How to Apply for Worker’s Compensation in the US

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Worker’s safety at the workplace is the most valued ethos in modern-day employment practices. While it may be desirable that nothing unfortunate ever happens at the workplace, but if it does happen, the role of worker’s compensation becomes very important.

Worker’s compensation offers a financial cover to the employees in the event of a work-related injury or illness. In return, it generally prevents the employee from filing a lawsuit against the employer.

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Let us find out, in detail, how the concept of worker’s compensation works in the US. You too can apply for it, and we will show you how.

How to Apply for Worker's Compensation in the US

What exactly is worker’s compensation?

Worker’s compensation is a compulsory system of financial support for the employees across the states. It has been designed to protect the interests of the workers in the event of an injury or illness while at work or due to work-related issues. It applies to most forms of employment in most places in the US.

According to this system, the employers have to mandatorily invest in a compensation fund for each of their employees. This fund is used to take care of the treatment and medical assistance to the employees if an injury or illness is caused to him/her at work.

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Are you eligible for worker’s compensation?

One needs to fulfil minimum eligibility criteria to be able to receive benefits under worker’s compensation. To qualify for worker’s compensation you have meet certain criteria.

  1. You must be a registered employee of an organization.
  2. Your employer must have invested in the worker’s compensation insurance.
  3. A candidate should have received the injury or illness while at work or while fulfilling your job responsibilities.
  4. You must apply for compensation before the stipulated deadlines.

Also, worker’s compensation in the US does not cover stress or psychiatry related health issues, and the injuries occurred while commuting to and from the workplace. 

Pro-tip: Both the employer and the employee need to act promptly in the event of an unfortunate incident. The illness or injury must be reported within a stipulated time frame, or else the claim might be denied.

What is not covered under worker’s compensation?

You may be denied the benefits under the worker’s compensation scheme for some reasons.

  1. You have incurred an injury or illness that is self-inflicted and is not on the virtue of the work.
  2. The injury took place when a crime was being committed.
  3. You incurred the injury while violating an explicitly mentioned company policy.
  4. You were not present on the job or job site when the event in question took place.

How to apply?

Having figured out in what events and circumstances you are eligible to receive the worker’s compensation, let’s now look at how you can apply for it. The process of staking a claim for worker’s compensation typically involves 4 steps.

Reporting of injury/illness to the employer

The most important role in the entire claim process is that of the employer itself. However, to kick the process running, the employee has to report the illness or injury to the employer in the first place.

In an emergency, rushing to the hospital and receiving immediate medical aid is important. However, in all other cases, the employee should undergo a health checkup, get the issue diagnosed, and report to the employer even before starting the treatment. This will help expedite the process.

Paperwork and formalities

Once an illness or injury has been reported, the next step is to do all the necessary documentation and prepare a dossier to stake the claim.

This is done by the employer based on the papers and medical proofs provided by the employee.

Filing of the claim by the employer

With the entire documentation ready, the employer would next file a claim with the concerned insurer. It is an online process that is simple and quick.

Approval or denial of the claim

Finally, the insurer would review the claim for worker’s compensation. Based on the hard facts of the case and the documentation, the insurer can either approve or reject the claim.

If accepted, the compensation amount will be processed against the actuals and credited directly to the bank account, within days.

In case the claim is rejected and the employee is not satisfied with the decision, he or she can file for reconsideration and ask the insurer to review it once again.

How to Apply for Worker's Compensation in the US

The bottom line

Worker’s compensation can prove to be a life savior in many cases. Therefore, knowing its benefits and how to apply for it is important.

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