm and need surgery. Without a workers compensation measure in place, you could end up paying for your worker’s medical expenses from your own pocket. If you’re unable to cover the costs, your business could end up at risk of a lawsuit.

Who Pays for Workers Comp Claims?

Even though workers’ compensation measures benefit employees, they aren’t required to contribute to the cost. Employers are generally required to pay the insurance company for workers’ compensation coverage.

Workers’ compensation claims can have very complicated processes. It can be different depending on each state. But, in general, if one of your workers get injured or sick for work-related reasons, they have to inform you immediately. There is a specific timeframe for an employee to report an injury or sickness to you. If they take too long to report it, you will not be able to file a workers’ compensation claim. As a result, your workers could lose their benefits. 

Once your workers report the illness or injury to you, you can file the workers’ compensation claim right away. The Workers’ Compensation Board or Agency in your state will then process the claim and direct an insurance company to provide the aforementioned employee with payments and benefits. 

Employers are also required to report the incident to the local Occupational Safety and Health Administration. Based on how severe the injury is, you might be required to report the accident/incident within eight to twenty-four hours. 

Are There Injuries Not Covered by Workers’ Compensation Claims Insurance?

Only injuries resulting from work-related accidents or illnesses that happen due to work are covered by workers’ compensation claims insurance. However, there are some situations wherein workers’ comp insurance is not applicable.

Here are a few examples of injuries covered by workers’ comp claims:

  • Back injuries from repetitive tasks
  • Carpal tunnel
  • Slips and falls at work
  • Lung problems or illnesses due to inhaling poisonous fumes and toxic substances
  • Injuries from car accidents while driving for business 

Injuries not covered by workers’ compensation claims are as follows:

  • When it’s proven that the worker or employee involved was under the influence of drugs or alcohol at the time of injury
  • Injuries that are self-inflicted
  • The employee was not on duty at the time of injury

How Does This Affect the Employer?

Most states in the United States require employers to carry workers compensation claims measures and insurance. If they are unable to or refuse to comply, they can face possible fines or lawsuits. If your business employ workers, then you need to have workers’ compensation insurance. You can get workers compensation coverage by phone, online, or through your insurance agent.

Who are Covered by Workers Compensation Claims Insurance?

This insurance policy covers a wide variety of employees. But there are states with regulations that exclude some types of employees from the workers comp claims insurance. These employeesa are as follows:

  • Business owners
  • Volunteers
  • Independent contractors
  • Private homes employees
  • Railroad workers
  • Maritime workers
  • Casual workers


Workers compensation insurance is beneficial and helpful not only to sick or injured workers, but for employers as well. This measure helps businesses avoid the real cost of employees’ medical expenses and lost wages after an accident or illness. If a company fails to provide workers with workers compensation coverage, the resulting medical expenses with just a single workers’ compensation claim could cause significant financial damage to a company. 

If you want to protect yourself and your business from lawsuits and focus more and improving your practice and bettering the lives of your workers, get workers compensation insurance.


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