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How do I know whether I am covered by workers' compensation?
Determining whether or not you are covered by workers' compensation can sometimes be quite complicated. Generally, however, there are two main factors that determine your status: first, whether you are an employee, and second, whether your injury occurred as a result of your employment. It should be noted that neither of these factors is an absolute guarantee that you will be covered by workers' compensation. For example, depending on the state, some employees (for example, agricultural workers) are not covered by workers' compensation. Also, if you were intoxicated at work or intentionally injured yourself, you might not be covered by workers' compensation. When in doubt, you should contact an experienced workers' compensation attorney, who can advise you of your rights.
If an employee is receiving workers' compensation benefits, but returns to work, does the employee still get to receive workers' compensation benefits?
The answer to this question is "maybe." If the return to work enables the employee to receive wages equal to or greater than he or she was earning prior to the injury, then it is likely benefits will be stopped. If, however, the employee is still experiencing a wage loss due to his or her injury, he or she may continue to receive wage loss benefits, although the benefits will most likely be for a lesser amount.
Can an employee recover workers' compensation benefits, no matter what he or she did, because it is a "no-fault" system?
No. Although most injuries are covered by workers' compensation, that does not mean that employees have free reign to injure themselves, or act in any manner in which they choose, and then collect benefits. Generally, if an employee sustains injures as a result of intoxication or illegal drug use, benefits may not be payable.
Can an employee recover workers' compensation benefits, even if he or she was not actually at the workplace when injured?
The answer to this question will depend on the laws in your particular state, and the facts of the specific case. Generally speaking, if the injury "arises out of" and occurs "within the scope of employment," it is covered. For example, if an employee is a traveling salesperson and is injured in the hotel where he or she is staying for business purposes, compensation may be appropriately paid.
Similarly, if an employee is running an errand that takes him or her outside of the workplace, at the request of the employer, compensation benefits may be payable if an injury occurs in the course of running that errand. If the employee is on a business errand, but has stopped or deviated from that errand for personal reasons, then a closer examination of the rules and facts is necessary.
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Did You Know?
SHMO means Social Health Maintenance Organization
A managed system of health and long-term care services geared toward an elderly client population. Under this model, a single provider entity assumes responsibility for a full range of acute inpatient, ambulatory, rehabilitative, extended home health and personal care services under a fixed budget which is determined prospectively. Elderly people who reside in the target service area are voluntarily enrolled. Once enrolled, individuals are obligated to receive all SHMO covered services through SHMO providers, similar to the operation of a medical model health maintenance organization (HMO).
Latest news about Disability cases in Kansas and nationwide:
A provision to prevent a person from receiving monthly SSI and OASDI benefits in excess of the total amount which would have been paid if the OASDI benefits had been paid when they were due rather than retroactively.
Substantial Gainful Activity (SGA)
The level of work activity used to establish disability. A finding of disability requires that a person be unable to engage in SGA.
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