State workers’ compensation laws do provide exceptions to the rule that workers injured on the job are entitled to compensation. Each state is different, but the exceptions may include:
- Denied compensation in those cases in which the employee’s injury results from his or her attempted suicide or homicide.
- Denial of compensation to employees injured during the commission of crimes while on the job.
- Dis-allowance of compensation for injuries at work that are the result of employees who are injured while engaged in unauthorized horseplay on the job, for those leaving the employers’ premises, or for other deviations from employment without the employers’ express approval for deviation.
- Reduction of benefits in some states if the injury was caused by an incident in which the employee failed or refused to use safety appliances provided by the employer.
Employers in all 50 states have the duty to provide workers’ compensation coverage according to their respective state’s laws and regulations. The laws in some states provide an exception for some very small employers and allow some large employers to be self-insuring. In addition to providing coverage, however, employers may have additional responsibilities. These responsibilities include:
- Posting notices of compliance with the workers’ compensation law of the state at each work site
- Making sure that reports of injuries are made to the appropriate workers’ compensation office
- Providing a written report of all accidents resulting in injury in which a worker loses a certain amount of time
- Providing immediate emergency medical treatment for employees who sustain on-the-job injuries
- Fulfilling all requests for further information requested by the state’s workers’ compensation enforcement agency
- Furnishing medical attention if the worker is unable or unwilling to find a physician on his or her own
Most state laws prohibit employers from discriminating against employees who file workers’ compensation claims. Each state also provides for penalties and fines for employers who fail to fulfill their responsibilities under the law. Each state has an administrative process to make a claim of violation of workers’ comp laws against an employer. If the employer fails to defend against the claim, or, after defending against the claim, is found to have violated the law, the law provides for fines and penalties to be assessed against the employer.
Some workers are not covered by state workers’ compensation laws, but are covered by federal legislation relating to particular classes of workers or work-related injury. These laws are:
- The Federal Employees’ Compensation Act (FECA) provides workers’ compensation for nonmilitary federal employees. Most provisions are similar to state workers’ compensation programs. FECA provides compensation benefits to federal civilian employees for work-related injuries or illnesses and to their surviving dependents, if work-related injury or illness results in employee death. The Department of Labor administers FECA through 12 Office of Workers’ Compensation Programs (OWCP). The OWCP district offices make determinations about claims by injured workers and pay benefits. The costs of the benefits are charged back to the agency for which the employee worked when injured.
- The Federal Employers’ Liability Act (FELA) is not actually a workers’ compensation program. Compensation is not awarded automatically like workers’ compensation benefits. Instead, it provides that railroads engaged in interstate commerce are liable for injuries to their employees that are caused by the employers’ negligence. As Justice William Douglas of the United States Supreme Court pointed out in one decision, “the FELA was designed to put on the railroad industry some of the costs of the legs, arms, eyes, and lives which it consumed in its operation.” However, under FELA, railroad employers were not liable for all their workers’ injuries, just those caused by the employer’s negligence. The compensation provided to qualified workers, however, is usually many times greater than that provided by state workers’ compensation programs.
- The Longshore and Harbor Workers’ Compensation Act (LHWCA) provides workers’ compensation to specified employees of private maritime employers. The Longshore and Harbor Workers’ Compensation Act provides employment-injury and occupational-disease protection to workers who are injured or contract occupational diseases occurring on the navigable waters of the United States, or in adjoining areas, and for certain other classes of workers covered by extensions of the Act. These benefits are usually paid through an authorized insurance carrier or, in instances when the employer is allowed to be self-insured, directly by the employer. In some specific circumstances, benefits are paid from a special fund administered directly by the Division of Longshore Compensation.
- The Black Lung Benefits Act (BLBA) provides compensation to miners suffering from black lung disease (pneumoconiosis). Black lung benefits are monthly payments to, and medical treatment for, coal miners totally disabled from the disease due to their employment in or around United States coalmines. The BLBA also provides for augmented payments to miners based on the number of their dependents, and to certain survivors of the miners who died due to, or were totally disabled from, pneumoconiosis. Coalmine operators pay an excise tax, based on their operation’s tonnage and price of coal sold, to support the payments of black lung benefits and the cost of program administration. In addition, when determined that they were the actual employers for specific workers, operators provide insurance, either through private carriers or on their own, to make benefit payments to those eligible workers.
Generally, any injury occurring at work which is due to a traumatic incident, such as falling from a ladder, or that is due to cumulative factors, like injuries caused by repetitive motions, would be considered as arising out of employment. Illnesses created by the work environment, like medical conditions caused by exposure to chemicals, are also compensable. In general, any injury or illness that requires the worker to see a doctor or that results in disability or death qualifies for workers’ compensation benefits. A doctor must be able to verify that there is objective medical evidence showing that an injury or disease exists and that work exposure was the major cause.
Even injuries resulting from recreational and social activities are compensable if such recreational or social activities are an expressly required incident of employment, such as a company golf tournament, holiday party, or picnic and they produce a substantial direct benefit to the employer.
Generally, however, those injuries suffered while going to or coming from work are not considered to be arising out of and in the course of employment, even if the employer provides transportation, unless the employee is engaged in a special errand or mission for the employer. Finally, if an employee becomes an inmate of a public institution, states may deny benefit payments, except possibly to the employee’s dependents.
Nearly all employers in Wisconsin are required by law to carry Wisconsin workers’ compensation insurance. However, if your employer does not carry worker’s compensation insurance and is illegally uninsured, you may still file for workers’ compensation benefits through the Uninsured Employers Fund (UEF).
Once you have received a physician’s permission to return to work following an occupational injury, you will most likely wish to return to your previous job. This can prove problematic. Your employer has no legal responsibility to hold a position for you or create a new one once you have made your recovery.
If your employer refuses you without a reasonable cause, Wisconsin state law states that you may be eligible for compensation for wages lost during the period of refusal. This can amount to up to one year’s worth of wages. Establishing clear lines of communication between you, your doctor and your employer throughout your recovery process is the surest way to avoid complications once you are ready to return to work. By maintaining an ongoing relationship, your employer can be informed as to your progress and together you can create a reasonable work plan outlining your re-insertion into the work force.
Sustaining a strong relationship with your employer can also benefit you should your employer decide not to rehire you and you request a hearing to challenge your employer’s decision.
One of the original rationales for the establishment of workers’ compensation laws was to protect employers from the drastic effects of failing to provide safe work environments. Prior to the passage of such laws, employees who were injured due to their employers’ negligence sued the employers under traditional negligence or personal injury law. Under that system, if the employer was found negligent, the employee could recover not only medical expenses and lost wages, but also such damages as pain and suffering. The parties had a right to a jury trial and the awards in particularly egregious cases could be quite high against the employer. As the industrial revolution created larger and larger workplaces and the possibility of many more worker injuries, employers often became embattled defending against multiple workers’ personal injury claims.
Thus, workers’ compensation systems, which are generally considered no fault, were instituted, giving employees a trade-off of guaranteed and purportedly quicker, establishment of benefits, without concern for their own contributory negligence. The employers, on the other hand, gained immensely in that they no longer had to defend against numerous lawsuits since they were granted virtual immunity from lawsuits for their negligence. A determination as to whether the employer’s or the employee’s negligent behavior caused the problem is irrelevant. Some, who find workers’ compensation an uneven trade-off between employer and employee, argue that, under most state workers’ compensation systems, employers often do not have to worry about the cost of possible consequential injuries, even in cases where they are more than merely negligent. However, under certain circumstances in most states, there are injuries for which the employee may either sue the employer or a third party, as in the case of injuries resulting from faulty or defective equipment.
As the terms imply, a worker may be disabled only partially or totally, and, temporarily or permanently. The laws treat each of these conditions differently.
Partially, temporarily disabled: This condition will generally allow the injured worker to receive benefits based on a schedule that bases payments on a percentage of maximum benefits. Generally, a worker will receive these benefits until released to their former job or until a determination that the injury is more permanent.
Partially, permanently disabled: This condition generally allows a worker to receive a percentage of the full benefit on a monthly basis for the remainder of his or her life, unless the condition improves.
Totally, temporarily disabled: Many injuries cause total disability for a temporary period. Workers with this condition are typically paid two-thirds of their lost wage, tax-free, until they are able to return to work or their condition improves.
Totally, permanently disabled: These workers generally receive the state’s full benefit amount on a monthly basis for the rest of their lives.
Each state has its own schedules and time limits regarding each of these conditions. Thus, as seen in the example where a worker in one state may receive a vastly different amount for the loss of an arm than a worker with the same injury in another state, workers from state to state, even with arguably the same condition, often receive greatly varying awards.
The catalyst for a fair and equitable system of workers’ compensation came out of the industrial revolution. As industrial activities increased both in Europe and in the United States, factories expanded and the occurrence of work-related injuries grew. Generally, the only recourse for workers injured on the job was to sue their employers in the courts. Eventually, court systems became overwhelmed by the flood of cases, resulting in long delays before workers realized any compensation for their injuries. Compensation was often insufficient and an award was in no way guaranteed. Many injured workers ended up with no income at all. Many of them were destitute and, along with their families, became a drain on state welfare systems. Furthermore, employers often found themselves completely embattled due to the glut of cases against which they defended.
Of the European nations, Germany was the initiator of a sort of workers’ compensation program when, in 1938, it passed laws providing compensation to railroad workers and passengers involved in railway accidents. In 1880, England provided a model for some of the first United States’ laws when the Parliament passed an act making employers responsible for injuries to workers.
The first state in the United States to pass an employers’ liability act was Maryland in 1902. Although later ruled unconstitutional, other states began passing legislation that passed constitutional muster. In 1911, Wisconsin passed the first workers’ compensation act, a precursor to present-day laws. It was just a matter of years for the rest of the states to follow suit. Currently, all states provide programs whereby injured workers receive medical care and disability income even when they are injured because of their own negligence. Employers are protected from potentially large losses by preset benefit schedules for injuries suffered by employees. The trade-off is that workers are prohibited from filing suit, while employers are obligated to pay mandated benefits.
Every state has passed workers’ compensation laws that provide benefits to employees injured at work. These laws have a variety of names, such as workers’ compensation, workman’s compensation, worker’s compensation, or work comp. These laws require that employees suffering on-the-job injuries receive compensation to replace lost wages and cover medical expenses. Most state laws provide that employers must either carry insurance through a private carrier or show that they can self-insure against claims by workers injured on the job. Other states provide that employers must pay into a state workers’ compensation fund.
Workers’ compensation is a no-fault system. No matter what caused the injury – worker’s negligence, employer’s negligence, or a combination of the two – workers injured on the job receive benefits under the law.
For the most part, states, rather than the federal government, regulate workers’ compensation. However, some workers, such as maritime, postal, and railroad workers, are covered by federal, rather than state law. Because of its interstate nature and because of the upsurge in claims in the late 1960s and early 1970s arising from black lung disease, the United States Congress passed legislation providing for compensation to coal field workers suffering from the disease. The Federal Employees’ Compensation Act (FECA) covers on-the-job injuries sustained by federal employees.