Workers’ Compensation: The Who, What, and When

Workers’ compensation, also known as workers’ comp, is a program mandated by individual states to provide protection and coverage to individuals injured or disabled on the job or in direct correlation to their job tasks. This type of insurance is purchased by employers to cover their employees during healing or disability and to help prevent lawsuits due to injury.

When Does Workers’ Comp Cover?

Workers’ compensation covers a broad range of injuries and incidents that can happen on the job. The types of injuries sustained and accidents covered will vary from job to job. Workers’ compensation can cover smaller, temporary injuries such as a broken bone to long-term conditions such as carpal tunnel. However, “pain and suffering” are not covered. The injury must have been sustained on the job or directly due to the work environment.

Most workplaces will provide workers’ comp to the individual regardless of who was at fault. In general, this form of insurance is to protect employees from carelessness at their profession. Every worker has a right to a safe work environment. 

However, each state has its own limits.

Some areas require the injured employee to pass a drug and alcohol test. This allows them to deny workers’ compensation benefits to the employee if they were under the influence during the time of the injury. Workers comp may also be denied in cases where the injuries were self-inflicted, the employee was violating a law or company policy, or if the employee was not working or “on the job” at the time of the injury.

Who Does Workers’ Comp Cover?

States have different laws and regulations regarding workers’ compensation. For example, workers’ compensation in Tennessee declares local governments and businesses that employ farm laborers exempt from workers’ comp requirements.

If a business is not by law required and therefore does not provide workers’ comp and an employee is injured on the job, the employee is not entitled to benefits. However, in this case, the employee is not barred from filing a lawsuit against the employer. Employees cannot sue an employer for damages if they are receiving workers’ comp benefits for the injury.

It’s also important to note that legally, employers cannot terminate an employee in retaliation for or to prevent filing for workers’ compensation.

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What Does Workers’ Comp Cover?

Wage replacement is usually two/thirds of the worker’s average wage, but there is a benefits limit. Workers’ comp is not taxed, and benefits begin immediately once the individual cannot resume their job due to the injury.

Here are some examples of what is covered by the benefits:

  • Medical care
  • Wage replacement
  • Training costs
  • Compensation for permanent injuries
  • Benefits to the survivors of workers who have passed away while on the job.

Different Types of Benefits

Medical Benefits Only

Workers’ comp covers the entire medical bill of the injured worker and provides cash benefits for lost wages after a waiting period of 3-7 days. In most cases, the person may return to work before the end of the waiting period. In that case, only the medical costs are covered.

Temporary Disability

Workers’ comp can cover two types of temporary disability: temporary total disability (TTD) and temporary partial disability (TPD). TTD benefits are given when an injury or illness prevents an employee from returning to their previous place of employment for a longer amount of time, but they are expected to make a full recovery eventually. Once the individual returns to work, the benefits end. If an injured employee returns to work before they are completely healed or improved and take a lower pay, they may receive TPD.

Permanent Disability

Individuals with severe, long-lasting impairments may be eligible for permanent total disability (PTD). Workers with permanent impairments who still retain some ability to continue their work may be eligible for permanent partial disability (PPD).

Fatalities

Workers’ compensation programs cover death benefits when an on-the-job injury is fatal. For employees who pass away without dependents, the coverage only includes funeral and burial costs. If the employee has family or dependents, they may be able to receive cash benefits.

How To Apply for Worker’s Compensation

It is critical to notify HR or another designated authority when an employee sustains an injury at work. Even if workers’ compensation may not be needed at that time, longer-term issues and injuries may arise. It’s important to document any instances or occurrences as they happen.

Here is a shortened example of a procedure for reporting an injury for possible workers’ compensation*:

  1. If the situation is critical, call 911.
  2. Notify your supervisor immediately in person, by call, or by email.
  3. List what happened, how it happened, and any witnesses available.
  4. You and your supervisor need to call the Workplace Injury & First Notice of Loss Call Center (1-866-245-8588, option #1).
  5. The nurse will help guide you through the necessary medical steps, and your supervisor will verify you are reporting a work-related injury.
  6. To complete the reporting process, your call will be transferred to the First Notice of Loss Unit (1-866-245-8588 and select option #2).

**Always check the full PDF document below if you need to file for workers’ compensation:
Click here for the full PDF document.

If you are an employer or employee with questions about workers’ compensation, contact McInturff, Milligan & Brooks via the form below or at (423) 639-5171. If you own or operate a business in Tennessee or Virginia, MMB can help you figure out what business policies you need.

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