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Workers’ Compensation Benefits

Every employer is liable for compensation for the personal injury or death of his employee, if that injury arose out of and in the course and scope of employment.

1. Personal Injury
Initially, personal injury was defined as an unusual strain or traumatic force, which produced a sudden injury to some physical structure or function of the body. Compensation was only awarded for these sudden injuries. However, most states now recognize preexisting disease can be aggravated or accelerated by employment and that cumulative, repetitive trauma over time may lead to a compensable disability.

 2. Arising Out of Employment.
The next element necessary for an employee to obtain compensation is that the personal injury must “arise out of” the employment. This element requires a causal connection between the conditions of employment and the employee’s resulting injury. Courts also review whether the employment subjected the employee to an increased risk, distinct from the general public. For example in a case where, after standing for two hours, a fast food clerk fainted and was injured, a worker’s compensation court found the prolonged standing increased risk and lead to the fainting.

3. In the Course and Scope of Employment
In addition to showing that an injury was a “personal injury” and “arose out of the employment”, the injured employee must show that the injury occurred in the “course and scope of employment”. “In the course and scope of employment” refers to the time and place of the injury. Any injury, which occurs on the employer’s premises during working hours, is nearly always compensable. Due to the complexity of the employer/employee relationship, gray areas have developed which the courts have clarified.
Courts have determined that employees injured while traveling to and from work are not in the scope of employment. It should be noted though that once the employee steps onto the employer’s property, parking lot or sidewalk, that employee is covered by workers compensation benefits. Courts in most states have clarified and expanded the course and scope” rule. For example it has been found that employees traveling on employer business or employees off premises, but on a special errand for the employer are covered. It has also been found that employees on a personal comfort break or at lunch on the employer’s premises are also in the course and scope of employment. Likewise employees injured while attending an employer sponsored party or recreational activity are in the course and scope if attendance was expected or the employee’s attendance benefitted the employer.

 4. Notifying the Employer
Even if the employee does show that he has sustained a “personal injury” “arising out of” and in the “course and scope” of employment, the employee could still be barred from receiving compensation if the employee failed to give the employer timely notice of the injury. The rule of thumb is that the more promptly the employer is notified the less likely the employer will deny liability. To protect your benefits, give the employer notice immediately.

B. BASIC BENEFITS

1. Medical
Employers/insurers are required to pay for medical and/or chiropractic treatment that is reasonable and necessary to cure and or relieve the employee from the effects of the injury. Many states have enacted laws or rules which profoundly limit or control medical care available within the workers compensation system.

 2. Vocational Rehabilitation
Since the basic premise of workers compensation is to facilitate moving the injured employee back into the work force, many states provide vocational rehabilitation benefits. A Qualified Rehabilitation Consultant (QRC) is assigned to injured employees who are physically unable to return to their former occupation. The QRC provides services which include overview of medical treatment, job placement services and in some cases retraining.

3. Wage Loss
The most substantial benefit available to injured employees is payment for wage loss. Wage loss benefits are available to partially compensate an injured employee when the employee is temporarily or permanently unable to work due to the work related injury or is working, but at a reduced wage or working reduced hours. Most states have durational and amount limits on wage loss benefits.