Worker's Compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence. The trade off between assured, limited coverage and lack of recourse outside the worker compensation system is known as "the compensation bargain".
While plans differ among jurisdictions, provision can be made for weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (past and future), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependents of workers killed during employment (functioning in this case as a form of life insurance).
General damages for pain and suffering, and punitive damages for employer negligence, are generally not available in worker's compensation plans, and negligence is generally not an issue in the case.
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Under the workers compensation system, employers are required to purchase insurance that provides benefits to employees who suffer work-related injuries and illnesses. The system strikes a compromise between employers and employees: Employees get benefits regardless of who was at fault. In return, employers get protection from lawsuits by injured employees seeking money damages for pain and suffering or mental anguish.
Workers compensation is governed by state law, and each state's system differs slightly in the details. However, the structure and operation of the overall workers compensation system is very similar from state to state. The main differences are the rates paid to injured employees and the procedural rules employers, employees, and insurance companies must abide by.
Workers compensation laws cover only work-related injury or illness. But, the injury or illness does not necessarily have to occur in the workplace. As long as it's job-related, it's covered. For example, employees are covered if they are injured while traveling on business, running a work-related errand, or attending a business-related social function.
Covered injuries and illnesses can range from sudden accidents -- such as falling off a scaffolding -- to injuries that happen over time, such as computer-related repetitive stress injuries (RSIs), or illnesses that result from exposure to workplace chemicals, air pollution, or radiation. For example, many workers receive compensation for repetitive stress injuries such as carpal tunnel syndrome and back problems. Workers also receive compensation for illnesses and diseases that are the gradual result of working conditions -- for example, heart conditions, lung disease, and stress-related digestive problems.
Not all problems that occur in the workplace are covered. Coverage may be denied in situations involving:
• injuries caused by intoxication or drugs
• self-inflicted injuries
• injuries from a fight started by the employee
• injuries resulting from horseplay or violation of company policy
• felony-related injuries
• injuries an employee suffers off the job
• injuries claimed after an employee is terminated or laid off, or
• injuries to an independent contractor.
The Workers compensation system provides:
• replacement income when employees are unable to work due to work related injuries
• payments for medical expenses, including doctors' visits, surgeries, and prescription drugs, and
• vocational rehabilitation benefits -- including on-the-job training, education, or job placement assistance (depending on the state where the employee is injured).
Employers have a number of obligations under the Workers compensation system. If these requirements are not met, employers can be fined and injured employees may be able to sue an employer in court.
If a business lacks the Workers compensation coverage required by law, employees may file a lawsuit against the business in civil court or, in some states, file a Workers compensation claim against a special uninsured employers fund (for instance, California has the Uninsured Employers Benefits Trust Fund).
Employers must post required notices in a convenient location frequented by employees during working hours. The notices or posters contain important information about employees' rights and:
• provide the name of the company's Workers compensation carrier, or the fact that the employer is self-insured, as well as who is responsible for claims adjustment
• state that injured workers have the right to receive medical treatment and to select or change treating doctors, and
• give details about available Workers compensation benefits.
Employers must also notify new hires of the above information.
Employers must Provide Claim Forms to Injured Employers
Employers must typically provide injured employees with a Workers compensation claim form within 24 hours of receiving notice of the injury. Employers must also supply the employee with written information (usually a pamphlet) about the employee's rights under the Workers compensation system. The written material should provide details about available benefits and how to file a claim.
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