Supplement to Accompany
Workers’ Compensation
Neal Bevans
ISBN: 1418013692
CHAPTER 1
Introduction to Workers’ Compensation
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.
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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.
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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.
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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
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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.
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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.
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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.
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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
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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
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Workers’ Compensation Benefits
 Workers’ compensation benefits include:
– Medical expenses
– Income during the injury/illness
– Death benefits
– Burial benefits
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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