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when an injured employee, in most circumstances, is legally entitled to the workers compensation benefits provided by law but is not permitted to sue his or her employer.
In every state except Wyoming, the workers compensation act applies to all employments except those that are specifically excluded. Wyoming takes the opposite approach of listing those employments that are covered by the act.
account for almost 34% of the total workers compensation benefit payments in the U.S. Typically unlimited in dollar amount and duration.
Disability Benefits (Lost Wages)
replaces the worker's loss of income or earning capacity that results from a compensable injury.
Temporary Total Disability
most common; expected to recover but cannot work while recovering; usually pays 66 2/3% of weekly wages.
Permanent Total Disability
unable to do any kind of work for the remainder of their life.
Temporary Partial Disability
can still do some work but is unable to earn their usual wage until recovery; pays a percentage of the difference in wage.
Permanent Partial Disability
no recovery but work is only partially affected for the remainder of their life.
Death (Survivor) Benefits
helps compensate those dependent on the lost income. Children's benefits usually end at age 18 and spouse benefits end with remarriage.
Work Related Claims
- Workers compensation statutes typically require the employee filing a claim to carry the burden of proof. To prove a claim is covered, an employee must show that
- an injury or illness has occurred;
- it occurred in the course of employment; and
- it arose out of employment.
- Proving that a claim is covered entitles an employee to medical benefits.The injured employee must prove two additional elements to qualify for wage replacement benefits
- the work-related condition resulted in impairment; and
- the impairment resulted in a wage loss.
Monopolistic State Fund
Employers must buy workers compensation coverage through a state workers compensation insurance fund in four states-North Dakota, Ohio,Washington,& Wyoming. the state fund is the only workers compensation insurer in these states. The state has a monopoly on workers compensation insurance, and insurance companies are not involved in the workers compensation insurance systems.