Worker Compensation Coverages

Worker Compensation laws give employees the right to collect from their employers for injury, disibility or death that occurs in the course of employment.

Prior to the enactment of Worker Compensation laws, a worker had to sue his or her employer and prove the employer negligent to be reimbursed for a work-related injury. Employers proved very successful at avoiding liability through the use of three common law defenses; Assumption of risk, Contributory negligence, The fellow servant rule.

When Worker Compensation laws were finally adopted, they were designed to provide a fair means of handling work-related injuries, including occupational diseases. They are based on the idea that the cost of most work-related injuries and occupational diseases should be charged directly to the employer, regardless of who is at fault, and without complex court proceedings.

Note: The benefits stipulated in Worker Compensation laws are the only means, the exclusive remedy, available to employees against employers for injuries covered by those laws. Employees cannot sue their employer in court to obtain additional compensation.

Occupations Covered:

Over the years the scope of Worker Compensation laws has expanded to cover more and more occupational groups. Every state has some exempt classifications, but the majority of the nation's employees are now covered under Worker Compensation laws. Although the exemptions are not the same in all states, the following classes of employees are typically exempt:

• Certain farm and agricultural workers
• Charitable organization workers
• Domestic employees and casual laborers
• Newspaper vendors

Worker Compensation Benefits Provided

Worker Compensation laws vary from state to state, but in general they pay benefits for four categories.

Disibility/loss of income benefits... compensate employees who are unable to work as a result of a work-related injury. These benefits are intended to replace a portion of lost income, but not all of it.

Medical benefits... pay for the cost of various types of medical services required because of an employment-related injury. Nearly any type of related medical expense is covered with neither an upper dollar limit or a limit on the period of time for which expenses will be paid.

Survivor/death benefits... compensate a surviving spouse, children or other relatives of an employee whose death results from a work-related injury. Generally, survivor benefits usually include a weekly benefit and a stipulated amount for funeral and burial expenses.

Rehabilitation benefits... include medical rehabilitation, such as physical therapy designed to improve physical functioning, and vocational rehabilitation, such as retraining for a different occupation. Workers Compensation rehabilitation benefits usually pay any reasonable justifiable expenses for these purposes.

Compensable Injuries:

Work-related injuries must arise out of employment and arise in the course of employment to be compensated under Worker Compensation laws. Three factors are used to determine if the injury arose in the course of employment: time, place and circumstances.

Types Of Disibility:

The level of disibility suffered by an injured worker is categorized into one of four types:

• Permanent total
• Permanent partial
• Temporary total
• Temporary partial

A permanent disibility is one that will affect the worker for the rest of his or her life.
A temporary disibility is one that will eventually go away.

Determining the difference between a total and a partial disibility depends on what standard the state uses to determine the degree of disibility. In different areas, the determination is made by deciding first whether the worker is:

Industrially disabled, which refers to the individual's loss of earnings, or
Medically disabled, which refers to the physical condition that affects functioning.

Where industrial disibility is the standard, the difference between partial and total disibility depends on whether the individual is able to earn at least some money by working or has completely lost the ability to work for a living.

When medical disibility is the standard, partial or total disibility depends on whether the individual has partial physical functioning after the injury or has sustained a complete loss of physical functioning.