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Topic 4.8: Workers’ Compensation

Before workers’ compensation statutes were common, employees injured on the job had very little recourse to recover damages for their injuries. They could sue their employer. That was not likely because the injured employee generally had very few financial resources to support a lawsuit. But if the employee did prevail in a suit against an employer, the employee could be awarded substantial money, creating an uncertain financial exposure for employers.

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Workers’ compensation laws were designed as a trade-off for both the employee and the employer. In exchange for giving up the right to sue, the employee receives a relatively easy and quick compensation for the work-related disability. The employer is relieved of the financial risk of paying a large damage award to an employee for a workplace accident.

The purpose of workers’ compensation laws is to make the workplace operate more efficiently by lowering the number of accidents, lost time, and lower production. Workers’ compensation statutes are remedial in nature, meaning that they are to be broadly construed to permit recovery when possible.

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

Filing Claims

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.

Covered Injuries

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.

Benefits

There are five categories of benefits:

· medical benefits

· temporary total disability

· permanent partial disability

· permanent total disability

· death

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