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What Falls under Workers' Comp Coverage?

By:
David Lack

Question :

My husband is a manager of a tire barn. His duties include tire alignment and tire changing. He is on his feet all day long, lifting tires, using his legs and shoulders. Now, after 15 years of work, he is having pain in his shoulders, knees and feet. Would these injuries fall under workmen's comp?

M.L.

Answer :

Federal and state laws require employers to carry workers' compensation insurance to cover the possibility that employees may be injured while on the job. Workers' comp (formerly known as workmen's comp, but changed to be more inclusive) provides specific benefits for people injured on the job, including coverage for medical care and lost wages.
Workers' compensation laws are designed to ensure that employees who are injured or disabled on the job are provided with monetary awards, eliminating the need for litigation. These laws also provide benefits for dependents of workers who die from work-related accidents or illnesses. Some state laws protect employers and fellow workers by limiting the amount an injured employee can recover from an employer and by eliminating the liability of co-workers in most accidents. State workers compensation statutes establish this framework for most employment.

Although jurisdictions may vary, most combine wage loss and medical loss. In other words, an injured employee is entitled to recover compensation for either, or both, any wage loss due to the inability to perform job duties as a result of a work-related injury and any medical expenses that are incurred in order to treat the injury or condition. Wage loss benefits are generally tied to the earnings of the employee in the relevant time period preceding the injury. Depending on the severity of the injury and the resulting inability to work, at all or with restrictions, the employee will often be compensated based on some percentage of the difference between pre-injury wages and post-injury earnings, if any. This percentage, and how it is calculated, varies from state to state.


To find out more about workers' compensation laws in your state, log on to Lawoffice.com, click on "Law Pathfinders," scroll down to "Knowledge Base" and select "Workers' Compensation Law," and click on "Go." You will have access to a variety of workers' comp information, with specific reference to your state. Another excellent workers' comp resource is found at Insure.com, complete with helpful links.

If your husband's physical condition is a direct result of his duties, he may be eligible for workers' comp benefits. To begin the process, he will need to file a claim through the employer. He may be required to see a doctor to help determine whether his physical condition is the result of his work and how severe the injuries are. The extent of his disability will determine the type and level of his benefits, and the information may assist the employer in assigning new duties that will not require the amount of physical effort as his current duties. If medical care is necessary, it is likely that workers' comp will pay for it.


Workers' comp laws are written to minimize the red tape and bureaucracy, making it easier for injured workers to receive benefits. In other words, it does not normally require the assistance of an attorney. If, however, an attorney is needed, the law also controls the fees charged so that the lawyer does not receive an excessive portion of the amount awarded to the injured party.

Filing a claim and visiting a doctor are the necessary steps to get the ball rolling.

 

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