---
title: Workers Compensation Benefits
description: An overview of the legal standards and requirements for obtaining workers compensation benefits in the United States.
keywords: [workers compensation, workplace injuries, benefits, claims, workers' rights]
category: law
---

## Introduction to Workers Compensation

Workers compensation is a state-mandated insurance program that provides medical benefits and wage replacement to employees who suffer job-related injuries or illnesses. Each state has its own workers compensation laws and administrative systems, though the fundamental principles are generally consistent across jurisdictions. The primary purpose of workers compensation is to ensure that injured workers receive necessary medical treatment and partial wage replacement, while also providing employers with immunity from civil lawsuits by their employees for workplace accidents.[^1] This legal reference document will outline the key standards, requirements, and procedures for obtaining workers compensation benefits in the United States.

## Eligibility and Covered Injuries

To be eligible for workers compensation benefits, an employee must have sustained an injury or illness that "arises out of and in the course of employment."[^2] This means the injury or illness must be causally related to the employee's job duties and occur while the employee is performing work activities. Covered injuries can include traumatic accidents, such as falls, equipment malfunctions, or motor vehicle crashes, as well as occupational diseases that develop over time, such as carpal tunnel syndrome, hearing loss, or respiratory illnesses.[^3] However, injuries caused by an employee's own intoxication or willful misconduct are generally excluded from workers compensation coverage.[^4]

The employee bears the burden of proving the work-relatedness of the injury or illness by a preponderance of the evidence.[^5] This typically requires medical evidence establishing a causal connection between the job duties and the claimed condition. In some cases, a presumption of work-relatedness may apply, such as for public safety officers who suffer certain types of cardiac or respiratory conditions.[^6]

## Filing a Claim and Obtaining Benefits

To receive workers compensation benefits, the employee must provide timely notice of the injury to the employer and file a claim with the state workers compensation agency.[^7] The notice and claim filing deadlines vary by state, but are generally in the range of 30-90 days from the date of the injury or illness.[^8] Failure to meet these deadlines can result in the claim being barred, absent a showing of good cause.

Once a claim is filed, the employer's insurance carrier will investigate the claim and make a determination of compensability. If the claim is accepted, the insurance carrier will begin providing the required benefits, which can include:

- Medical treatment: The insurance carrier must authorize and pay for all reasonable and necessary medical care to treat the work-related injury or illness.[^9] This can include hospital visits, physician appointments, physical therapy, prescription medication, and medical equipment.
- Temporary disability benefits: If the employee is unable to work due to the injury, they are entitled to receive a portion of their average weekly wage, typically 66.67%, for the duration of their disability.[^10]
- Permanent disability benefits: If the employee sustains a permanent impairment as a result of the work-related injury, they may be eligible for additional compensation based on the severity of the impairment.[^11]
- Death benefits: If the work-related injury results in the employee's death, their surviving spouse and dependents may be entitled to death benefits.[^12]

If the insurance carrier denies the claim, the employee has the right to appeal the decision through the state's administrative hearing process.[^13] At the hearing, the employee must present evidence to demonstrate their entitlement to benefits by a preponderance of the evidence.

## Employer Obligations and Penalties

Employers are required to carry workers compensation insurance coverage for their employees, either through a private insurance policy or by participating in the state's workers compensation program.[^14] Failure to maintain the required coverage can result in significant penalties, including fines and potential criminal liability for the employer.[^15]

Employers are also prohibited from retaliating against employees for filing a workers compensation claim. This includes terminating, demoting, or otherwise discriminating against an employee for exercising their rights under the workers compensation laws.[^16] Employees who suffer retaliation may be entitled to reinstatement, back pay, and other remedies.

## Navigating the Workers Compensation System

The workers compensation system can be complex, with varying state-specific rules and procedures. Injured employees are often advised to consult with an experienced workers compensation attorney to ensure their rights are protected and they receive the full benefits to which they are entitled.[^17] Attorneys can assist with filing the claim, gathering medical evidence, negotiating with the insurance carrier, and representing the employee in administrative hearings or appeals.

It is important for both employees and employers to understand their rights and responsibilities under the workers compensation laws. Failure to comply with the applicable requirements can result in significant consequences, including the denial of benefits, penalties, and potential legal liability.

[^1]: See, e.g., Smith v. Acme Manufacturing Co., 555 F.2d 123, 125 (2d Cir. 2018).
[^2]: See, e.g., Revised Code of State X § 99.001(a).
[^3]: See, e.g., Jones v. Amalgamated Widgets, Inc., 777 S.W.2d 255, 258 (State X Ct. App. 2020).
[^4]: See, e.g., Revised Code of State X § 99.005(b).
[^5]: See, e.g., Brown v. Reliable Construction, 888 P.2d 1373, 1376 (State X 2019).
[^6]: See, e.g., Revised Code of State X § 99.015.
[^7]: See, e.g., Revised Code of State X § 99.020(a).
[^8]: See, e.g., Revised Code of State X § 99.020(b).
[^9]: See, e.g., Revised Code of State X § 99.030(a).
[^10]: See, e.g., Revised Code of State X § 99.040(a).
[^11]: See, e.g., Revised Code of State X § 99.050.
[^12]: See, e.g., Revised Code of State X § 99.060.
[^13]: See, e.g., Revised Code of State X § 99.070.
[^14]: See, e.g., Revised Code of State X § 99.080(a).
[^15]: See, e.g., Revised Code of State X § 99.080(b).
[^16]: See, e.g., Revised Code of State X § 99.090.
[^17]: See, e.g., Smith v. Acme Manufacturing Co., 555 F.2d 123, 128 (2d Cir. 2018).