Workers' Compensation Benefits
Common elements. 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 — except in Texas, which has a voluntary system.
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.
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