What is workers compensation, and what does it actually cover?

Workers compensation is a state-mandated insurance system covering employees injured on the job. It is no-fault, meaning benefits are paid regardless of who caused the injury, including cases where the worker was careless. In exchange, the system is generally the exclusive remedy, meaning the employee gives up the right to sue the employer for negligence. Benefits typically include medical treatment for the injury, partial wage replacement while unable to work, commonly around two thirds of average wages, permanent disability benefits where applicable, vocational rehabilitation, and death benefits to dependents.

Coverage is broader than acute accidents. Repetitive stress injuries developing over time, occupational illnesses from workplace exposure, and aggravation of a pre-existing condition by work duties are generally covered. Injuries during the ordinary commute usually are not, under what is called the coming and going rule, though travel that is part of the job typically is. Injuries from intoxication, from horseplay, or from intentional self-harm are commonly excluded, and those exclusions are where most disputes originate.

What to do if injured. Report the injury to your employer promptly and in writing, because state deadlines for notice are short and missing them can bar the claim entirely. Seek medical care and state clearly that the injury is work-related, since that determines how it is billed and documented. Follow your state's rules on choosing a physician, which vary from free choice to selection from an employer-approved list. Keep records of everything. Retaliation for filing a claim is prohibited in every state, and if a claim is denied there is an administrative appeal process. Independent contractors are generally not covered, which is one of the practical stakes in worker misclassification, and in the specific case where a third party rather than the employer caused the injury, a separate personal injury claim against that party may exist alongside the workers compensation claim.