Under the workers' compensation system in almost every state within the U.S., most employers are required to get insurance that gives a variety of advantages to employees who are injured or become ill due to their jobs. The system strikes a compromise between employers and employees: Employees get benefits no matter who was guilty. In return, employers get protection from lawsuits by injured employees seeking money damages for pain and suffering.
State law governs workers' compensation (except for the federal workers comp audit, which covers employees of the U.S. government). Each state's system differs within the details, but the general structure and operation of workers’ comp are very similar from state to state. From the employer’s perspective, the most differences are the procedural rules that they need to follow.
To find out the small print of your state's law, contact your state department of business relations or workers' compensation. You can find phone numbers for workers’ compensation officials in your state by using this map tool on the U.S. Department of Labor’s website.
Which Employers Need to Carry Workers’ Comp Insurance?
Every state but Texas requires the overwhelming majority of employers to hold workers’ compensation insurance. In most states, any employer with even one employee has got to have coverage; in other states, the minimum may range from two to 5 employees. a couple of states exempt certain agricultural or construction businesses; charities can also be allowed to opt-out of the system. Although private employers in Texas don’t need to carry workers’ comp coverage, they’re subject to reporting and notification requirements if they choose to not do so.
Very large employers may insure themselves, but they need to apply with the state and meet stringent self-insurance requirements.
Businesses don’t need to provide coverage for all types of workers. for instance, workers’ comp generally doesn’t cover independent contractors, domestic workers privately homes, and volunteers. Some states also exclude casual or seasonal workers when the work they are doing isn’t a part of the employer’s regular business or profession. Even if they aren’t required to shop for workers’ comp insurance, many employers prefer to do so. States generally allow exempt employers to opt into the workers’ comp system, which then affords them an equivalent liability protections.
What Happens If Employers Don’t Have Workers’ Comp Insurance?
If a business lacks workers’ comp coverage, an injured employee may sue the employer in civil court (more thereon below). Some states have special funds to supply workers’ comp benefits for injured employees of illegally uninsured employers. The funds may then follow the employers to hunt reimbursement for the value of these benefits. Employers who don’t have legally required insurance can also face criminal charges and steep fines.
What Injuries and Illness Are Covered by Workers’ Comp?
Workers' compensation laws cover only injuries or illnesses that are associated with the employee’s job—or, in legalese, “arising out of employment and occurring during the course of employment” (AOE/COE). An injury doesn’t necessarily need to happen at the workplace to be considered AOE/COE. for instance, workers’ comp usually covers injuries that happen while employees are traveling on business, running an office errand, or attending a business-related affair. (Learn more about the principles on whether injuries or illnesses are work-related.)
Along with sudden accidents like falling off scaffolding on the job, injuries and illnesses covered by workers’ comp may also include:
- cumulative trauma, such as repetitive strain or stress injuries that develop over time from performing the same physical tasks over and over; and
- occupational diseases that result from workplace conditions, such as lung disease or cancer from exposure to toxic chemicals or (in some states) heart disease or digestive problems related to on-the-job stress.
However, workers’ comp generally won’t cover injuries that were caused by the employee’s intoxication or use of illegal drugs. many nations also deny coverage in other situations involving misconduct, including injuries that:
- were self-inflicted
- resulted from a fight the injured employee started, or
- happened when the employee was committing a felony or serious crime.
In some states, injuries might not be covered if they happened while the workers were violating company policy or engaging in ‘horseplay” (that is, fooling around). But courts should decide those injures are work-related if the employer condoned the behavior, or it had been an accepted or common a part of the working environment.
State laws often have special rules for workers’ comp claims that are filed after the worker is fired or laid off.
When Can Employees Sue Employers in Court for Injuries?
Workers’ comp laws don’t protect employers from all employee lawsuits associated with injuries. There are limited exceptions that allow employees to sue their employers when they’ve been hurt, but those exceptions vary from state to state. When employees are injured due to their employers’ intentional actions, some states allow those employees to bypass the workers’ comp system and sue the employer in court for a full range of cash damages, including exemplary damages (intended to punish the employer) and pain and suffering (the pain, physical discomfort, or overall loss of enjoyment of life caused by the injuries). But employees generally must prove that their employers actually intended to harm them. additionally, injured workers may sue if their employers didn’t obtain the specified workers’ compensation insurance. (Learn more about when injured employees may sue their employers.)
Employees may also be able to file lawsuits outside workers’ comp against third parties, such as the manufacturers of defective products, or the other driver in a work-related car accident.
What Are Employers’ Responsibilities Under Workers' Compensation?
In addition to carrying insurance to hide work-related injuries, employers have a variety of other obligations under state workers' compensation laws.
Post Notices and Advise Employees of Their Legal Rights
Employers must post required notices during a convenient location frequented by employees during working hours. The notices or posters must:
- include important information about employees' right, including the proper to receive medical treatment
- give details about available workers’ compensation benefits, and
- provide the name of the company's workers' compensation carrier, or the very fact that the employer is self-insured, also as who is liable for adjusting claims.
Employers must also provide an equivalent notice to new hires.
Provide Claim Forms to Injured Employers
Typically, employers must provide injured employees with a workers' compensation form within 24 hours after the worker has given notice of an on-the-job injury or work-related illness. albeit the worker hasn’t given this notice, the employer should be obligated to supply the forms if it knew about the injury. Employers must also supply the worker with written information (usually a pamphlet) about the employee's rights under the workers' comp system. The writing should provide details about available benefits and the way to file a claim.
0 Comments