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Workers' Compensation

The state no-fault system that pays medical care and part of lost wages for an injury at work without any proof of fault - and, in exchange, takes away the right to sue the employer, though not the right to sue anyone else who caused it.

Informational only - this is not legal advice. These definitions explain general legal vocabulary in plain English. They are not advice about your situation, reading them creates no attorney-client relationship, and the law differs from state to state and changes over time. For advice you can rely on, speak to a lawyer licensed in your state.

What it means

Workers' compensation is a trade written into every state's law. An employee injured in the course of employment, or made ill by it, receives defined benefits - medical treatment, a portion of lost wages while unable to work, compensation for permanent impairment, retraining in some states, and death benefits to dependants - without having to prove the employer did anything wrong. In return, the employee gives up the right to sue the employer for negligence: compensation is the "exclusive remedy" against the employer, and pain and suffering are not compensated. The system is administered by a state agency rather than the courts, and most employers are required to insure through a private carrier, a state fund, or approved self-insurance.

The disputes are about coverage and extent rather than fault. Whether the injury arose out of and in the course of employment - a commute, a lunch break, a company event, a pre-existing condition aggravated by work, a cumulative injury with no single accident - is the first contested question. The second is the medical one: what treatment is reasonable, whether the worker can return to some work, and what degree of permanent impairment remains, which is usually rated under a published guide and translated into a benefit by the state's schedule. Insurers can require examination by a physician of their choosing, and a denied or terminated claim is contested before the state agency, with appeal to the courts on limited grounds.

The exclusive remedy protects the employer, not everyone. A worker injured by a third party - the driver who hit the delivery van, the manufacturer of the machine, the contractor on the site - keeps an ordinary negligence claim against that party, and can pursue it alongside compensation; the compensation carrier then has a lien on the recovery for what it paid. Most states also let a worker sue the employer where the injury was caused intentionally, and some where the employer failed to carry insurance. Federal employees, longshore and harbour workers, and railroad workers are covered by separate federal schemes rather than the state system.

Where this comes from

Workers' compensation is state law: each state's act sets who is covered, what benefits are paid, how impairment is rated and what the exclusive-remedy rule excepts. Federal schemes cover particular workforces - the Federal Employees' Compensation Act, 5 U.S.C. § 8101 and following; the Longshore and Harbor Workers' Compensation Act, 33 U.S.C. § 901 and following; and, for railroad employees, a fault-based system under the Federal Employers' Liability Act, 45 U.S.C. § 51, rather than compensation. The AMA Guides to the Evaluation of Permanent Impairment is the rating standard most states adopt by statute or rule, in an edition each state names.

When people hire a lawyer for this

A straightforward claim - an accepted injury, treatment paid, a return to work - rarely needs a lawyer. The situations that do are a denied or disputed claim, a termination of benefits after an insurer's examination, a permanent-impairment rating that seems low, a settlement offer, and any injury with a possible third-party claim, because that claim is worth more than compensation and has its own deadline. Fees in these cases are set or capped by the state and usually approved by the agency, so the cost of asking is known in advance.

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Part of the LawyerLand plain-English legal glossary. Definitions are written from primary sources - statutes and court rules - and each entry states the authority it rests on, or says plainly when the doctrine is state law with no national rule.

If you cannot afford a lawyer, civil legal aid programmes provide free help with many of these problems: civil legal aid programmes by state.

Related free reference tools: statute of limitations for a personal-injury claim, by state, quoted from each state's official text - part of LawyerLand's legal reference tools.