Workers Compensation Newsletters

Accidental Disease

Like an injury, an employee's accidental illness is generally compensable if it is contracted in the course of employment. An "accidental" disease is one known as resulting from an unanticipated or unique exposure. To obtain workers' compensation for an infectious disease, the employee is usually required to show that contraction of the disease was unforeseen and that the exposure and the disease are causally linked through the employee's job. Many state statutes address diseases in relation to workers' compensation with some denying compensation outright for specified illnesses and others allowing compensation only for diseases contracted after an occupational injury.

Implementation of Workers' Compensation Policies and Procedures

The escalation of workers' compensation claims and, by correlation, premiums, makes it vital that employers create and implement policies and procedures to effectively address disability management and comply with state and federal law. These policies and procedures should be reduced to writing for reference and to ensure their consistent application.

Impairment Meets or Equals Listing of Impairments for Social Security Disability Evaluation

In the sequential evaluation of disability by the Social Security Administration (SSA), a major step is whether the individual has a condition that meets the twelve-month duration requirement and that is represented on the Social Security Administration's Listing of Impairments (LOI) or equal to a listed impairment. The LOI is divided into two parts. One part applies to individuals over age eighteen and one part is applicable to individuals under eighteen.

Distribution of Proceeds From Third Party Action

Once a third party action has concluded and a recovery achieved for an employee's injury, the matter of distribution arises. As a first priority, the general rule is that the party who paid the employee compensation (most likely the employer or its carrier) will be reimbursed in an amount equivalent to its compensation outlay. The employee will then be entitled to any excess funds that remain. Some states vary this by mandating that only a portion of the excess be turned over to the employee.

Cessation of Social Security Disability Benefits Based on Lack of Disability

Social security disability benefits are paid only so long as the individual remains disabled. The Social Security Administration (SSA) will cease paying benefits if the individual can engage in substantial gainful activity. The Social Security Disability Reform Act of 1984 established conditions for the cessation of disability benefits based on a lack of disability, which include: