Coverage Flashcards
(35 cards)
Is worker’s compensation an at-fault doctrine?
No, it does NOT matter who is at fault
What two persons are covered by worker’s compensation?
- Employees; and
2. Employers
What 2 circumstances is an Employer not covered by worker’s compensation?
- Small employers with fewer than 3 full time employees; and
- Federal government employers
Are employees independent contractors?
No
What are the five IRS factors to consider when determining whether an employee is in fact an employee?
CHEST:
- What control does employer exercise over the worker?;
- Is the working holding himself out to the public to do specific work? If so, then an independent contractor;
- Does employee depend on job for payment of living expenses?;
- Is the worker furnishing his own supplies?; and
- If employer terminates, what are the legal ramifications?
What 5 areas are covered by worker’s compensation?
- Injury or disease arising out of and in the course of employment;
- Mental Disabilities;
- Conditions of aging process;
- Pre-Existing Conditions; and
- Actions within the Scope of employment
What is the scope of “injury related out of the course of employment?”
Activities that one can reasonably expect a person to engage in during his or her work time, regardless if it furthers the employer’s business.
What are the two requirements for a mental disability to be covered by worker’s compensation?
- Employee’s work significantly aggravates or accelerates the mental disability; and
- Injury arose out of actual events at work
Not delusions or unfounded perceptions
Hard to prove
What is the 2-step analysis when determining whether a pre-existing condition is covered by worker’s compensation?
- Difference in kind not just difference in magnitude (A bad back that gets significantly worse from lifting at work is insufficient. A bad back that is worsened by a slip disc from lifting at work is sufficient); and
- The work-related injury changed the pathology of the condition, so that the new injury is medically distinguishable from pre-existing condition.
Is an injury suffered during the commute to work within the scope of employment?
No, unless employee is on the premises
When is an injury that occurred during social/recreational functioning covered by worker’s compensation?
When the social/recreational functions are sufficiently related to the job or a major purpose to the job
Does worker’s compensation apply where an employee’s misconduct is intentional/willful/bad?
No
When is an injury from horseplay covered by worker’s compensation?
When the injury results from work itself, or from the stresses, the tensions, or the associations of the working environment.
What 4 factors should be considered when determining whether horseplay has deviated from the course of employment?
- the extent and seriousness of the deviation;
- the completeness of the deviation;
- the extent to which the practice of horseplay had become an accepted part of the employment; and
- the extent to which the nature of employment may be expected to include horseplay.
What must an employee show to earn lost wages?
That the employee has a work-related disability
What is a work-related disability?
A reduction of an employee’s wage-earning capacity
What 4 factors must you prove for an employee to earn lost wages per their work-related disability?
- Employee’s complete qualifications/training;
- What the employee is qualified/trained to do that might pay as much or more than the old job?;
- How does the employee’s injury prevent him from doing jobs for which he is qualified?; and
- Can the employee actually get to jobs that he is qualified and able to perform in spite of the injury?
When would workers’ compensation NOT be the exclusive remedy?
An intentional tort where employer actually knew that the injury was certain to occur, and employer willfully disregarded the fact
What is the priority of funds for worker’s compensation?
First reimburse employer’s insurance company then P keeps anything left
Wage Loss Benefit
Difference between what employee used to make and what he could be making now
How do you determine if an employee has a total disability?
The employee lost all wage-earning capacity
What wage loss benefits does an employee get if they have a total disability?
Indefinite payment
How do you determine if an employee has a partial disability?
The employee has some wage-earning capacity
What is the computation for wage-loss benefits?
The employee gets 80% of their wage loss
