What Workers’ Compensation DOES Cover

Every state has its own workers’ compensation laws. The law requires employers to purchase workers’ compensation insurance for this purpose. When an employee is injured at work while doing their job, he or she can make a claim for workers’ compensation benefits. That general rule applies even if the employee was injured through his or her own negligence. Injuries that aren’t likely to be covered are those that occurred when:

  • The employee was intoxicated or under the influence of drugs when injured
  • The injuries are intentionally self-inflicted
  • The employee violated company policy
  • Injuries arose from activities outside of the employee’s course and scope of employment

Workers’ compensation laws also cover certain occupational illnesses or diseases that are a risk of a particular employee’s employment. Depending on the nature and extent of the injury, an employer is generally required to provide the following benefits, as a skilled Brooklyn workers compensation lawyer might explain:

  1. Medical Expenses

All reasonable and necessary medical expenses must be paid by the employer or its insurer regardless of whether the injured employee is eligible for temporary total disability. That includes:

  • All reasonable medical, surgical and hospital treatment in connection with the injury.
  • Any lost time from work and traveling expenses to be seen or treated by health care providers must also be compensated.
  • In some states, the injured employee must be treated by a doctor appointed by the employer. In other states, he or she has a choice of a first free doctor and any other doctor that might be referred through a chain referrals and doctors.
  1. Temporary Total Disability

When you’re out of work for a certain period of time as a result of a covered injury or occupational disease that you sustained while at work, you should start receiving temporary total disability (TTD) payments. In most states, you need to be off of work for seven straight days, after which you will be eligible for TTD benefits on the 14th day. However, it might be more than 21 days before you receive your initial TTD payment. The TTD rate is ordinarily set at a sum equal to two-thirds of your average weekly wage. Each state has a maximum average weekly wage that is allowed.

  1. Permanent Partial Disability

If you suffered a covered permanent injury or illness at work that was partially disabling, you might be eligible for a permanent partial disability award.

  • These usually come as a lump sum of compensation that represents a loss of a percentage of a person as a whole after reaching maximum medical improvement.
  • Depending on the state, if it’s a severe injury, it might come with one large payment and then monthly payments for the duration.
  • If a person suffers a catastrophic injury, he or she is eligible for permanent total disability. These cases are rare.

Every state contemplates job re-training benefits, but they might not be mandatory. Re-training could ultimately be less costly for the employer or insurer. Every state also provides for death and survivor benefits in the event of a fatality that occurred at work. Don’t prejudice your right to workers’ compensation benefits by trying to represent yourself. That’s when the insurance company has you right where it wants you. Preserve and protect your rights after any workplace injury or illness.

Contact a workers’ comp lawyer immediately after suffering a workplace injury or if you acquire an occupational illness. Most attorneys will provide a free consultation and case evaluation. When you retain a skilled lawyer, you can expect to receive quality, aggressive and compassionate advocacy.


Thanks to our friends and contributors from Polsky, Shouldice & Rosen,  P.C. for their insight into workers compensation cases.

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