Workers’ compensation is a state-mandated system that provides benefits and fixed-monetary awards to employees who are injured or develop work-related illnesses on the job. In exchange for these benefits, an employee loses the right to sue his employer civilly, except in those circumstances where the employee was injured by an intentional or reckless act. An employee may be entitled to benefits even if there was a pre-existing condition as long as a subsequent work-related injury aggravated the condition. Additionally, an award of benefits does not preclude an employee from suing another person who may have also been responsible for his injuries, such as the manufacturer of a defective product.
While most employers use insurance offered through a private insurer or a state-operated fund to provide workers’ compensation benefits, some employers are allowed to self-insure. In some instances, an employer may not be required to provide benefits at all if the employer does not have a minimum number of employees.
Types of Benefits Available
The benefits an employee can potentially receive are medical care and treatment, payments for temporary disability, and permanent disability, and vocational rehabilitation. If an employee dies as a result of his work injury, the dependent family members are entitled to the payments and limited burial expenses.
The employer or its insurer is responsible for providing medical treatment and hospitalization. While the employer is entitled to choose the medical doctor that treats the employee, if the employer fails to do so, the employee is free to choose his own doctor. The employee is also entitled to seek emergency treatment and should notify his employer upon such treatment.
Temporary Disability Benefits
If an employee loses time from work exceeding seven calendar days, the employee is entitled to temporary disability benefits beginning with the first day. The employee is entitled to approximately two-thirds of his gross pay for a state-mandated period.
Permanent Disability Benefits
An employee may receive partial or total permanent disability benefits. A partial permanent disability is based on scheduled or nonscheduled losses. A permanent disability is one that is caused by the loss of two or more major body parts or results from injuries that cause the employee to be unemployable. These benefits continue for a state-mandated period. Beyond that period, the benefits may be reduced based on the total wages earned.
Those Ineligible for Benefits
Not all employees are entitled to state benefits. Some employees, such as independent contractors, business owners, domestic workers such as maids in private homes, agricultural workers, and volunteers, among others, are not entitled to state benefits. Federal employees receive benefits under federal, not state, law.
Injuries Not Covered
Generally excluded from coverage are those injuries that were self-inflicted, occurred during the employee’s commission of a crime, or occurred while the employee was under the influence of alcohol or other substances at the time of the injury. Benefits may also be denied in instances where an employee violated company policy at the time the injury occurred. Usually an employer will not be required to pay for an employee’s pain and suffering or for punitive damages arising from negligence.
Advantages of a Workers’ Compensation System
The workers’ compensation system provides advantages in many ways. An employee’s need for litigation is reduced or eliminated, the method for receiving benefits is streamlined, and the amount of money an employer may be liable for is reduced. Some state laws also eliminate the liability of co-workers in employment-related accidents.