Injuries or illnesses or occupational exposures


1) What is workers' compensation?

Each state has its own worker's compensation laws to handle claims from employees who are injured on the job. These laws are strict liability - fault and negligence by the employer need not be established in order to collect benefits. However, the injury or illness has to be incurred in the course of employment in order for the workers' compensation system to provide benefits to the injured worker. Since workers' compensation law imposes strict liability on employers, it is the exclusive remedy for an employee's injuries or illnesses arising out of the course of employment.

Workers' compensation insurance is typically required by the state for every employee - although state law may provide for specific exemptions for officers/owners, small companies (those with three/four/five or fewer employees), domestic workers, farm hands, and independent contractors.


2) What type of occupational exposures are covered by workers compensation?

Workers' Compensation systems provide benefits to those workers who suffer immediate and long term effects of occupational exposures. The exposure may have occurred recently or have occurred many years previously. Individuals are able to seek benefits for occupational exposure to toxic substances at work including asbestos, lead, latex and many other chemicals. Employees may seek benefits for: repetitive stress disorders, i.e.. carpal tunnel syndrome; occupational exposure to loud noise, i.e.. binaural hearing loss; cardiovascular disorders, i.e.. myocardial infarctions, and hostile work environments, i.e.. psychiatric and possible physical disorders.


3) What benefits are typically available under workers' compensation?

There are three major components to workers' compensation:

(1) Medical Expense - the cost for hospitals, doctors, medical treatment, etc.

(2) Disability Pay - either temporary while you are getting back to normal, or permanent if you will never fully recover. The amount varies, but can be as high as one-half to two-thirds of your normal pay.

(3) Vocational Rehabilitation - if your injury renders you unable to perform the usual duties of your occupation, you may need re-training so that you can enter into a new trade or business. Also, you may need physical therapy to get your normal strength back.

Since workers' compensation imposes strict liability without inquiry into fault, an employer could be penalized where its conduct was egregious - violation of federal or state safety standards, failure to correct known defects or other conduct - situations where there is a need to punish and deter such conduct in the future.


4) What if i'm exempt - do I need to be concerned about workers' comp?

Even if you are covered by one of the exemptions, you should consider having workers' compensation insurance anyway. It typically is very affordable coverage that could really save you a bundle if someone got injured while working for you. Not only is workers' compensation coverage the right thing to do, it can protect you and your business from a devastating claim in its absence.

You'll also need other general liability insurance for your business. It's not always your employee who poses potential liability. If an employee of an independent contractor you hired to work on your house gets injured, you hope the independent contractor has coverage for the employee because if there is no coverage, its injured employee may begin looking for other sources of compensation and you will be in his/her direct line of sight.


5) What kinds of injuries or illnesses might be compensated by workers' compensation?

Injuries or illnesses are typically covered only when they "arise out of and in the course of employment." There needs to be a nexus between the accident that caused the injury/illness and the scope of your employment duties. Examples of compensable injuries are those caused by lifting heavy equipment, slipping on a wet or oily surface, defective machinery, or fires or explosions. Many state workers' compensation programs preclude coverage for injuries which occur while you are not acting within the scope of your employment - such as while you are playing football with friends on your day off. But closer examination of the situation should be made - if you were injured while playing football at a company sponsored picnic, there may be coverage.

Illnesses which "arise out of and in the course of employment" can be covered under the workers' compensation system where the working conditions present unusual or extraordinary risks of contracting an illness - such as coal miners being able to recover for black lung disease or computer workers for carpal tunnel syndrome. Careful inquiry into the hazards arising out of the scope of your employment can determine whether the illness is one that is common to everyday life as opposed to risks of illness that are present in your particular employment situation.


6) Does workers' comp insurance cover long-term illnesses and diseases?

Your injury does not have to be caused by an accident to be covered by workers’ compensation . As an employee, you can receive compensation for repetitive stress injuries, including carpal tunnel syndrome and back pain that are caused by overuse or misuse over a long period of time. A worker who has sustained a documented repetitive motion injury is entitled to workers’ compensation benefits according to the benefit schedules in their state’s workers’ comp statutes.

You may also be compensated for some illnesses and diseases that are the gradual result of work conditions, including heart conditions, lung disease and stress-related digestive problems.