What Workers’ Compensation Covers and What It Doesn’t

One of the most significant benefits of workers’ compensation is the payment of medical expenses. This usually includes hospital visits, doctor consultations, surgeries, physical therapy, medications, and necessary medical equipment. It also applies to ongoing care if you need it to recover. However, the treatment has to be deemed essential and related to your workplace injury. You’ll usually have to see a doctor within the employer’s network or approved list. If you visit someone outside that network without proper authorization, your bills might not be reimbursed. It’s also important to note that elective or non-essential procedures are rarely approved, even if they seem helpful to you.

If your injury keeps you from working, workers’ compensation may provide a portion of your lost income. This benefit is often about two-thirds of your regular wages, up to a weekly limit set by the state. It’s meant to offer temporary financial relief while you recover. If your condition is more serious and results in permanent disability, you may qualify for long-term benefits based on how much your ability to work is reduced. However, workers’ comp doesn’t usually cover the whole paycheck and doesn’t account for lost promotions, future raises, or bonuses. These limits can leave you feeling like your financial stability is still at risk.

Not all job-related issues qualify for benefits. Emotional stress or mental health conditions are often excluded unless there is clear evidence that they were directly caused by work. If your injury happened while you were intoxicated, violating company policies, or not performing work-related duties, you likely won’t be covered. Commuting to and from work also doesn’t count unless your job involves travel. Pain and suffering, a significant part of personal injury lawsuits, isn’t part of workers’ comp either. This is one of the biggest surprises for many people filing claims. The system focuses more on function and recovery than on emotional or punitive damages.

It’s easy to feel overwhelmed when dealing with workers’ compensation claims, especially if your benefits are delayed, denied, or incomplete. That’s where a skilled attorney can make a difference. You can avoid costly mistakes and delays by understanding the system and fighting for your rights. At the Law Office of Scott M. Blumen, we help you break through the confusion and take clear, confident steps forward. Whether your case is just beginning or you’re facing pushback from insurers, you don’t have to face it alone. Call (619) 439-1837 or complete our online form today to schedule your consultation and take the first step toward fair compensation.