What
In an attempt to help individuals who were hurt on the job or contracted an occupational disease, the concept of workers’ compensation was developed. It is a way where wages and medical benefits can be paid due to the employee giving up the right to sue his or her employer for the tort of negligence. It also requires that the employer cannot have an employee contribute to the cost of compensation. This is a first day coverage but there may be a waiting period before wages are paid, i.e., in the State of New York cash benefits are not paid for the first seven days unless it extends beyond 14 days. Medical care is provided no matter duration of disablement.
This concept was codified in 1916 with an organization being established to administer claims under the Federal Employees Compensation Act. Each individual state now mandates this coverage for qualifying occupations operating within the state. This is generally overseen by a Department of Labor and Industry Section of state government or by a State Board of Workers’ Compensation. Rather than trying to describe each state and how they handle workers’ Compensation issues in this narrative, please be referred to internet sources which are extremely helpful in understanding your particular state’s resources. It is easy to access information by simply typing in Workers’ Compensation and name of state you wish to access.
Though none are directly quoted, many of the sources were used to describe the what, why, where, who and how for this narrative.
Why
It is fair to say that since the beginning of civilization there has been a societal desire to take care of individuals who are the unfortunate ones to be harmed or killed in the arena of doing their labors making it so they cannot be a contributor to the economic welfare of the society. This desire extends to those who are dependent on the harmed producer as well.
In order for a society to be humane and to exhibit the highest moral character of charity, we reach out to those in need of our help. We also recognize in the statement, “. . .but for the grace of God, there go I,” we could be the next in line to receive that act of charity. Though there does come a time when the producer can no longer be an active participant in the wheel of economy, we do try to assist one another to stay productive as long as we can. In the event of an injury or ailment which would temporarily remove one from the workforce, we try to help each other take care of the financial obligations which are there. In the event of death we try to alleviate the financial burden still faced by the surviving impacted family members.
It could be said that the social philosophy underlying workers’ compensation is the efficient and dignified provision of financial and medical benefits to those injured on the job and the allocation of the expenses to appropriate source, the consumer.
Where
This can best be answered with the statement, if the injury, occupational disease or death occurs while in the legitimate course of employment, then workers’ compensation laws will be in effect.
In the United States each individual state governs the workers within its confines. If an employer has business operations in separate states, it must comply with each of those state’s regulations. It would be wise for an employer not to assume since they have insurance in the state in which they are domiciled that it will meet the requirements of another state. Also, if they are using the same employees across state lines, they need to know which state’s regulations will be in effect. An example is the carpentry company having employees living in Idaho who cross Washington state line every day to build homes in Washington. They leave Idaho in company owned vehicles, travel to Washington, perform labors, and then return to Idaho in company owned vehicles. It is beyond the scope of this article and the expertise of the author to answer this concern of what State would be responsible. This is where good sound legal and knowledgeable, competent insurance advice would be worth seeking.
Who
Under the workers’ compensation laws, most individuals providing services to a for-profit business will be deemed an employee of that business. A few exceptions are worth noting. Volunteers, business owners, sole proprietors, independent contractors and partners do not qualify automatically for coverage. If they want coverage, they must elect it and pay appropriate premiums. Persons requested by a firefighter or police officer to assist in emergency are also eligible for coverage. Part time domestic workers such as maids and nannies, part time gardeners, and maintenance workers, taxi drivers and some agricultural workers are others who do not qualify for coverage.
It also should be noted that workers’ compensation can be withheld if injury results solely from intoxication from drugs or alcohol or from deliberate attempt to injure oneself or someone else.
Federal employees are covered under the Federal Employees’ Compensation Program; Longshore and Harbor Workers under Longshore and Harbor Workers’ Compensation Program; while Railroad employees are covered under Federal Employers’ Act, also known as Railroad Workers’ Act. (Information gleaned from U.S. Dept of Labor website, Office of Workers’ Compensation Programs–OWCP.) The benefits under these programs are for wage replacement, medical treatment, vocational rehabilitation and other benefits.
As a side note, what do people who are not eligible for any workers’ compensation benefits do to protect themselves? They either go without coverage or attempt to get a disability income insurance policy to replace lost wages, and private life insurance policies to compensate their families in the event of death. The other recourse would be litigation against employer in an attempt to prove negligence so some compensation could be had.
The question has also been raised regarding ecclesiastical occupations and their standing for workers’ compensation. Some have felt ministers are independent contractors or self employed. A case which set a precedence for coverage was St. Johns Lutheran Church vs. State Compensation Insurance Fund, 830 P.2d1271 (Mont. 1992) From issue: Church Law and Tax Report 1993, March/April posted: March 1, 1993.
This ruling stated that since the place of worship, equipment, and supplies were provided, and method of worship was provided, the minister was deemed to be an employee. They also cited that since the church had been paying workers’ compensation premiums for a lengthy period of time, the church must have determined their ministers were employees and therefore eligible for benefits. A caution was given in the ruling for all churches to get advice beforehand as to the ruling so no one would be caught in question.
These are some examples of measurements used to determine employee status when determining necessity to provide workers’ compensation in any given occupational field:
- Right to control task
- Right to hire/fire
- Payment of taxes and maintaining income records
- Providing equipment and supplies
- Right to determine when job will be performed.
If any of these criteria are met, the company would be wise to seek clarification from the state governmental body regulating workers’ compensation to see if they should be paying premium.
Not only should they check to see if workers’ compensation is required, but also make sure of classification of employees. Trying to classify a meat cutter in a meat processing plant as a delicatessen sandwich maker would be problematic at best. For example, in the State of New York, if an employer willfully violates the Fair Play Act by failing to properly classify its employees, it will be subject to civil penalties of up to a $2500 fine per misclassified employee for a first violation, and up to $5000 per misclassified employee for a second violation within a five year period of time. The term “willfully violates” means a contractor knew or should have known that his or her conduct violated the law. Judges will impose civil penalties based on the evidence presented at the hearing.
How
If an employee feels he or she has been injured on the job, the first thing one should do is report it to the employer and then receive proper medical attention. Once that has been done, proper claims forms will be provided either by the attending physician or the insurance carrier. As an example, in the State of Washington, a claim can be reported through the doctor’s office, through the Department of Labor and Industry website, or by calling the Department of Labor and Industry directly.
While the claim is being reviewed, your employer may be able to give you some light weight duties to help you stay employed, and help to reduce the employer’s claim expenses. Also, in the State of Washington, 50% of the base wage as well as expenses for training and tools for the light duty job will be reimbursed to the employer by the Department of Labor & Industry.
Once the claim has been approved, medical bills will be paid directly to the provider. Wage replacement, return-to-work help, and disability or pensions for the severely disabled will be attended to by Department of Labor and Industry directly with the claimant.
If claim is rejected because the doctor cannot certify the worker’s medical condition is related to something specific that happened at work or the occupational disease is result of work environment, you do have the right to a hearing to present evidences you feel may assist in a different decision.
Sometimes an injury is approved and closed in the same notification because the injury was minor and treatment was successful.
Each State has its own method for calculating cash payment benefits. Again, the State of New York uses the formula of ⅔ average weekly wage x percent of disability to determine weekly benefit. If death occurs, death benefits are payable to surviving family at a maximum of ⅔ of the deceased’s average wage for year before the accident.
If there are no surviving spouse or children, the estate may receive compensation. Funeral expenses are in addition to survivor benefits.
Summary
In order to maintain a well-cared-for workforce and to eliminate friction caused by the need to litigate in the event of an accident or occupational disease, workers’ compensation stands as a pillar in the economic system in our society. It answers the concerns for the what, why, where, who and how of providing for lost wages caused by injury or occupational disease in our modern day economic engine–another great example of society striving to uplift the less fortunate and to provide a degree of dignity to those who can no longer be a producer in that society.