Understanding No-Fault Insurance Claims

Workers’ Compensation insurance is a line of coverage that is intended to cover every worker against injury or disease resulting from work, workplace conditions, or accidents that occur in the workplace. It is classified as no-fault insurance because “fault” for the cause of the injury or disease does not need to be established for the policy to pay out benefits.

Nationwide, workers’ compensation programs are operated by insurance companies approved to do business in the state and/or by a state government agency.

As detailed in this Guide For Claiming No-Fault Insurance Benefits, coverage for medical bills, lost wages, and other costs associated with an injury or disease are automatically covered by Workers’ Comp. However, there are some exceptions: gross negligence on the part of the employee, intentional acts that result in injury, the use of alcohol or drugs, and other acts that clearly make the worker responsible for the injury or disease are not covered.

Because the coverage is triggered automatically except when an exclusion applies, it seems as though claiming Workers’ Compensation benefits should be easy to do. However, that is not always the case.

Employers pay into the program through premiums, which are based on the industry they operate in and the history of accidents at the company. Because claims can increase the cost of those premiums, some employers discourage employees from claiming benefits, even though it is unlawful in most states to do so.

Benefits for specific injuries and disease, such as asbestos exposure, may be covered differently. And even under normal circumstances, navigating a sometimes clunky bureaucracy can be daunting.

The first step is understanding the benefits that are available, how to go about collecting them, and whether the injury or disease relates to an issue for which a benefits fund has already been established.

In addition to reading the guide, it’s important to speak with an expert attorney who understands the Workers’ Compensation program and can ensure that you receive all the benefits you are due.