Workers Compensation

Question 1

What is workers comp?

Answer 1

The statutes that provide fixed awards & medical reimbursement - in case of work related injuries
AND
A form of no-fault insurance designed to recompense injured workers for work-related injuries and illnesses

Question 2

Why was workers comp developed?

Answer 2

Developed to allow injured employees to be compensated w/o the need for litigation.

Question 3

Who was workers comp intended to benefit?

Answer 3

The employee & employer

Question 4

Historically, prior to workers comp, no payment was made if/due to…

4

Answer 4

-Assumption of risk law
-Fellow Servant Law
-Fearful of retribution (blackedballed with other employer)
-an employee filed suit

Question 5

What are the state law exceptions with workers comp?

Answer 5

· Texas exception (employers can opt out)
-Those who don’t can be sued for work related injuries.
· Federal government employees and those in Maritime industries have different laws (ex: Longshore and Jones Act)

Question 6

What are the options to provide coverage for WC?

Answer 6

· Commercial insurance
· State funded
· Risk pools
· Self insurance (for larger employers)

being high risk can make some more difficult to get

Question 7

What are the different routes organizations usually take for providing coverage for WC?

Answer 7

· small employers: usually buy workers’ compensation insurance
· large employers: spread the risk (Hence stable costs)
· Self insurance: requires permission making sure employer can pay

Question 8

What are the objectives of workers comp?

Answer 8

1. Replacement of income
2. Rehabilitation of the injured employee
3. Prevention of accidents (lower premiums)
4. Cost allocation (spread cost out)

Question 9

When is the insurance company liable for compensation?

Answer 9

1. Injury arises out employment (AOE)
2. In the course of employment (COE)
3. Scope of employment (SOE)

(Working, location, performance)

Question 10

Wage loss compensation % depends on what 5 types of disability?

Answer 10

-Permanent total disability (can never do any job)
-Permanent Partial disability (never do some jobs)
-Temporary total disability (for now, can’t do any jobs)
-Temporary partial disability (for now can’t do some jobs)

Question 11

What are workers compensation benefits?

Answer 11

· Benefits include all reasonably necessary medical treatment.
· Rehabilitation (Therapy, education)
· Death benefits for all survivors

Question 12

Can employers challenge workers comp benefits?

Answer 12

· Employers can challenge all “reasonableness” of treatment
· Employers can challenge medical bills for errors or charges in excess of state guidelines.

Question 13

What are the exceptions to receiving workers comp? (no benefits owed)

Answer 13

1. Employee’s knowing, self inflicted injury
2. Employee’s intoxication
3. Employee’s commission of a criminal offense
4. Employee’s knowing failure to use safety appliance
5. Employee’s knowing failure to obey a reasonable written rule posted in a conspicuous position in the work place
6. Employee’s horseplay caused injury
7. Employee’s knowing failure to perform a statutory duty (going around railroad gate)
8. Employee participating in an off-duty recreational.

Question 14

How do accident rates affect companies premium?

Answer 14

The higher the accident rates, the higher the premium

Question 15

What do employers have to do if worker is injured onsite?

Answer 15

1. First Report Injury / Notify insurance carrier
2. Investigate whether injury covered by the Act
3. Investigate whether an affirmative defense applies
4. Can provide first aid/emergency medical care without admitting liability
5. At least 30 days to decide if injury is covered by the act