Supplement to Accompany Workers’ Compensation Neal Bevans ISBN:

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.

© 2009 Delmar | Cengage Learning. All rights reserved.4 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.

© 2009 Delmar | Cengage Learning. All rights reserved.5 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.

© 2009 Delmar | Cengage Learning. All rights reserved.6 A Short History of Workers’ Compensation  Employers could raise defenses to injured workers’ claims  Assumption of the risk  Negligence of the employee  Intentional actions by third parties

© 2009 Delmar | Cengage Learning. All rights reserved.7 Exclusiveness of Remedy  The 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.

© 2009 Delmar | Cengage Learning. All rights reserved.8 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.

© 2009 Delmar | Cengage Learning. All rights reserved.9 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.

© 2009 Delmar | Cengage Learning. All rights reserved.10 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

© 2009 Delmar | Cengage Learning. All rights reserved.11 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

© 2009 Delmar | Cengage Learning. All rights reserved.12 Workers’ Compensation Benefits  Workers’ compensation benefits include: –Medical expenses –Income during the injury/illness –Death benefits –Burial benefits

© 2009 Delmar | Cengage Learning. All rights reserved.13 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.

© 2009 Delmar | Cengage Learning. All rights reserved.14 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.

© 2009 Delmar | Cengage Learning. All rights reserved.15 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.

© 2009 Delmar | Cengage Learning. All rights reserved.16 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.

© 2009 Delmar | Cengage Learning. All rights reserved.17 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.

© 2009 Delmar | Cengage Learning. All rights reserved.18 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.

© 2009 Delmar | Cengage Learning. All rights reserved.19 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.