When you’re injured at work, understanding your rights as an injured worker is essential. Most people automatically apply for workers’ compensation coverage for their injuries. However, occupational accident insurance may be what you’ll deal with.
Knowing the difference between the two will help make your recovery and return to work feel less overwhelming, so you know which you must apply for.
What is Workers’ Compensation?
Workers’ compensation is a state-mandated program that provides essential benefits to employees with work-related injuries or illnesses. This no-fault system ensures that workers receive benefits as long as they qualify, regardless of fault.
Workers’ comp is excellent because it provides the financial support workers need to recover and protects the employers. It’s a safety net for millions of workers nationwide because it can provide peace of mind if a workplace injury or illness happens.
Benefits Provided by Workers’ Compensation Insurance
Workers’ compensation insurance can provide compensation for several things, mainly covering medical expenses. Here’s a look at the benefits of workers’ compensation:
- Medical Expenses: This includes compensation for emergency room visits, hospitalizations, prescribed medications, doctor appointments, specialist consultations, travel expenses for medical appointments, medical equipment, and physical therapy services.
- Lost Wages: If the injured worker can’t work for a while or never returns, lost wages can compensate. Temporary Total Disability (TTD) is for those who cannot return to work. Temporary Partial Disability (TPD) is for those working light duty or reduced hours. Permanent Partial Disability (PPD) is payment for lasting impairments, and Permanent Total Disability (PTD) is long-term benefits for those unable to return to work.
- Vocational Rehabilitation: This helps injured employees find work when they can’t return to their previous roles. It can include education expenses for new career paths, job search assistance, career counseling, job retaining programs, and resume and interview prep.
- Death Benefits: Workers’ compensation includes death benefits in cases where a work-related injury or illness causes someone to pass away. These benefits help the family cover funeral or burial expenses, coverage for outstanding medical expenses, ongoing financial support for surviving dependents, and education benefits for dependent children.
What is Occupational Accident Insurance?
Occupational accident insurance is a private insurance policy that provides coverage for work-related injuries and illnesses, predominantly for independent contractors and those not covered by traditional workers’ compensation. It is more flexible than workers’ compensation but has specific limitations and conditions.
Benefits Typically Covered by Occupational Accident Insurance
Like workers comp, occupational accident insurance typically covers medical expenses but not necessarily compensation for lost wages you’d get with traditional workers’ comp. Some of the benefits of occupational accident insurance include:
- Medical Expenses: This usually covers emergency medical treatment, hospital stays, surgical procedures, follow-up care, rehabilitation costs, and prescribed medications. However, independent contractors using this coverage might have to pay co-payments or reach deductibles.
- Disability Benefits: These will help replace lost income for the injured worker, but they’re different from workers’ compensation. They can include short-term disability payments and long-term disability coverage, but they might have long waiting periods and be capped at certain amounts.
- Accidental Death and Dismemberment: Similar to workers’ comp, this includes death benefits for the surviving family members. This also includes specified payments for loss of limbs or bodily functions. The amount will vary based on the specific injury or loss and policy limits.
Key Differences and Considerations
While workers’ compensation and occupational accident insurance have similarities, they also significantly differ.
Eligibility
Eligibility is a significant difference between the two. Workers’ compensation covers:
- Full-time employees
- Part-time employees
- Regular workers
- Seasonal employees (in most cases)
Occupational accident insurance covers:
- Independent contractors
- Non-covered workers
- Owner-operators
- Self-employed individuals
Fault and Negligence
Another difference between workers’ compensation and occupational accident insurance is how fault and negligence come into play.
Workers’ compensation is a no-fault program. This helps ensure that most employees are covered regardless of if the accident or injury was their fault.
Occupational accident insurance sometimes uses fault to determine whether someone should be approved for coverage and how much. Many occupational accident insurance companies are known to deny claims based on negligence. Because this program can use fault, independent contractors and others eligible often face many coverage disputes.
Coverage Limits and Exclusions
Workers’ compensation is more comprehensive coverage and provides:
- Comprehensive coverage without monetary limits
- Few exclusions beyond willful misconduct
- Guaranteed benefits based on state law
Unlike workers’ compensation policies, occupational accident coverage includes:
- Defined coverage periods
- Specific policy limits and benefit caps
- Variable coverage based on premium costs
- More extensive exclusions and limitations
Cost and Choice
Workers’ compensation:
- Mandatory for most employees
- Regulated rates and benefits
- Costs borne by employers
Occupational accident coverage:
- Flexible premium options
- Optional coverage
- Negotiable terms and conditions
When to Seek Legal Advice
Whether you work in the trucking industry, at a major retailer, or anywhere else, contacting a Chicago workers’ comp attorney from Rosenfeld Injury Lawyers is beneficial to securing compensation for your work-related accident.
We understand the intricacies of a workers’ compensation or occupational accident policy and can help increase your chances of compensation.
Denied Claims
When dealing with workers’ comp or occupational accident insurance, you should seek legal representation when:
- Your claim is denied without a clear explanation
- Administrative deadlines are quickly approaching
- Evidence supporting your claim is being disputed
- There are complicated legal issues that arise from your claim
Disputes Over Benefits and Medical Expenses
If your claim is approved, but there are disputes surrounding medical expenses and care, an attorney can help handle:
- Insurance companies, when recommended medical treatment is denied
- Questions that arise about maximum medical improvement
- Benefit calculations that don’t seem accurate based on the injuries incurred
- Any delays in your benefit payments
Third-Party Liability
Any injured workers who have to deal with third-party liability shouldn’t do so without legal counsel. This can get tricky and potentially cause a delay in your coverage and benefits. We highly recommend legal representation when:
- Multiple parties might be responsible for the injuries
- Workplace accidents that involve non-employees
- Equipment manufacturers share liability
- Additional compensation might be available
Secure Expert Legal Counsel!
At Rosenfeld Injury Lawyers, our Chicago personal injury lawyers understand the complexities of workplace injury claims. Whether dealing with workers’ compensation or occupational accident insurance, we’ll help you navigate the claims process to get the compensation you need to heal and support your family.
Our workers’ comp attorneys will be there for you every step of the way. Whether you’re dealing with a denied claim or haven’t even started the process, you can count on us to provide guidance and support. Contact us today for your free consultation by visiting our website or calling us at (888)-424-5757.