Workers’ Compensation Research Paper - 10 - 12 Page Paper - High Quality - 12 - 15 Hours
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WeekOnePPT-CourseIntroandFoundationsofWorkersComp.pptxWeek One: Introduction and Foundations of Workers’ Compensation
OSH 390 Workers’ Compensation
Eastern Kentucky University
Dr. Barry s. Spurlock, Esq., CSP
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Approach to Course
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Claims
Injured Worker Benefits
Compensability of Injuries/Illnesses
Loss Control
Analyzing WC Loss Data
Coverage
Insurance Coverage Options
Experience Rating
Claims Process
Claims Disputes/Litigation
Underwriting
Employer Loss Control Measures
Insurance Carrier Loss Control Measures
Loss Control Pros
https://www.thoughtco.com/agriculture-and-the-economy-1146847
http://www.history.com/topics/industrial-revolution/pictures/industrial-inventions/postcard-of-ford-motor-companys-river-rouge-plant
Societal backdrop for the development of workers’ comp
Agrarian to Industrial
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PRE-WORKERS’ COMP INJURY OUTCOMES
Injured worker becomes a burden upon society.
Family,
Churches/Charitable Organizations,
Etc.
Injured worker sues employer through tort action (negligence).
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Suing your employer for negligence Pre-workers’ Comp
Tort
Civil Wrong (act or omission)
Harm to Another Party
Legal Remedy/Liability
Various Types
Common Tort Cause of Action for Work Injury: Negligence
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Elements of negligence
Duty
Breach
Causation
Cause in Fact
Proximate Cause
Damages
Economic
Non-Economic
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Suing your employer for negligence Pre-workers’ Comp (Contd.)
Common Negligence /Tort Defenses (Irrelevant to Workers’ Compensation)
Contributory Negligence (Now replaced by comparative fault in tort law.*)
Assumption of the Risk
Act of God
Fellow-Servant
Etc.
Effect of employers successfully raising defenses?
Effect of employees successfully suing company?
*Generally speaking, workers’ comp pre-dates wide adoption of contributory negligence in tort.
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Pre Workers’ comp
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Work Injury
Burden on Society
Worker sues employer.
Employer successfully defends against lawsuit.
Employee wins lawsuit against company; maybe large jury verdict.
Employee gets no benefits.
Business harmed; jobs lost.
Workers’ compensation: The tradeoffs
No-Fault
Fault is almost/virtually irrelevant.
Primarily a tradeoff that benefits employee.
Exclusive Remedy for:
Injured Worker
Injured Worker’s Family
Primarily a tradeoff that benefits the employer (Employee can’t sue employer via tort for the injury)*
Exclusive Remedy Protects The Following From Liability:
Employer
Agents of the Employer
Co-Workers
*Largely applies to negligence and various forms of negligence. Arguably, in some jurisdictions common law intentional tort suit (i.e., battery) may still be viable claims.
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Workers’ comp v tort (negligence): Establishing liability
”Fault” is the “F-Word.” Using the “F-Word” in OSH 390 is problematic!
Don’t use “fault” in your analysis of compensability in OSH 390.
Employee intentional misconduct really deals with the two-prong compensability test:
Did the injury arise out of employment (causal connection); and
Did the injury arise in the course of employment (time, place and circumstances)
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Workers’ comp v tort (negligence): dispute litigation Jurisdiction and processes
Tort actions litigated in ordinary trial court.
Examples: Circuit Courts, District Courts, Courts of Common Pleas, etc.)
Judge and Jury
Typical American Court Room Perception
Workers’ compensation disputes are litigated though administrative hearings.
Examples: Workers’ Claims Board; Industrial Commissions, Etc.
Administrative Law Judge (ALJ)
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Acceptance
Benefits Paid to Claimant
Denial
Claimant Accepts Benefits
Dispute Over Benefits
Claim Resolves
Appeal to Commission/Board
Appeal to State Ct. of Appeals
Appeal to State Sup. Ct.
Settlement
WORKERS’ COMP ADJUDICATION
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Employee Report of Injury
Employer Records/Investigates
Employer Completes and Files WC First Report of Injury (i.e., IA-1)
Acceptance / Denial / Conditional Acceptance of Claim
Carrier Evaluates Claim and Assigns Adjuster (Medical Only vs Lost Time)
Discovery
Administrative Law Judge Assigned
Application for Resolution of Claim
Hearing Before ALJ
Common Workers’ compensation benefits
Medical (100%; often subject to state/jurisdiction fee schedule)
Temporary Total Disability (TTD) (Often 66 and 2/3 % of average weekly wage, subject to waiting day period.)
Permanent Partial Disability (PPD) (Often subject to AMA guidelines, earnings formulas, etc.)
Permanent Total Disability (PTD) (Subject to age, earnings, education, etc.)
Rehabilitation/Vocational Rehabilitation
Death Benefits (Payable to injured workers’ spouse/family/dependents. Whether payable to estate, and if so how much, varies.)
May be other benefits – dependent upon jurisdiction.
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Worker’s Comp State Specific. In many respects
Rates
Business / Employee Classifications
Insurance Renewal and Cancellation Requirements
Compensability of Claims
Benefits
Claim Resolution & Adjudication
and More
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Compensability: Looking ahead to Week Two
In order for a workers’ compensation claim to be compensable, it must have:
Arisen out of the course of employment,
AND
Arisen in the course of employment.
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