Workers' Compensation Benefits

Here are some common elements shared by the state workers' compensation laws:

• Benefits are provided for accidental job-related injury. An employee is entitled to statutory benefits from you when the individual suffers a "personal injury by accident arising out of and in the course of employment."
• Benefits include wage-loss, medical, and death benefits. Wage-loss benefits usually cover about one-half to two-thirds of the employee's average weekly wage.
• Covered "employees" are defined by law. "Employees" generally does not include independent contractors.
• Fault is generally not an issue. Neither the employee's own negligence in causing the accident nor your complete lack of fault are factors in deciding whether the worker gets benefits.
• Employees give up the right to sue you. In exchange for the assured benefits, employees give up their right to sue you for any injury covered by workers' compensation laws.
• Employees retain the right to sue negligent third parties. If a third party's negligence helped cause the accident, the employee can still sue the third party; any proceeds from the suit should be first applied to reimburse you for benefits paid to the employee.
• The system is administered by a state agency. The responsibility for administering the system is placed in the hands of a state agency.
• Most employers are required to participate. Exceptions exist for employers with less than a minimum number of employees.

What are benefits payable for? You should remember that workers' compensation benefits are payable only for work-related injuries. Benefits are not available for self-inflicted injuries or for those caused by intoxication or substance abuse. The payable benefits include:

• income replacement for partial or total disability of a temporary or permanent nature
• medical and rehabilitation costs
• survivor benefits in the case of a fatal illness or injury

In addition, coverage is provided for certain occupational diseases that are set out in the state laws.