Whats Covered

What types of incidents are and are not covered by workers’ compensation insurance?

Workers’ compensation insurance is designed to cover injuries that result from employees’ or employers’ carelessness. The range of injuries and situations covered is broad, but there are limits. States can impose drug and alcohol testing on the injured employee, and can deny the employee workers’ compensation benefits if such tests show the employee was under the influence at the time of the injury. Compensation may also be denied if the injuries were self-inflicted; where the employee was violating a law or company policy; and where the employee was not on the job at the time of the injury.

What types of expenses does workers’ compensation insurance cover?

Although the payments are usually modest, workers’ compensation insurance covers

  • medical care from the injury or illness
  • replacement income
  • costs for retraining
  • compensation for any permanent injuries
  • benefits to survivors of workers who are killed on the job

But remember that if a person collects workers’ compensation benefits, he or she cannot sue the employer. And workers’ compensation benefits do NOT cover pain and suffering.

Wage replacement is usually two/thirds of the worker’s average wage, but there is a fixed maximum amount that the benefits will not go over. That may seem modest, but note that these benefits are not taxed. So, as long as the employee was making a fair wage, he or she should have no major problems. The eligibility for wage replacement begins immediately after a few days of work are missed because of a particular injury or illness.

Does workers’ compensation insurance cover long-term and permanent injuries?

Yes. Workers’ compensation insurance is not limited to just incidental accidents. It also covers problems and illnesses that are developed over a long period of time of doing the same injurious activity–for example, carpal tunnel syndrome or back problems from some sort of repetitious movement.

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