What Workers’ Compensation Covers and What It Doesn’t
Understanding what workers’ compensation covers and what it does not is important if you are thinking about filing a claim.
In 2019 there were 5,333 workplace fatalities. The U.S. Department of Labor reports that accidents relating to transportation account for 40% of workplace deaths. Logging, aircraft pilots, roofers, flight engineers, and fishing and hunting have the largest number of workplace deaths. Those industries average 3.5 deaths per 100,000 workers.
When you are injured on the job, workers’ compensation provides you with immediate financial assistance. It will pay medical expenses related to your injury and also pay wage replacement.
It sounds simple, but the biggest hurdle can be receiving approval from the workers’ compensation insurance company. They may claim the injury and its severity are not relative to work in an attempt to deny you compensation. Read on to learn everything you need to know about workers’ compensation coverage.
What is a Workplace Injury?
If you suffer injury or become ill due to the workplace, that usually qualifies as a workplace injury. Common injuries at work include slips and falls, crushing, and burns. Black lung disease and carpal tunnel are also frequently the result of work.
You must meet specific criteria for your illness or injury to qualify for workers’ compensation payment:
- The injury occurs while you are working and on-the-clock
- You report your injury to your employers as quickly as possible and no longer than four (4) days after its occurrence
- You were not doing anything illegal at the time of injury
- You file your workers’ compensation claim before the deadline set forth by Colorado state law
When determining what workers’ compensation covers and what it does NOT cover, a variety of factors are taken into consideration. This includes if your injury took place at work but does not relate to your job duties. For example, breaking a tooth while eating in the lunchroom will not qualify for coverage.
If your job requires you to perform duties offsite, injuries while working will qualify for coverage. This may be something such as a window washer falling off a ladder, resulting in injury.
You do not have to prove that your injuries are the result of your employer’s negligence. Even if you make a mistake causing yourself an injury, that will be covered as long as you were acting in good faith during the performance of your work duties.
How to File a Workers’ Compensation Claim in Colorado
The first step is to check with the Human Resources Department of your employer. If your business is small and there is no HR Department, report your injury to your direct supervisor. Request a workplace injury report form and workers’ compensation claim form.
In Colorado the Department of Labor Employment Division of Workers’ Compensation in Denver, Colorado processes all submissions. Do not assume your employer is filing the appropriate claim.
Each state has a deadline for filing, and you need to take action to make sure the Colorado statute of limitations, which is two (2) years from the date of injury, does not pass. You may handle filing yourself or hire a workers’ compensation attorney to handle the paperwork.
Your workers’ compensation insurance company should respond quickly once the claim is filed. The only time there may be an issue is if your employer does not support you filing the claim. If there is a dispute the process may take twelve months or more.
During this time workers’ compensation facts will be gathered for a final determination on your claim. Workers’ compensation does not allow you to sue your employer except in extreme cases.
This does not mean that you can not file against workers’ compensation. If you receive a denial of your claim, you are being told to go back to work when your injuries are not healed, or there are other problems with your claim you need to contact a personal injury workers’ compensation attorney immediately.
Who Does Not Have Workers’ Compensation Coverage?
If you are performing duties at a place of business but are a volunteer, you may not be eligible for workers’ compensation benefits. There is an exception in most states for volunteer firefighters. Other persons who usually have no coverage under workers’ compensation laws include:
- Freelance or contract workers
- Seasonal workers
- Temporary or agency workers
- Undocumented workers
- Domestic employees in private homes
If you suffer an injury and fall within one of these categories, you need to contact a personal injury attorney about filing a claim under the personal injury statutes of Colorado. Be aware that the state has a statute of limitations for filing. The same evidence necessary for workers’ compensation claims is also necessary for a personal injury claim.
Federal workers are not eligible for state-mandated workers’ compensation. This is because federal and post office employees have coverage under the Division of Federal Employees Compensation.
What Workers’ Compensation Covers
When you suffer work injuries, workers’ compensation will pay all approved medical expenses that directly relate to the injury you incurred at work. This usually includes rehabilitation therapy and mileage to and from all medical and rehabilitation appointments. If an employee dies as a result of work injuries the family will receive death benefits.
There are four different types of workers’ compensation that are available. What you receive will depend on your injury. The coverage includes temporary total disability, temporary partial disability, permanent partial disability, and permanent total disability.
When you are recovering workers’ compensation will pay for your physical rehabilitation. This includes physical therapy that helps you in building your physical strength and restoring mobility.
Vocation rehabilitation provides training for you to take on a new job at your present employer or find a job at a different location if your injuries prevent you from performing your original type of work. This assistance may include any or all of the following:
- Counseling about employment qualifications and expectations
- Testing to determine your skills for a new career
- Job search assistance
- Employment application and resume assistance
- Education and tuition payments for retraining
- Retraining to perform a different job with your existing employer
The necessity of any or all of the above will be based on your injury and abilities.
What Workers’ Compensation Does NOT Cover?
When you suffer an injury at work you receive workers’ compensation, but there are limitations. In the majority of cases, you are unable to sue your employer. Your compensation is limited to partial wages and coverage for approved medical costs.
Because this is being paid by your employer’s workers’ compensation insurance, there may be specific medical providers you need to see for treatment. There is no compensation for the pain and suffering you incur as a result of your injury.
Hire a Workers’ Compensation Attorney
An experienced attorney will be able to help guide you so you know exactly what workers’ compensation covers in your unique case. Understanding the pros and cons of hiring a workers’ compensation attorney can help you determine if this is the right course of action for you. When you have Elkus & Sisson P.C. handle your workers’ compensation claim you are in great hands of a team that is experienced in this area of personal injury law.
You can concentrate on your recovery and let your attorney use their legal knowledge to negotiate your claim and file petitions for any necessary legal action. Contact the law offices of Elkus & Sisson P.C. at (305) 567-7981 for a consultation on your employment law issues.