Workers' Compensation
The Workers’ Compensation Law is intended to protect employees who suffer injury or occupational illness in the course of their employment. The overall scheme of workers’ compensation laws was to provide employees “no-fault” protection against illness or injury incurred on the job, in return for limitation on employer tort liability for worker injuries.
Workers’ Compensation laws vary by state. They exist to provide a prompt and adequate remedy to injured workers for on-the-job injuries, and provide employers with protection through limited liability. Some examples of these protections include:
- coverage for medical expenses for treatment for the injury or occupational illness
- income protection for those who must be absent from work because of they occupational illness or injury; and
- limited compensation for serious permanent injury such as loss of limb or loss of life
Two types of injuries covered under Workers' Compensation laws are; the specific and the cumulative trauma. Each one is handled the same way, but the results may be different. There is also the type of injury caused by a condition that was dormant or asymptomatic that is caused to be aggravated or "lit up" by actions at work. An example would be a person who is allergic to bees and gets stung while at work. Or better still, one who has arthritis that has not caused any problems and due to work exposure, they become symptomatic.
- A specific injury is one that occurs at a single moment; a slip and fall, a lifting accident, an automobile accident, etc. These injuries occur on a specific date and injury specific body parts and the worker knows about the injury right then. Hopefully, he or she notifies the employer at or near the time of the accident.
- A cumulative trauma, or CT, is a series of micro events that culminate in a claimed injury. For example, a repetitive stress injury to the upper extremities is a cumulative trauma. There is no one specific date when the injury occurred; rather it is when the pain and discomfort affect the worker enough that they claim the injury. This can also be a back injury, due to repetitive lifting in a job.
There are also two types of psyche injuries; pure psyche and physical psyche. A pure psyche injury is one where the injured worker claims a specific event or series of events has caused an injury in their mental state. This could be an armed robbery of the worker or a co-employee or supervisor who has been harassing them.
The other type of psyche injury, a physical-psyche injury is one where the injured workers' physical injury has caused a compensable consequence of a psychiatric condition. An example would be a laborer who sustains a back injury and cannot return to his job; they tend to get depressed. Or, where a worker loses a limb due to an injury or accident and then gets depressed.
Notice/Knowledge of Injury
Once a worker is injured or claims injury, the employer is required to do a number of things. The first is to provide the injured worker with a claim form within twenty-four (24) hours of being notified of injury. Problems arise when a worker sustains an injury and then does not report it to the employer. This is due to a number of factors; the employee does not know that what he or she has suffered is in face a compensable injury, they feel that it is just a sprain or strain and they hope that they will get better in the next few days or they are either told or pressured not to file a claim by supervisors or co-employees.
Many employers still treat injured workers or those who file for comp claims as no better than thieves and have names for them such as "comp diver." However, with the amount paid to injured workers, it is rarely beneficial to file.
Once the employer is notified of the injury and returns the employee's portion of the completed form or DWC-1, the employer is obligated to immediately contact their insurance carrier with the information.
Reporting/Investigation Duties LC 5402
Labor Code Section 5400 provides that the employer/carrier has ninety (90) days from the date the employer has notice of the claim to investigate the claim and either accept it or deny it. Failure to deny the claim within the 90 day window makes the claim presumed compensable. This section also provides that if the employer wants to deny the claim after the ninety (90) day period they must show that they could not have obtained the evidence necessary to deny the claim with the first ninety (90) days. The burden is then on the employer/carrier to show that they could not have obtained the evidence within that period. Hence early investigation is crucial to not having to pay claims that are not really work related.
RU-91
The RU-91 is the form used by the Workers' Compensation system to outline for the treating doctor what the physical requirements of the employee's job duties were. This is a form that is completed both by the employer and the employee and signed by them, which details the job duties performed. This is often a wake-up call to the carrier when they were told that the employee was an office worker and it turns out they were a roofer. Or despite job titles, we have found that workers who were described as secretarial or clerical workers, were in fact, acting as janitor or garbage person, loading and dumping 75 pound trash cans filled with files.
The other benefit, in addition to those above for the RU-91, is to allow the doctor who is treating the applicant to see what his or her job duties were and to hopefully provide work restrictions for the injured worker when they are able to work at modified duties.
Get access to all Workers' Compensation material. Click here to become a member: www.hrresource.com/account.php
Related Products
August 03, 2010
Price: $199.00
August 05, 2010
Price: $199.00
