Workers’ Compensation: How Work Injury Claims and Benefits Work

If you get hurt at work, the normal route is a workers’ compensation claim through your employer’s insurer, not a lawsuit. You don’t have to prove anyone was careless. In exchange, the benefits are set by state law: your medical care plus part of your lost pay, with nothing for pain and suffering. And in most cases you give up the right to sue your employer at all.

Each state runs its own system, so the deadlines, the share of your wages you get and the rules about doctors all depend on where you work. This guide uses California, New York, Texas and Florida as examples and points to the official agencies that can answer the rest.

Work injuries and illnesses2.5 millionReported by private employers in 2024

Tell your employer30 daysThe limit in CA, NY, TX and FL

Wage replacementAbout two-thirdsOf your pay in CA, NY and FL, up to a cap

Optional for employersTexas onlyPrivate employers can opt out

Report the injury, in writing, right away

The first deadline is the one that sinks the most claims, because it starts on the day you get hurt. California, New York, Texas and Florida all give you 30 days to tell your employer. California’s statute and New York’s Workers’ Compensation Board both call for written notice. A text to your supervisor is better than nothing, but an email or a signed note that gives the date, what happened and which body part was hurt is much harder to dispute later.

Telling your employer is not the same as filing the claim. That second step has its own, longer deadline:

State	Tell your employer	File the claim
California	Within 30 days, in writing	Generally 1 year from the injury, or from the last benefit paid or provided
New York	Within 30 days, in writing	Notify the Workers’ Compensation Board within 2 years
Texas	Within 30 days	Send DWC Form-041 to the state within 1 year
Florida	Within 30 days	Generally 2 years for a Petition for Benefits; a claim can close 1 year after the last treatment or payment

In California, your employer has to give you the DWC 1 claim form within one working day of learning about the injury. If nobody hands you one, ask for it.

Injuries that build up over time, like a bad back from years of lifting or hearing loss from a loud plant, still count. In many states the clock for these starts when you knew, or should have known, that work caused the problem. That date is often argued over, so report it as soon as a doctor connects the two.

What workers’ comp pays

Medical care for the work injury, paid by the employer’s insurer. In California, the insurer has to cover up to $10,000 of treatment while it decides whether to accept the claim.

Temporary disability pay while you can’t work or can only work reduced hours. California, New York and Florida all pay roughly two-thirds of your pre-injury wages, capped at a weekly maximum, and many other states use a similar formula. The caps matter if you earn well:

California pays two-thirds of your gross wages. For 2026 the weekly maximum is $1,764.11 and the minimum is $264.61. Payments start once a doctor says you can’t do your usual job for more than three days, or if you were hospitalized overnight. For most injuries since 2008, temporary disability is limited to 104 weeks within five years.
New York pays two-thirds of your average weekly wage, times your percentage of disability. For injuries on or after July 1, 2026, the maximum is $1,281.50 a week. The first seven days aren’t paid unless you’re out more than 14 days.
Florida usually pays 66 2/3% of your average weekly wage. The first seven days aren’t paid unless the disability lasts more than 21 days.

Because the benefit is tied to a percentage, a partial return to work usually brings partial pay. In New York, for example, if you go back at lower wages you may get two-thirds of the difference between your old and new pay.

Permanent disability benefits come later, if you’re left with a lasting impairment. This is where most disputes are, since a doctor has to rate how much of your function you lost and each state turns that rating into money its own way. Death benefits, paid to dependents, cover a fatal work injury.

Late payments carry penalties in some states. California’s guidebook says the first temporary disability check is due within 14 days after your employer learns of the injury and the disability, and an unexcused late payment can add 10% to that payment.

Who picks your doctor

Often not you, at least at first. In Texas, if your employer’s coverage uses a certified network, you have to choose a doctor from the network list, and changing doctors outside a network takes state approval. Florida’s injured-worker guidance says care comes from a provider authorized by your employer or the insurer. In New York, except in an emergency, your doctor generally has to be authorized by the Workers’ Compensation Board.

This matters because the treating doctor’s reports drive almost everything: whether you’re off work, when you go back, and what your permanent rating will be. If you disagree with the doctor, ask your state agency how to challenge the opinion. In California, disputes over a treating doctor’s findings usually go to a Qualified Medical Evaluator. Once you get the evaluator’s report, you have 30 days to decide whether you accept it.

Can you sue your employer instead?

Usually not. Workers’ comp is the “exclusive remedy” against an employer that carries it. California’s version is typical: when the conditions for compensation are met, comp is the sole remedy for the worker or their dependents against the employer. The exceptions are narrow. California’s include an injury caused by the employer’s willful physical assault, an injury made worse because the employer fraudulently hid it, and some injuries from a defective product the employer made and sold to others.

The bigger opening is someone other than your employer. Say a delivery driver is rear-ended by another car while on the job. The driver files a comp claim with the employer’s insurer and can also bring an ordinary injury claim against the other driver, which can include pain and suffering that comp never pays. A defective machine, a property owner’s dangerous premises or a subcontractor’s mistake can work the same way. California’s labor code says plainly that a comp claim doesn’t affect the right to sue a third party. Expect the comp insurer to want repayment from that recovery. Our personal injury guide covers how those third-party claims work.

Texas: where coverage is optional

Texas is the only state that still lets private employers choose whether to carry workers’ comp. Employers who don’t are called non-subscribers. State surveys found 24% of Texas employers were non-subscribers in 2024, employing 13% of the state’s workers. Non-subscribers have to post a notice that they don’t carry coverage and tell new hires in writing.

If you’re hurt working for one, there’s no comp claim, but you can sue. You still have to prove your employer was negligent. The law strips away the employer’s usual defenses, though. It can’t argue that you were partly at fault, that you assumed the risk, or that a co-worker caused the accident. It can defend on the ground that you meant to hurt yourself or were intoxicated. Many non-subscribers offer their own injury benefit plans instead, and those plans can have their own deadlines and arbitration clauses, so read the plan documents closely.

If the insurer denies or cuts off benefits

A denial isn’t the end of the claim. Each state has its own system for resolving disputes, which can end in a hearing before a workers’ comp judge or similar official. Typical reasons for a denial: the insurer says the injury didn’t happen at work, notice came late, a pre-existing condition is to blame, or its doctor says you can go back to work.

Several states offer free help before you hire anyone. California’s Information and Assistance officers answer questions and help sort out disputes with the claims administrator. Texas has ombudsmen at the Office of Injured Employee Counsel. Florida’s Employee Assistance Office helps with disputes and with filing a Petition for Benefits. None of them can act as your lawyer, but they can tell you where your claim stands.

If you’re punished for reporting an injury

Firing or disciplining someone for reporting a work injury is illegal under federal law. OSHA lists reporting a work-related injury or illness as protected activity under Section 11(c) of the Occupational Safety and Health Act. The deadline is short: a retaliation complaint has to be filed with OSHA within 30 days of the retaliatory action. Many states also have their own anti-retaliation rules for comp claims, sometimes with longer deadlines and better remedies. For more on job-related claims, see our employment law page.

Stress and mental health claims

Mental injuries without a physical injury are the hardest comp claims to win, and the rules shift often. New York shows how fast. A law signed in December 2024 opened mental injury claims from extraordinary work stress to all workers, not just certain first responders. In February 2025 the legislature passed and the governor signed an amendment that rewrote those provisions. Under the amended text, police, firefighters, EMTs and dispatchers have special protection for stress from a work-related emergency. Other workers can claim PTSD, acute stress disorder or major depressive disorder caused by extraordinary stress from a distinct work event. If you have a claim like this in any state, check the current rules with the state agency before relying on a summary.

Federal workers, longshore workers and miners

Some workers aren’t covered by state comp at all. The US Department of Labor’s Office of Workers’ Compensation Programs runs four federal programs: the Federal Employees’ Compensation Act, covering about 2.9 million federal employees; the Longshore and Harbor Workers’ Compensation Act, for maritime workers; a program for current and former Department of Energy workers and their survivors; and the Black Lung program for coal miners. Each has its own forms and deadlines. Start with the Labor Department, not your state agency.

If a work injury keeps you out of work long-term, you may also qualify for Social Security Disability Insurance. The two programs don’t simply add together. Under Social Security’s offset rule, your total from SSDI and workers’ comp generally can’t exceed 80% of your average earnings before the disability, and Social Security cuts its check to stay under that line. The reduction lasts until you reach full retirement age or the comp benefits stop, whichever comes first. How a lump-sum comp settlement is worded can change the offset, which is one more reason to get advice before signing one.

Do you need a workers’ comp lawyer, and what does one cost?

For a minor injury where the insurer accepts the claim, pays on time and you’re back at work in a few weeks, many people handle it themselves. Lawyers become more useful when the claim is denied, when benefits are cut off, when you’re offered a settlement that closes out future medical care, when there’s a permanent disability rating to fight over, or when a third party may also be responsible.

Comp lawyers work on contingency, but fees are usually set or approved by the state rather than negotiated freely, and they tend to be lower than in injury lawsuits. In California a workers’ comp judge must approve the fee, which the state says is usually 9% to 15% of the permanent disability settlement or award. In Texas, an attorney can take no more than 25% of your benefits and can bill no more than $200 an hour. Ask any lawyer you’re considering how the fee is calculated in your state, and whether it comes out of medical benefits or only wage benefits. If your job is unionized, your union representative may also be able to help or recommend someone; our labor attorney page has more on that side of things.