General Statutory Scheme
Workers’ compensation statutes in some form have been adopted in all states. The employer pays an insurance premium that pays benefits to employees injured during employment. The benefits cover lost wages, medical benefits, and may compensate an injured worker for the loss of use of a body part.
Depending on the state law, an employer may oppose the employee coverage by claiming:
· contributory negligence—the employee did some act that falls below the reasonable care standard appropriate for the circumstances, thereby contributing to the injury
· voluntary assumption of risk—the employee knowingly engaged in an act that the employee knew could result in injury
· fellow servant doctrine—the accident was the fault of some other employee’s misdoing
After an accident, an employee files an incident report with the state workers’ compensation agency. The circumstances surrounding the incident are investigated and compared with the medical report that established the worker’s disability from earning wages. A determination is made as to whether or not the worker is entitled to coverage and the degree of coverage (partial or total, temporary or permanent). If the worker is not satisfied, the decision may be appealed. Generally, agricultural and domestic workers are not covered.
Workers’ compensation laws apply to accidental, personal injuries arising out of or in the course of employment. Coverage includes mental and emotional and physical injuries. The issue of occupational diseases—medical conditions that are not the result of one traumatic incident—are also often covered.
One of the more frequently contested areas is whether an accident occurred in or arose out of the course of employment. Having an injury occur at work does not necessarily mean it is covered. If it occurred away from work, that does not necessarily mean that it is not covered. The key to determining coverage is whether the injury has a causal connection with the employee’s employment or is reasonably incidental to it.
There are five categories of benefits:
· medical benefits
· temporary total disability
· permanent partial disability
· permanent total disability