Chapter 12: Workers' Compensation
Employees are protected by workers' comp as long as the injury happened ____________________________.
"In the course of employment" - Ex: A computer repair technician would be covered by workers' comp while making service calls on customers, but not while commuting to and from work or going to a purely social dinner later that evening
General exceptions to workers' compensation coverage
- Harbor workers - Seafarers - Railroad employees - Federal employees - Others as determined on a state-by-state basis
Workers who are not covered by workers' comp but who suffer work-related illnesses or injuries are usually relegated to getting compensation from their employers through __________________________.
1. A company-backed policy, such as paid time off for sick days 2. A settlement reached through arbitration or mediation 3. A lawsuit filed against an employer or former employer (for negligence or breach of contract, for example).
Dependents (usually a spouse, children, or other close family members) of a worker who is killed on the job or dies as a result of a work injury or illness are ________________________ to collect workers' compensation benefits. if an employee is found dead in the workplace, no one witnessed the death, and no cause of death is obvious, the death is ___________________ by workers' compensation.
1. Almost always eligible 2. Usually covered
Benefits paid by workers' compensation are financed primarily by ______________________________________. In most states, larger employers may opt to _______________________________.
1. Insurance premiums paid by employers - Required to purchase workers' comp insurance from a private insurer or through a state-run program 2. Self-insure - They can pay any claims themselves
Types of workers' compensation benefits
1. Medical bills 2. Temporary disability - Tax-free temporary disability payments to make up for lost wages - Cannot work at all: usually two-thirds of average wages - Reduced work: partial benefits 3. Permanent disability - Permanent total: Usually receive benefits at their temporary disability rates for the rest of their lives - Permanent partial: Still able to perform some type of work, even if it's not their normal job, are usually measured against a "schedule" of injuries, listing certain body parts and a corresponding amount of compensation (awarded regardless of wage loss) 4. Vocational rehabilitation - Have a permanent disability that prevents you from returning to your job, but you can still perform some type of work - Schooling, training, career counseling, or other resources designed to help you find a job in a new line of work 5. Death benefits - Burial expenses - Weekly compensation benefits are paid to surviving dependents (usually children and spouses) of workers who are killed in the course of employment or as the result of a work-related injury or occupational disease - Usually about two thirds of the deceased worker's weekly - May limit length of time or total amount can receive in benefits salary
Laws that work in tandem with work-related illnesses and injuries
1. Social Security disability insurance - Provides some income for people who are unable to work because of a physical or mental disability 2. The Americans with Disabilities Act - Prohibits discrimination against workers who have physical or mental impairments 3. The Family and Medical Leave Act - Allows an employee to take up to 12 weeks of unpaid leave in a year due to a serious health condition that makes the employee unable to do his or her job
Death benefits for surviving children usually end when they reach age _____________________
18 - May be later for full-time students
True or false: filing a workers' comp claim involves suing the employer
FALSE - More like submitting a claim to a car insurer following an accident - Only involves a lawsuit if the employer has committed some serious wrong or is illegally uninsured or underinsured
True or false: to be covered by workers' compensation, an injury must be caused by a sudden accident such as a fall
FALSE - Nearly any injury that occurs in connection with work is covered May also be covered: 1. Claims for injuries due to repeated physical motions - Ex: backstrain from lifting heavy boxes 2. A physical condition that was aggravated by workplace conditions - Ex: emphysema made worse by airborne chemicals 3. The effects of psychological injuries caused by the job
The __________________________ is responsible for paying for all reasonable and necessary treatment related to your work injury for life.
Insurance company - Have the choice to trade away future medical payments for cash if case is settled
A worker receiving workers' compensation benefits ___________________________ have the right to be treated by her regular doctor.
May - State-to-state (employee or employer may have the right to select the treating physician)
Illnesses that are the result stressful work conditions _________________________ covered by workers' compensation.
May be - Requires a clear connection between the job and the illness - Varies from state-to-state - May depend on type of illness and job (ex: heart attacks usually covered for police and fire) - Investigators will look into non-work factors (ex: diet, exercise, smoking and drinking habits, and hobbies) that might have contributed to a particular condition
Injuries that are the result stressful work conditions _________________________ covered by workers' compensation.
May be - Typically subject to stricter requirements and are more difficult to prove Better chance of proving claim if any of the following: - Physical manifestations of the mental or emotional injury (ex: high blood pressure or hair loss) - The mental injury was caused by or related to a physical injury (ex: depression caused by chronic pain from a work-related injury) - The mental injury is clearly related to an on-the-job incident (ex:developing PTSD after a robbery at the workplace)
In general, anyone who qualifies as a _______________________________ is covered by workers' compensation insurance.
Part-time or full-time employee
The workers' compensation system is administered by the _______________________.
States - Similar to unemployment insurance
True or false: possibilities of suicide or murder in workplace deaths are usually ignored by courts unless there is strong evidence that the death qualifies as one or the other.
TRUE
True or false: independent contractors are not covered under the workers' comp systems in most states
TRUE Remedies: 1. Can still sue for injuries, but will need to prove that the company was somehow at fault for causing them 2. May argue that, although categorized as an independent contractor, a worker should actually be considered an employee and should receive coverage
True or false: from the employee's standpoint, workers' comp is a no-fault system
TRUE - It does not matter whether a worker was careless when injured - EXCEPTION: Injuries incurred outside the bounds of "work-related activity" (ex: claims from employees hurt while drunk or fighting) - POSSIBLE EXCEPTIONS: Injuries due to "willful misconduct," injuries that are intentionally self-inflicted by the employee, injuries caused by a coworker's violent behavior, or injuries caused by substance abuse (state-to-state)
True or false: death benefits to surviving spouses usually come to an end if they remarry
TRUE - Some states provide for a lump sum to a former spouse upon remarriage
True or false: In almost every state, workers' compensation insurance coverage is mandatory
TRUE - Texas is the only state that makes workers' comp insurance optional for employers (may be sued by an injured worker in court for their full range of damages) - Some states may have an exception for smaller employers
Purpose of Workers' Compensation
To allow employers and employees to settle their potential differences over money and liability privately and quickly 1. Injured employees - Compensated for the costs of workplace injuries and illnesses 2. Employers - Can run their businesses free from the threat of negligence lawsuits filed by their employees
