How Workers' Compensation Claims Work

Workers' compensation is insurance most employers must carry that pays for work injuries and illnesses, regardless of who was at fault. In exchange, employees generally can't sue their employer for those injuries. Each state runs its own system, but the basics are similar.

What it covers

Medical care for the injury, usually with no deductible or copay.
Wage replacement while you can't work, typically a portion of your average weekly wage (often around two-thirds), subject to state minimums and maximums.
Permanent disability benefits if you have lasting impairment.
Vocational rehabilitation in some states, if you can't return to your old job.
Death benefits to dependents.

Covered injuries include accidents, repetitive-stress injuries like carpal tunnel, and occupational illnesses caused by work conditions.

Steps to file

Get medical care. Tell the provider it's a work injury. Some states let the employer choose the initial doctor.
Report the injury to your employer in writing, right away. States set deadlines for notice, sometimes as short as a few days or weeks. Late notice is one of the most common reasons claims are denied.
Your employer reports it to its insurer, and you may need to file a claim form with the state agency.
The insurer accepts or denies the claim.
Benefits begin, usually after a short waiting period for wage benefits.

If your claim is denied

Common reasons: late reporting, disputes over whether the injury happened at work, pre-existing conditions, or gaps in treatment. Every state has an appeals process, usually starting with a hearing before a workers' comp judge or board. There are strict deadlines to appeal.

Can you sue instead?

Usually not your employer. But if a third party caused the injury, such as a negligent driver, a defective machine's manufacturer or a subcontractor, you may have a separate personal injury claim on top of workers' comp.

Retaliation

It's illegal in nearly every state to fire or punish someone for filing a workers' comp claim.

Lawyer fees

Workers' comp attorney fees are typically capped by state law and paid as a percentage of the benefits you win, often approved by the judge, so there's usually nothing up front. A lawyer is especially valuable if your claim is denied, you have a permanent injury, or the insurer wants you to settle your future medical rights.

Find a workers' comp lawyer near you.

This guide is general information, not legal advice. Benefits, deadlines and rules vary by state.