The Employee's Guide to Workers' Comp Insurance

As a W-2 employee, you're not required to purchase workers' compensation insurance to cover yourself. However, knowing a bit about how your employer's workers' comp policy works could save you from unnecessary losses. Knowing your rights as an employee is important and can help ensure your employer pays for your medical expenses for work-related accidents, injuries, and illnesses.

A local independent insurance agent can also help you understand how you're covered by workers' compensation. They can review your employer's policy with you and explain how coverage works. But first, here's a complete guide to workers' compensation insurance for employees, including some of the most commonly asked questions about this coverage.

What Is Worker's Compensation Insurance?

Workers' compensation insurance is a policy held by the employer or subcontractor that pays for expenses relating to injury or illness as a result of getting hurt or sick on the job. For a W-2 employee, you are covered under your employer's workers' compensation policy if they have one.

Some states mandate this coverage for any employers with a certain number of employees, with limited exceptions. However, each state has unique workers' comp state laws. Each employee is assigned a classification code depending on what their job duties entail. The riskier the job duty, the higher the workers' compensation premium is for your employer.

How Does Workers' Compensation Insurance Cover Employees?

Workers' comp can cover expenses related to necessary medical care to treat cases of occupational illness, injury, or disability. A workers' comp policy can reimburse employees or their beneficiaries for the following:

Workers' comp also protects employers from a liability standpoint. If an employer follows state workers' compensation laws and obtains enough coverage for all of its employees according to official regulations, then these employees are exempt from filing lawsuits against the business for covered incidents.

Workers who have suffered a work-related injury, illness, disability, or fatality are not allowed to sue the employer, nor are their family members. However, uninsured employers who are also not self-insured open themselves up to employee lawsuits for these incidents as well as possible state penalties for non-compliance.

When Do Employees Qualify for Workers' Comp Coverage?

Employees qualify for workers' comp coverage if they sustain an injury, illness, or disability due to a workplace accident or incident, or if the condition develops over time, such as due to repetitive motions or job tasks. To be covered, a condition must have been caused by either required job duties or the work environment.

When Are Employees Not Covered by Workers' Comp?

Injuries, illnesses, and disabilities are not covered if the employee was intoxicated at work or failed to follow proper safety procedures when it occurred. Injuries, etc., that did not result from the job in some way are also not covered and would fall under a private health insurance policy.

Does an Injured Employee Have to Pay for Medical Treatment?

If your employer has an active workers' compensation policy, as a qualified employee, you can file a claim for an injury, illness, or disability caused by your job or workplace. If your employer does not have a workers' compensation policy, you may need to seek legal counsel about your options for medical expenses if your employer is unwilling to pay.

Should an Employee Stay in Contact with Their Employer During Temporary Disability Leave?

Yes, after filing an approved workers' compensation claim and receiving temporary disability leave, it's wise to keep in touch with the business. Staying in contact with your employer is beneficial for both parties and can get you back to work sooner with light-duty tasks until you're ready to resume all of your normal job duties.

How Long Does Medical Treatment Last Under Workers' Compensation?

The length of your medical treatment will vary depending on your injury or condition. Your treatment must last for the duration of recovery ordered by your caring physician or medical professional. 

It's not advised to return to work before your prescribed treatment ends. This may cause complications in the workers' comp benefits you have received.

What If an Employee Disagrees with the Treating Physician's Findings?

The claimant is able to choose another physician or medical care provider from a list of approved facilities by the workers' comp insurer if they're unhappy with the first doctor they see. However, the insurance company can call for a third opinion of their own choosing to ensure that your selected second opinion is worthy.

What If an Employee Does Not Receive the Benefits They Were Promised?

If you're not receiving the promised benefits from your employer's workers' compensation coverage, the best resource is your independent insurance agent, possibly in addition to legal counsel. Your independent insurance agent can fight on your behalf where they have jurisdiction, and they can tell you if they feel you should hire legal counsel. You can work with a workers' compensation lawyer to dispute with your employer's insurance carrier.

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Does an Employee Have to Use Their Sick or Vacation Time While They're off Work to Recover?

Whether an employee will be required to use their vacation or sick leave during recovery for a covered illness, injury, or disability depends. It's best to discuss this question with your employer's workers' compensation claims adjuster. If you find their information or coverage unsatisfactory, your independent insurance agent or legal counsel can further assist you.

Is an Employee Paid for the Time Spent Going to Doctor's Appointments?

In many cases, workers' comp laws dictate a seven-day waiting period for coverage to begin. This period refers to the time after the injury or illness occurs. During this waiting period, the employer doesn't have to pay the employee for time off work, even to go to doctor's appointments. 

If the employee is able to return to work within these seven days, the employer likely won't have to pay them for any missed work. However, more serious injuries, illnesses, and disabilities that require an employee to miss at least eight days of work can result in compensation from the employer for the time off.

How Do You Know If Your Employer Has a Workers' Compensation Policy?

It's best to ask your employer outright if they have workers' compensation coverage. If they don't, you may decide not to work for them as a personal decision. 

Which employers provide workers' compensation insurance depends on whether their state mandates coverage. Even if the state doesn't require coverage by law, many employers still choose to get a policy to protect themselves and their employees. 

Unfortunately, not all employers are so willing to spare the extra expense that comes with a workers' compensation policy if they're not actually required to have coverage. To better protect yourself, it's wise to ask the employer questions about workers' comp coverage and protection for the business's employees before signing a contract with them.

The Benefits of an Independent Insurance Agent

When you have questions about how workers' compensation insurance protection works or you're looking to find coverage, no one's better equipped to help than an independent insurance agent. These agents have access to multiple workers' comp insurance companies, so they're free to shop and compare policies and rates for you. 

They can also answer any coverage questions you may have. And down the road, your agent will still be there to help update your coverage as necessary and can even file workers' comp claims for you.