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Workers compensation: Frequently asked questions

What government agency administers workers compensation?

Each state administers its own program, and the federal government protects those not covered by state laws. Under the Longshore and Harbor Workers Compensation Act, which is administered by the U.S. Department of Labor, certain maritime employees are covered, and the federal government administers workers compensation for all of its employees.

How long can I get benefits?

If your work injury is severe, you may receive benefits for the rest of your life. But that is less likely today because medical advances are helping to get people back to work quicker, and of course managed care is guarding the purse strings with respect to medical benefits.

How is workers comp different from health insurance?

You get benefits under workers comp only if you are injured on the job or develop an occupational disease.

What kind of benefits can I receive?

Workers comp insurance covers medical care, dismemberment, disability, and death (with each state defining a benefit level that employers must meet). Essentially, the medical benefits are the same as those you would get with health insurance. But, unlike with health insurance, you also get compensated for lost wages as long as you are considered partially or permanently disabled.

Also, the goal in your medical treatment is slightly different. It is the job of the doctor who treats you under workers' comp laws to assess what percentage of disability you have and when you are fit to work again. This is in addition to the usual treatment responsibilities.

Will I be compensated for pain and suffering?

It is tricky to make generalizations about compensation for pain and suffering because it depends on the state. Melody Cathey, director of education and research for the International Association of Industrial Accident Boards and Commissions in Lawrence, Kan., explained, "Payment for pain and suffering is sometimes a part of a lump-sum settlement. It is not a benefit per se, but it may be included. [Compensation for] pain is recognized in some jurisdictions as part of the total body award" (meaning the settlement a worker receives if he or she is permanently and totally disabled).

There is a controversy over whether physical pain can be measured, said Cathey, and many jurisdictions don't compensate for mental anguish. But if the workers compensation jurisdiction takes a holistic approach in assessing eligibility for benefits — including an analysis of the worker's ability to perform the tasks of daily living — then pain and mental anguish payments may be included.

How do I file a claim?

Your employer — not you — needs to file the claim. You should report an injury to your employer as soon as it happens, and they should take it from there. For your own records, you may want to jot down the details about the accident.

In general, your employer will file a claim with its insurance carrier, which in turn files with the state. Or, if your company is self-insured, it will file the claim directly with the state.

If you are concerned about the status of your workers comp claim, you should check with your employer first and then seek out your state's workers compensation agency.

What do I do if I believe I'm wrongly denied benefits?

In some cases, you may have to resort to litigation if you have been wrongly denied workers comp benefits. But there are usually other ways to handle the dispute. Some states have an ombudsman who explains workers' rights, and the services of the ombudsman may be enough to resolve the claim. For example, if an employer has told an employee that he or she has to go to a doctor chosen by the employer, when in fact state law entitles him to use a doctor of his choosing, an ombudsman will inform him of that right. Other states use mediators to resolve disputes.

To find an ombudsman, contact the workers compensation agency in your state.

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