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How does Workers' Comp "No-Fault" Systems Work?

The worker’s compensation program ensures that injured employees in the line of duty are able to receive monetary compensation to cater for medical bills and a part of their wages should they be physically impaired from going to work.  Under the program both employers and employees have a number of responsibilities to fulfill under the law.

Understanding correctly the worker’s compensation act?

The no-fault worker's compensation law insures workers against on-the-job illnesses and injuries. The program is mandated by almost all states America but each state has slightly different rules to cater to its populace.

Injured employees receive a portion of their wages while they are away from work depending on the laid down rules of the state. Each state is also at liberty to determine the rate of compensation to a worker who loses a member and is permanently disabled or dies from work-related accidents.

Under the no-fault law the injured employer doesn’t have to go to court in other to receive benefits or compensation and can’t file a lawsuit to his employer for his or her injuries. Compensations are paid without taking into consideration the offending party.

Who is covered by the no-fault worker’s compensation act?

Each state is at liberty to decide when an employer should acquire worker’s compensation insurance. While some states set a minimum number of employees before the no-fault act can be purchased, others require that the compensation act must be in place if the employer has any worker at all.

States are also at liberty to exclude certain industries from the program. For example some states exclude agricultural workers, domestic workers and seasonal employment workers from coverage.  If any of the excluded workers are injured by work-related accidents they may stake a claim under lability but not under the worker’s compensation law.

In general only workers properly classified as employees are covered. Here is a list of the categories of workers that are excluded from the plan:

  1. Independent contractors
  2. Agricultural workers
  3. Seasonal Workers
  4. Undocumented work force
  5. Domestic workers

What are the covered injuries in the Worker’s comp

The law is meant to compensate workers who sustain injuries while on the job without having them go through the rigorous process of filing a lawsuit against their employer. Injuries also include illnesses that are work-related but there are some states that explicitly define the type of illness that can trigger the coverage.

Injuries related to continuous stress or exposure to a certain type of chemical is also covered. This means that the injury doesn’t always have to be a single incident but can take the form or a repetitive process.

Employers don’t always have to be at work before they can stake a claim for a benefit. If they are completing a work-related task on behalf of their employer and get injured then they are qualified for a worker’s compensation benefit. Injuries not considered to be work-related are those that occur when the worker is driving to and from his work place.

Some states make a modification to the law by incorporating a DUI on employees to ascertain if they were in the right frame of mind before an accident happens. The employer won’t be heard accountable if the employee fails such tests.

Benefits and Payouts

The nature of the injury usually dictates the kind of benefits that is available to the worker. Other factors include the state requirements and included benefits of the policy in question. Outside the obvious compensation of wage replacement and medical bills other compensations could include vocational rehabilitation and benefits for permanent disability.

How medical providers are assigned to cases varies from state to state. While some states allow the employers to send employees to any medical practitioner of their liking other states require that the injured employer visit their own healthcare provider if the formally make such requests.

Processing claims on worker’s comp

Both employers and employees have a set of obligations and roles to play when it comes to filing a workers comp claim. It’s the sole purpose of the employers to carry out worker's comp insurance on their employees. Failure to do so by law will result in damaging lawsuits that can be far-reaching. Insurance for employees can be purchased via an insurance broker that is duly registered in the state. Be advised that you can be fined if you fail to carry the necessary insurance coverage.

As for employees, they must report all injuries to their employers on time. Well established companies will have a specific form they can submit to the employer. There is usually a timeframe for which injuries need to be reported. An employee can lose the right to receive compensation if fails to report accident within the stipulated time.

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