Worker’s Compensation is designed to assist those employees who are injured on the job regardless of who is at fault. However, the employee does have the “burden of proof.” Or, in other words, has to prove certain work-related activities or conditions contributed to the accident.
Although navigating Worker’s Compensation cases today can get very complicated due to differing laws in almost every state, there are four basic areas of proof that apply across the board. These are the elements that must be present in order to file a Worker’s Compensation claim:
1. Employer/ Employee Relationship
This may seem blatantly obvious, however, there must be a legal work agreement that can be proved easily in order for a claim to be allowed. Such forms of proof can include a hire letter, a contract, or the employer paying Social Security, FICA, and payroll taxes. As one can imagine, issues arise with temps, interns, and labor leasing — particularly independent contractors. Independent contractors (freelancers) are not currently included in coverage, but solutions for compensation for these more temporary positions have been discussed in recent years. For now, the only insurance for the people left out is elected added insurance.
2. Accidental Both in Character and Result
The second component of a workers compensation case is a little more complex as it delves a little deeper into the background and situation of the incident and the business. Once the employer/employee relationship is established, then it must be decided whether or not the event that occurred was truly an accident.
An accident in this case is specifically defined as ‘an unusual or extraordinary circumstance that causes an unexpected result.’ This not only pertains to an incident like a piece of equipment falling onto an employee. It also applies to more complex cases such as occupational diseases, and this is when the employee/employer relationship and history need to be examined further. For example, a photographer could develop eye injuries that occurred over time due to working with harsh chemicals. He has to prove that his employer is liable. These types of injuries would sometimes be covered under standard health insurance, so what is examined in a potential Worker’s Compensation case is – was this an extraordinary event with an unpredictable result that took place?
3. In the Course of Employment and Work Hours
This element of the claim focuses on specific details around the extraordinary event or accident. The main factor is if the employee was “on the clock.” Time, place, and circumstances are the key factors examined in this portion. This may seem simple, but there are exceptions to time and place that create grey areas – like breaks (break time injuries), parking lot injuries, and combined personal and business activities. If you are working and run to the post office for your employer but also stop to pick up your dry cleaning and get in an accident on your way there, who is liable?
That is why each circumstance must be examined. You’re probably seeing the picture now – that Workers Compensation cases are not black and white or cut and dry. The rule of thumb in determining if an incident happened ‘in the course of employment’ is that the employee must have specifically designated that time as a “work circumstance” even if not being technically clocked in, or the activity that they were participating in must be in their job description.
4. Arising out of Regular Duties
Lastly, the focus of this part of the claim is that there is risk associated with exposure to certain job requirements. This risk or hazard must be the direct cause of the workplace injury. These risks come from three different areas: toxic exposure, repetitive motion trauma, and heart attacks and strokes. Examples from each category include asbestos exposure, carpal tunnel syndrome, or heart attack/stroke that occurs on the job.