Workers’ compensation insurance is designed to provide benefits to individuals injured in the course of their employment, according to Cornell University School of Law. Workers’ compensation laws exist to provide fixed monetary awards. This is done in an attempt to avoid litigation regarding injuries sustained in the workplace. There are five key facts that you need to understand how workers’ compensation insurance works.

1. What Types of Losses are Covered by Workers’ Compensation Insurance?

The types of losses covered by workers’ compensation insurance do depend on the nature and extent of injuries sustained by a worker. With that said, the types of losses typically covered by workers’ compensation insurance include medical bills and expenses, pain and suffering, permanent disability or disfigurement, and lost wages or salary.

2. Does the Employer Need to be at Fault for Workers’ Comp Benefits to be Paid?

One of the key principles underpinning workers’ compensation insurance is that an injured worker does not need to demonstrate fault on the part of an employer to obtain coverage for losses. This differs from a personal injury case. In a personal injury case, an injured person needs to establish that another party was negligent or responsible for causing an accident and the resulting injury. A worker must only initially establish that an injury occurred during employment.

3. Can a Lawsuit be Filed Instead of Obtaining Workers’ Compensation Benefits?

In nearly all U.S. jurisdictions, an employee does not have the option to file a lawsuit instead of a workers’ compensation claim. In other words, under the workers’ compensation laws of a particular state, the only avenue for recovery following a work-related accident is pursuing a claim via a workers’ compensation insurance policy or the state workers’ compensation fund.

4. Are There Timeframes to File a Workers’ Compensation Claim?

There are specific timeframes that must be followed when an injured worker files a workers’ compensation claim. First, an employee typically needs to report an accident to an immediate supervisor promptly. Second, an employee will then need to file a formal, written workers’ compensation claim by a specific deadline. The failure to meet these deadlines can negatively impact a workers’ ability to pursue a claim.

Keep in mind that there are both state and federal laws governing workers’ compensation claims, according to the U.S. Department of Labor. An injured worker needs to understand what laws are involved in a particular case. Often, this is best accomplished with experienced legal representation

5. What Types of Medical Examinations Occur in a Workers’ Compensation Case?

There can be a variety of different types of medical examination associated with a workers’ compensation claim. With that said, there are two primary types of medical examinations to anticipate after filing a workers’ compensation claim.

First, there will be a medical examination by a physician designated by the workers’ compensation insurance company. Second, a worker who files a claim also has the legal right to obtain an independent medical evaluation from a physician of his or her choosing.