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Workers Comp 101

- Friday, July 07, 2017
TriState workers comp insurance

By now you know that all of the independent insurance professionals here at TriState Business Insurance invest significant time and energy in educating the general public about personal and business insurance topics.  It is our way of giving back.  We cover topics pertaining to personal insurance needs and business insurance needs of those in Maryland, Virginia, and DC but are warmed by feedback from outside those areas that the information that we provide is useful.  

Today, in keeping with our quest to educate the public, we credit the following tips from a great reference source of ours: NOLO.com. We find their advice to always be spot on. Below covers the very most important points regarding workers comp insurance for those operating in Virginia, Maryland, and DC.  We know that reading about this subject often spurs a whole series of follow-up questions. That’s where we come in to further assist you.  So read on.

Does workers' compensation cover just my medical bills?

Workers' comp does pay hospital and medical expenses that are necessary to diagnose and treat your injury. But it also provides disability payments while you are unable to work (typically, about two-thirds of your regular salary), and may pay for rehabilitation, retraining, and other benefits as well.

Are all on-the-job injuries covered by workers' compensation?

Workers' compensation, also known as workmans' comp, covers most, but not all, on-the-job injuries. The workers' compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer's or  employee's carelessness. But there are some limits. Generally, injuries that happen because an employee is intoxicated or using illegal drugs are not covered by workers' compensation. Coverage may also be denied in situations involving:

  • self-inflicted injuries (including those caused by a person who starts a fight)
  • injuries suffered while a worker was committing a serious crime
  • injuries suffered while an employee was not on the job, and
  • injuries suffered when an employee's conduct violated company policy.

For more information, see Nolo's article on when injuries are work-related.

Does workers' compensation cover only injuries or does it also cover long-term problems and illnesses?

Your injury need not be caused by an accident -- such as a fall from a ladder -- to be covered by workers' compensation. Many workers receive compensation for injuries that are caused by overuse or misuse over a long period of time (for example, repetitive stress injuries such as carpal tunnel syndrome or chronic back problems). You may also be compensated for some illnesses and diseases that are the gradual result of work conditions, such as heart conditions, lung disease, and stress-related digestive problems. For more information on repetitive stress injuries, see the Nolo article Repetitive Stress Injuries in the Workplace.

Do I have to be injured at my workplace to be covered by workers' compensation?

No. As long as your injury is job-related, it's covered. For example, you will be covered if you are injured while traveling on business, doing a work-related errand, or even attending a required business-related social function. For more information on what counts as a job-related injury (and what doesn't), see Nolo's article Workers' Compensation: Is Your Injury or Illness Work-Related?

Are all employees covered by workers' compensation?

No. First of all, not all employers are required to have workers' compensation coverage. State laws vary, but an employer's responsibility to provide coverage usually depends on how many employees it has, what type of business it is, and what type of work the employees are doing. Second, every state excludes certain types of workers. Although these exclusions vary, they often include farm workers, domestic employees, and seasonal or casual workers.

Can I be treated by my own doctor and, if not, can I trust a doctor provided by my employer?

In some states, you have a right to see your own doctor if you make this request in writing before the injury occurs. More typically, however, injured workers are referred to a doctor recruited and paid for by their employers.

Your doctor's report will have a big impact upon the benefits you receive. Keep in mind that a doctor paid for by your employer's insurance company is not your friend. The desire to get future business from your employer or the insurance company may motivate a doctor to minimize the seriousness of your injury or to identify it as a preexisting condition. For example, if you injure your back and the doctor asks you if you have ever had back problems before, it would be unwise to treat the doctor to a 20-year history of every time you suffered a minor pain or ache. Just say "no" unless you really have suffered a significant previous injury or chronic condition.

Can I ever sue my employer in court over a work-related injury?

Yes. If you are injured because of some reckless or intentional action on the part of your employer, you can bypass the workers' compensation system and sue your employer in court for a full range of damages, including punitive damages, pain and suffering, and mental anguish.

What is workers' compensation?

Workers' compensation, also known as workmans' comp, is a state-mandated insurance program that provides compensation to employees who suffer job-related injuries and illnesses. While the federal government administers a workers' comp program for federal and certain other types of employees, each state has its own laws and programs for workers' compensation. For up-to-date information on workers' comp in your state, contact your state's workers' compensation office.

In general, an employee with a work-related illness or injury can get workers' compensation benefits regardless of who was at fault -- the employee, the employer, a coworker, a customer, or some other third party. In exchange for these guaranteed benefits, employees usually do not have the right to sue the employer in court for damages for those injuries.

For those of you with workers compensation needs in Virginia, Maryland, and/or DC, call us today.  We’ll get your questions answered!