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GENERAL INFORMATION ON WORKERS'COMPENSATION
Q: How do I know whether I am covered by workers' compensation?
A: Determining whether or not you are covered by workers' compensation can sometimes be quite complicated. Generally, 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 lawyer, who can advise you of your rights.
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Q: If an employee is receiving workers' compensation benefits, but returns to work, does the employee still get to receive workers' compensation benefits?
A: 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.
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Q: Can an employee recover workers' compensation benefits, no matter what he or she did, because it is a "no-fault" system?
A: 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.
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Q: Can an employee recover workers' compensation benefits, even if he or she was not actually at the workplace when injured?
A: 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.
Finally, employees injured while attending an employer-sponsored recreational event, like a company picnic or outing, may be able to receive workers' compensation benefits even though they were not physically on the employer's premises at the time of the injury.
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Can I Recover Workers' Compensation Benefits if I Work for Federal, State or Local Government?
State and Local Employees
Whether a state or municipal employee is covered by the state's workers' compensation statutes, or by a different system, depends on the specific provisions of each state's laws. In general, state workers' compensation statutes specifically set forth which types of employees are eligible to receive benefits under the state system, and which types of employees are not.
Most state statutes prohibit payment of workers' compensation benefits to "officials" of the state. However, who is considered an "official" can often be questionable. As a general rule of thumb, if an individual exercises some portion of the state's sovereign power, he or she will be considered an official and therefore ineligible to collect workers' compensation benefits.
A common issue arises regarding the right or ability of police officers and firefighters to recover workers' compensation benefits. These individuals do not fit squarely into the definition of an employee nor can they be considered "officials." Many state statutes, in recognition of this issue, have specific provisions within their acts to clarify that workers' compensation benefits, rules, and requirements will apply to these individuals.
In order to determine whether a particular state or municipal employee is covered by the state's workers' compensation scheme, an attorney should be consulted to carefully examine the particular state's laws.
Federal Employees
In general, federal employees do not receive workers' compensation benefits from their employers under state systems. Instead, federal employees have separate systems through which they can seek to recover benefits for work-related injuries.
The Federal Employee's Compensation Act (FECA) controls the rights of most federal employees to obtain workers' compensation benefits. FECA allows for the recovery of benefits when a federal employee is either disabled or killed as a result of an injury "sustained while in the performance of duty."
Special types of employees may bring claims for benefits under other, specific federal acts. For example, the Federal Employer's Liability Act was enacted to provide recovery for injuries sustained by employees engaged in interstate transportation, such as railroad workers. The Jones Act provides for seamen in the case of work-related injuries, and the Longshore and Harbor Workers' Compensation Act provides similar benefits to longshoremen and others who are engaged in maritime activities on navigable waters. Other statutes that play a role in the compensation of certain employees include: The Outer Continental Shelf Lands Act, the Death on the High Seas Act, and the Defense Base Act (for employees working on defense bases or public works projects outside the U.S.).
Whether an employee falls under the protection of FECA, or another act designed to protect other specific categories of employees, will depend on the nature of the employment and a close examination of the facts of the particular case. Therefore, it is advisable to discuss the laws that might govern your workers' compensation claim with an experienced workers' compensation attorney.
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