Injured Worker: 7 Key Things to Know About Workers’ Compensation

What do car accidents, burns, and falls, have in common?

These 3 injuries account for the majority of worker’s compensation claims. On average, claims for these injuries will total close to $95,000 or more. In many cases, an injured worker wouldn’t be able to receive the care they need if it wasn’t for the help of workers’ compensation settlements.

Yet, even though workers’ compensation claims are common, they still remain a mystery for many workplaces. Employers find themselves scrambling to provide the right amount of coverage. While employees end up suffering because they aren’t aware of the help that’s there.

Don’t let yourself be caught up in the confusion. Read on to find out 7 tips everyone should know about workers’ compensation.

1. Helping an Injured Worker

Most employers and employees understand the basics of how workers’ compensation operates. If an employee sustains an injury on the job, the injured worker can file a worker’s compensation claim to help cover their medical expenses.

Yet many workers and employers don’t understand that coverage isn’t the same across the board. Every state will have different rules about the level and types of coverage employers have to carry.

Here are some of the coverage categories states differ in:

  • Types of injuries
  • Proof needed
  • Excluded illnesses

Worker’s compensation settlements will vary depending on where they occur. For example, some states don’t even require employers to carry workers’ compensation coverage.

2. Certain States Are Exempt

Workers’ compensation isn’t mandatory in every state. For example, Texas is one of the states in America that doesn’t require employers to carry workers’ compensation.

Yet, even though it’s not mandatory, many employers still opt to carry coverage. Employers can decide to either self insure to meet the worker’s compensation requirements, or they can join their state’s program. The state workers’ compensation program receives its funding from employers, not employees.

3. Federal Mandates

Sometimes, the federal government is responsible for administering different workers’ compensation programs. For example, coal miners have to carry specific coverage as deemed fit by the federal government.

4. Determining Costs

The cost of workers’ compensation benefits varies for each group. State programs calculate the cost using several different factors.

First, they take into account the gross payroll. Next, the amount of risk an industry has goes into determining the price. For instance, a factory is going to have higher workers’ compensation costs than an office environment.

For learning more you can consult this guide on how to calculate workers compensation cost per employee.

5. Extent of Coverages

What type of things will workers compensation cover? Here’s a list of the type of compensation state laws typically provide:

  • Medical coverage
  • Vocational rehabilitation
  • Disability
  • Death benefits

The type of benefits that employees receive from on the job injuries is very similar from state to state. Yet, the amount of the benefits an injured worker receives varies greatly in each state.

Medical Coverage

The medical coverage is one of the broadest categories workers compensation provides. Coverages include doctor visits, hospital bills, medications, and physical therapy.

Vocational Rehabilitation

Vocational rehabilitation is there to help workers who can’t return to their prior place of business. This is usually the case when their injuries prevent them from performing the same type of work.

Vocational rehabilitation assists employees by helping them learn a new job skill. Specifically, a skill that suits their physical limitations after the injury.


Workers who aren’t able to return to work because of their injuries may qualify for disability. This coverage can be temporary, partial, total, or permanent.

Death Benefits

Death benefits only apply if the worker loses their life while on the job. This coverage goes toward the worker’s spouse and minor children.

Exposure and Repetitive Stress

Workers’ compensation coverage also helps with injuries that happen over a long period of time. While some injuries are sudden and obvious, like dropping something on your foot, others are subtle and take years to surface.

For example, repetitive stress injuries can take years to happen. One stress injury that’s common in office settings is carpal tunnel. Another good example would be illnesses like black lung, which result from years of on the job exposure.

6. Excluded Injuries

Employers must understand that workers’ compensation doesn’t guarantee coverage for every incident. Here’s a list of injuries and illnesses that are outside the scope of worker’s compensation:

  • Self-inflicted injuries
  • Injuries occurring during crimes
  • Injuries resulting from violations
  • Injuries that happen off the clock

If an employee purposefully harms themselves, workers’ compensation will not provide coverage. The same holds for any injuries that occur while a crime is being committed.

Coverage also won’t apply to any employees who get hurt because they were violating company policy. Finally, when an incident happens and the employee wasn’t on the job, they won’t be eligible for workers’ compensation.

7. Handling Fraud

Typically, employers will commit workers compensation fraud in the hopes that they’ll be able to lower their premiums. Here are 2 common ways workers’ compensation fraud occurs from the employer:

  • Listing employees as non-employees
  • Listing employees as owners
  • Underreporting employee numbers

When employers list their workers as owners or non-employees, they’re able to make it appear as if they’re a smaller organization. Since premiums depend on how many workers you have, these employers sometimes receive lower premiums.

Yet, the risk isn’t worth the reward. Employers found committing fraud can face extensive fines and possible jail time. 

Increase Safety Awareness

Now you know more about how workers’ compensation can help an injured worker. Yet, wouldn’t it be great if you could prevent workplace injuries from happening in the first place?

Raising safety awareness in the workplace is a great way to keep workers safe. You can start by having a conversation with your employees about workplace safety. Ask for their help in identifying ways you can improve procedures to make them even safer.

Need some advice on how to make your workplace safer? Check out our tools section today!

Ted Jones