If a worker is injured at work or develops a health condition due to the nature of the work—and if the worker’s employer has workers’ compensation insurance (is a subscriber)—the worker may file a workers’ compensation insurance claim. If the worker’s employer does not have workers’ compensation insurance the worker may choose to file a lawsuit against the employer—usually based on negligence in failing to provide a safe workplace.
Most employers do have workers’ compensation insurance and workers’ compensation claims are usually administered by a state agency—such as the Division of Workers’ Compensation, Department of Industrial Accidents, or Workforce Commission. An injured worker or other claimant (the estate representative of a deceased employee) may file a workers’ compensation claim by completing the form provided by the state—which is usually available online.
The state agency will then notify the employee’s employer and insurance carrier—if the employer has workers’ compensation insurance. An injured worker will usually be treated by a medical doctor or other health care provider and the worker’s compensation insurance carrier will evaluate the worker’s claim for benefits based in part on the health care provider’s diagnosis.
There are four types of workers' compensation benefits:
1. Income benefits replace some of the money the worker lost because of the work-related injury or illness—except for impairment income benefits. Types of income benefits include:
• temporary income benefits (TIBs);
• impairment income benefits (IIBs);
• supplemental income benefits (SIBs); and
• lifetime income benefits (LIBs).
2. Medical benefits pay for reasonable and necessary medical care to treat the worker's work-related injury or illness.
3. Burial benefits pay for some of an employee's funeral expenses to the person who paid those expenses.
4. Death benefits help families replace some of the money lost when an employee dies because of a work-related injury or illness. In some states spouses of first responders can get death benefits for life even if they remarry.
It is illegal for an employer to retaliate against a worker for filing a workers’ compensation claim. Retaliation may include firing or termination of employment, demotion, or other adverse employment action.