OVERVIEW
The worker’s compensation law (in some states, ‘workman’s compensation’) is designed to provide medical and wage replacement benefits for workers who are injured during ‘the course and scope’ of their employment. Worker’s compensation laws are creatures of statute, that is, they have been formulated by the various state legislatures and do not necessarily comply with rules of logic or common sense.
Each state has its own worker’s compensation laws that provide benefits to injured workers. The laws of any state may be quite dissimilar from the worker’s compensation laws of a sister state. There are also separate federal worker’s compensation laws covering federal government employees and employees of the railroad and maritime industries. There are however several themes common to worker’s compensation laws generally.
COVERED ACCIDENTS
Course and Scope of Employment
For a workplace injury to be compensable, the injury must have taken place “within the course and scope” of the employee’s duties. Ordinarily, this means that the accident must have occurred during normal business hours while the employee was carrying out his/her usual duties.
Coffee Breaks
Under most state laws, accidents that take place during coffee breaks at the work premises, or while on an errand at the request of the employer or a supervisor are also compensable.
Going to and Coming From Work
While injuries incurred while traveling on behalf of an employer are covered, many states have a “coming and going” rule whereby injuries that take place while traveling to work or going home are excluded from the operation of the law.
Traveling Employees
Employees who regularly travel as part of their duties (e.g., traveling salesman) are ordinarily engaged in covered employment when going from a hotel room to a customer.
Horseplay
Injuries incurred during “horseplay” or non-work-related activities are normally excluded.
Employer Sponsored Events
Injuries sustained during employer sponsored events, such as picnics, sporting events and the like may or may not be covered under state law. Generally, to be covered by worker’s compensation, the employee may have been required to attend and there must have been a benefit derived by the employer from the employee’s attendance.
Exposure/Repetitive Trauma Injury
Illnesses that are caused by working conditions, such as exposure to chemicals or smoke and repetitive-trauma injuries, such as carpal tunnel syndrome sustained by a typist, are ordinarily considered covered injuries.
Safety Rule Violations
In many states, failure to comply with safety requirements, such as wearing goggles or lifting belts, may reduce benefits available under the law.
Negligence by the Employer
Under the worker’s compensation system, the negligence of the employer or the comparative or contributory negligence of the employee are irrelevant; the mere fact that the injury took place in the course and scope of employment is sufficient to trigger entitlement to worker’s compensation benefits.
COVERED EMPLOYMENT
Most workers are eligible for worker’s compensation coverage, but certain workers are excluded in every state. Most often, independent contractors (individuals who work for themselves even though they are rendering services for an employer), casual workers (who are not regularly employed by the employer), domestics, farm workers, volunteers and athletes are excluded. Railroad workers, longshoremen and federal employees are not covered under state worker’s compensation law; they are subject to separate, but similar laws unique to those occupations.
BENEFITS AVAILABLE
Medical Expenses
Every state’s worker’s compensation law provides for payment of medical expenses incurred by the employee in the treatment of work-related injuries. Often, medical care must be authorized and obtained through a physician authorized by the worker’s compensation insurance carrier.
Wage Loss
Likewise, every state provides for some form of wage replacement benefit during the time that the employee is unable to work. Partial wage replacement is generally available when the employee can work only part-time, or due to an injury, cannot earn the same income as they made before the accident.
Amount of Compensation
Ordinarily, workers receive a fixed weekly benefit of between one-half and two-thirds of their regular salary during the time that they are temporarily unable to work as a result of a work injury. There may be an additional entitlement to a lump-sum payment for a permanent injury. Some states award a fixed amount of compensation for a specific injury, such as the loss of an arm or a leg.
Other Benefits
Additionally, vocational and rehabilitation benefits, including re-training, schooling and job placement assistance may be available.
Pain and Suffering
An injured worker is not entitled to recover the value of his pain and suffering or loss of ability to enjoy life (even though these elements of damage are ordinarily available in a negligence action.) If, however, the injured employee also has sustained a psychological or emotional injury, the employee is entitled to psychiatric or psychological care.
Total Disability
If a worker becomes permanently and totally disabled as a result of a work injury, the worker may be entitled to lifetime benefits with cost of living increases. Generally, there will be a reduction in either social security or worker’s compensation benefits during the time that the employee is entitled to both.
Death Benefits
Death benefits are available to certain members of the family of a worker who dies as a result of a work-related injury. These benefits ordinarily include funeral expenses and a lump sum or periodic payments to a surviving spouse or minor children.
SUING FOR NEGLIGENCE
Employer Immunity from Lawsuits
Since worker’s compensation is payable even if the employee was him/herself negligent, the worker’s compensation system has been structured to prevent the employee from suing the employer in tort (outside of the worker’s compensation system) even if the injury resulted from the employer’s negligence; the employer is said to be ‘immune’ from traditional lawsuits for personal injuries. There are limited exceptions to this rule in some states, as when the injury was caused by the “gross negligence” (extreme negligence) or willful and wanton conduct of the employer.
Liability of Third Parties
If, however, the injury was caused by a third-party who is not connected to the employer, an injured worker can collect worker’s compensation benefits and institute a personal injury lawsuit against the negligent party. In most cases, if the injured worker recovers money damages from the negligent party, he/she must reimburse all or a portion of the worker’s compensation benefits received to the worker’s compensation insurance company or to the employer.
CLAIMS
Worker’s Compensation Insurance
Worker’s Compensation coverage is generally provided through a policy of insurance obtained by the employer, although certain large employers may be self-insured. Worker’s compensation insurance is mandatory; in most states, an employer who regularly employs a minimum number of employees is legally required to purchase a policy of worker’s compensation insurance. If the employer has failed to secure worker’s compensation coverage, the employee is usually entitled to sue for either worker’s compensation benefits, or in some states, may elect to sue the employer directly for damages.
Notice of Injury
As soon as possible after an injury, the employee must notify the employer of the work-related accident. The employer is required to fill out a notice of injury form and notify the worker’s compensation insurance carrier of the pending claim.
Compensation Courts
Worker’s compensation disputes are generally handled in a special court system that deals exclusively with work-related injuries.
Attorneys
An injured worker would be well advised to contact an attorney experienced in worker’s compensation if he/she has sustained a serious work injury. This area of the law is highly complex and is often related to federal laws, such as social security. Depending on state law, an attorney will accept the case on a contingency fee basis or will look to the employer to pay fees for any benefits obtained through the services of an attorney.