supplement to accompany workers’ compensation neal bevans isbn: 1418013692

Supplement to AccompanyWorkers’ Compensation

Neal BevansISBN: 1418013692

CHAPTER 1

Introduction to Workers’ Compensation

© 2009 Delmar | Cengage Learning. All rights reserved.3

What Is Workers’ Compensation?

Workers’ Compensation is a form of insurance that guarantees compensation to injured workers, both for medical expenses, rehabilitation, and weekly wages until the employee has recovered sufficiently to return to work.


The Basic Premise of Workers’ Compensation

The basic premise behind workers’ compensation is that an injured worker will receive a specified monetary award for a particular injury. Under workers’ compensation, employees and employers do not have to waste time and resources pursuing personal injury actions.


A Short History of Workers’ Compensation

Workers’ Compensation movements began in the early part of the twentieth century.

Prior to the enactment of workers’ compensation statutes, the law took a harsh view of employee injuries.


A Short History of Workers’ Compensation

Employers could raise defenses to injured workers’ claims

Assumption of the riskNegligence of the employeeIntentional actions by third parties


Exclusiveness of RemedyThe workers’ compensation system is usually the only forum through which the parties can work out their differences.

Injured workers must bring their claims through the workers’ compensation system or not at all.


Do Workers’ Compensation Statutes Violate the U.S. Constitution?

If a statute requires employees to submit their claims to the Workers’ Compensation Board and bars them from bringing civil suits, is that an unconstitutional infringement of a citizen’s rights?

Courts have consistently answered that it is not.


Determining Who Is Covered by Workers’ Compensation Statutes

It is important to determine who is and who is not covered under Workers’ Compensation statutes.

Covered employees are entitled to benefits.

Employees who are not covered are not entitled to benefits.


Who Is Covered Under Workers’ Compensation? Employees who are employed by for-profit businesses

Employees who work for counties and towns and work in “hazardous” areas

Most public school teachers, with some important exceptions

Employees who work 40 or more hours per week

Seasonal or agricultural workers who earn $1200 or more

Any other employee deemed covered by the State Board of Workers’ Compensation


Persons Who Are Not Covered Under Workers’ Compensation

Members of the clergy

Teachers at religious institutions

Members of the merchant marines and other sea-going professions

Railroad workers

Federal employees

Casual laborers

Employees of foreign governments

Sole proprietors and other small business owners


Workers’ Compensation Benefits

Workers’ compensation benefits include:–Medical expenses

–Income during the injury/illness

–Death benefits

–Burial benefits


Medical Expenses

The medical expense benefit provided under Workers’ Compensation pays the total cost of the medical bills that flow from treating the injury/illness.


Income During Injury/Illness

Workers’ compensation also provides for payments to an injured employee during the period that he or she is unable to work because of a work-related injury/illness.

These payments are usually a percentage of the employee’s total income.


Death Benefits

Death benefits under workers’ compensation pay family members for some of the income lost because of an employee’s death.

Only certain family members are qualified to receive death benefits, such as dependent children and spouses.


Burial Benefits

Many states provide a maximum $6,000 benefit for an employee’s funeral expenses under the burial benefit provisions of a workers’ compensation insurance plan.


Determining the Amount of Benefits

One of the responsibilities of the state Board of Workers’ Compensation is to determine the extent of the employee’s injuries.


Special Protections for Firefighters and Law Enforcement Officers

Firemen and law enforcement officers often have a specific statutory protection when it comes to defining “accident” or “injury.”

In these cases, a statute will require an administrative law judge or Workers’ Compensation Appeals Board to presume that any heart or lung disease is caused by working conditions. Most other employees do not receive this special legal presumption.


Denying Benefits for Claims of Fraud

All of the benefits discussed so far can be denied in cases where an employee engages in fraud.

There are numerous kinds of fraud, from employee fraud to medical billing fraud.

supplement to accompany workers’ compensation neal bevans isbn: 1418013692

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