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What is Workers’ Compensation?

Apr 12, 2016 - Articles by

Workers’ compensation is the legal framework by which individuals injured on the job may have the ability to have their medical treatment paid for, and receive a disability benefit while unable to perform work. Workers’ compensation pays the medical bills associated with medical treatment related to the on-the-job injury. If a worker is unable to perform his or her regular job, and is unable to perform alternative available work due to restrictions related to the injury, the worker is entitled to receive a weekly disability benefit. Workers’ compensation DOES NOT provide payment for “pain and suffering” nor does it provide any compensation for the troubles that a worker endures as a result of his or her injury.

Generally speaking, to be entitled to workers’ compensation an employee must suffer an “injury by accident.” This means that there must be some type of deviation from the normal work routine which resulted in an injury. If a worker sustains a traumatic injury while performing his or her normal work routine — without any unusual occurrence or interruption — then the worker is generally not entitled to workers’ compensation benefits. There is an exception to this for injuries to an employee’s back. Back injuries are covered by workers’ compensation as long as there is a “specific traumatic incident” that caused the back injury — even if there is no “accident” or deviation from the normal course of work. Thus, if an employee strains his or her back or suffers a herniated disc while lifting an object which is a normal part of work duties, the employee is still entitled to workers’ compensation. Additionally, an employee may be entitled to workers’ compensation benefits due to injuries that are caused by repetitive stresses, such as carpal tunnel syndrome, or occupational diseases such as medical conditions arising from exposure to environmental hazards. These types of claims likewise do not require an “accident” to have occurred.

If a workers’ compensation claim is accepted, the workers compensation insurer has the legal right to direct the medical care of the injured worker. This means that the insurance company gets to select the treating physician, and also authorizes care. That being said, an injured worker still possesses some rights when an insurer refuses to authorize recommended medical treatment, and an attorney can help to obtain that medical treatment. Additionally, an employee can have a right to receive a second opinion if there are questions unanswered by the treating physician designated by the workers’ compensation insurer. In certain circumstances, an employee may have the ability to get care transferred to a physician of his or her choosing.

An injured employee is entitled to a disability benefit if the employee’s physician has written the employee out of work. The employee may also be entitled to a disability benefit if the physician has provided work restrictions that the worker’s employer cannot accommodate, or if the worker is unable to obtain other employment as a result of these work restrictions. The disability benefit is based on what is termed the employee’s Average Weekly Wage. This number is typically the average gross wage that the employee has received on a weekly basis over the 52-week period immediately preceding the date of the worker’s injury. If the employee has worked with the employer for less than a year, or if the 52-week method does not fairly approximate the employee’s wage earning capacity, there may be other methods available for calculating the employee’s Average Weekly Wage. The disability benefit that an employee receives is equal to two-thirds (2/3) of the employee’s Average Weekly Wage. This disability benefit is paid on a weekly basis, and is not subject to taxation. This weekly benefit is subject to a 500-week limit.

If an employee has returned to work, but due to his or her restrictions is making less than the employee’s pre-injury wages, then the employee is entitled to what is known as a Partial Disability Benefit. This benefit is equal to two-thirds (2/3) of the difference between the employee’s Average Weekly Wage and the amount of post-injury wages the employee is earning.

Finally, workers’ compensation provides benefits to family members, financial dependents, or next-of-kin of workers who die as a result of their on-the-job injuries, or as a result of an on-the-job accident. The amount of benefits varies based upon the individual or individuals to whom such death benefits are paid.