Coverage

Question 1

Is worker’s compensation an at-fault doctrine?

Answer 1

No, it does NOT matter who is at fault

Question 2

What two persons are covered by worker’s compensation?

Answer 2

1. Employees; and

2. Employers

Question 3

What 2 circumstances is an Employer not covered by worker’s compensation?

Answer 3

1. Small employers with fewer than 3 full time employees; and
2. Federal government employers

Question 4

Are employees independent contractors?

Answer 4

No

Question 5

What are the five IRS factors to consider when determining whether an employee is in fact an employee?

Answer 5

CHEST:

1. What control does employer exercise over the worker?;
2. Is the working holding himself out to the public to do specific work? If so, then an independent contractor;
3. Does employee depend on job for payment of living expenses?;
4. Is the worker furnishing his own supplies?; and
5. If employer terminates, what are the legal ramifications?

Question 6

What 5 areas are covered by worker’s compensation?

Answer 6

1. Injury or disease arising out of and in the course of employment;
2. Mental Disabilities;
3. Conditions of aging process;
4. Pre-Existing Conditions; and
5. Actions within the Scope of employment

Question 7

What is the scope of “injury related out of the course of employment?”

Answer 7

Activities that one can reasonably expect a person to engage in during his or her work time, regardless if it furthers the employer’s business.

Question 8

What are the two requirements for a mental disability to be covered by worker’s compensation?

Answer 8

1. Employee’s work significantly aggravates or accelerates the mental disability; and
2. Injury arose out of actual events at work
   Not delusions or unfounded perceptions
   Hard to prove

Question 9

What is the 2-step analysis when determining whether a pre-existing condition is covered by worker’s compensation?

Answer 9

1. Difference in kind not just difference in magnitude (A bad back that gets significantly worse from lifting at work is insufficient. A bad back that is worsened by a slip disc from lifting at work is sufficient); and
2. The work-related injury changed the pathology of the condition, so that the new injury is medically distinguishable from pre-existing condition.

Question 10

Is an injury suffered during the commute to work within the scope of employment?

Answer 10

No, unless employee is on the premises

Question 11

When is an injury that occurred during social/recreational functioning covered by worker’s compensation?

Answer 11

When the social/recreational functions are sufficiently related to the job or a major purpose to the job

Question 12

Does worker’s compensation apply where an employee’s misconduct is intentional/willful/bad?

Answer 12

No

Question 13

When is an injury from horseplay covered by worker’s compensation?

Answer 13

When the injury results from work itself, or from the stresses, the tensions, or the associations of the working environment.

Question 14

What 4 factors should be considered when determining whether horseplay has deviated from the course of employment?

Answer 14

1. the extent and seriousness of the deviation;
2. the completeness of the deviation;
3. the extent to which the practice of horseplay had become an accepted part of the employment; and
4. the extent to which the nature of employment may be expected to include horseplay.

Question 15

What must an employee show to earn lost wages?

Answer 15

That the employee has a work-related disability

Question 16

What is a work-related disability?

Answer 16

A reduction of an employee’s wage-earning capacity

Question 17

What 4 factors must you prove for an employee to earn lost wages per their work-related disability?

Answer 17

1. Employee’s complete qualifications/training;
2. What the employee is qualified/trained to do that might pay as much or more than the old job?;
3. How does the employee’s injury prevent him from doing jobs for which he is qualified?; and
4. Can the employee actually get to jobs that he is qualified and able to perform in spite of the injury?

Question 18

When would workers’ compensation NOT be the exclusive remedy?

Answer 18

An intentional tort where employer actually knew that the injury was certain to occur, and employer willfully disregarded the fact

Question 19

What is the priority of funds for worker’s compensation?

Answer 19

First reimburse employer’s insurance company then P keeps anything left

Question 20

Wage Loss Benefit

Answer 20

Difference between what employee used to make and what he could be making now

Question 21

How do you determine if an employee has a total disability?

Answer 21

The employee lost all wage-earning capacity

Question 22

What wage loss benefits does an employee get if they have a total disability?

Answer 22

Indefinite payment

Question 23

How do you determine if an employee has a partial disability?

Answer 23

The employee has some wage-earning capacity

Question 24

What is the computation for wage-loss benefits?

Answer 24

The employee gets 80% of their wage loss

Question 25

What are wage-loss benefits capped at?

Answer 25

90%

Question 26

What happens if an employee turns down a job offer?

Answer 26

No more wage-loss benefits

Question 27

Is an offer to an employee that is less than their previous job considered a bad faith offer?

Answer 27

No

Question 28

Must an employer reimburse all reasonable medical expense?

Answer 28

Yes

Question 29

Must an employer pay rehabilitation for work already had?

Answer 29

Yes

Question 30

What happens if an employee refuses rehabilitation?

Answer 30

The employee will lose wage-loss benefits

Question 31

What can dependent relatives left behind collect through worker’s compensation, if anything?

Answer 31

80% of wage loss

Question 32

What happens if an employee is collecting both social security and worker’s compensation?

Answer 32

Worker’s compensation will be reduced by 50% of the amount of social security benefits

Question 33

Can an employer voluntarily pay worker’s compensation instead of going through formal process?

Answer 33

Yes

Question 34

What can an employee do after payments have terminated?

Answer 34

Go back and apply through formal process

Question 35

What happens where a general contractor contracts with a subcontractor who doesn’t have worker’s compensation insurance?

Answer 35

The General contractor is liable to an injured employee of the subcontractor