Changes in workers' compensation laws during 2001;
workers' compensation coverage was extended to certain law enforcement
and public safety officers, but excluded from some sports officials,
inmates, musicians, and horse trainers - Workers' Compensation, 2001 -
United States - Statistical Data Included
The issue of coverage under workers' compensation laws received a great
deal of attention in 2001. For example, extending presumptions of
coverage for certain diseases suffered by law enforcement officers or
firefighters, or both, occurred in Arizona, California, Florida,
Maryland, and Virginia. On the other hand, sports officials, State
prisoners and county inmates in Florida, musicians in Louisiana, horse
trainers in Montana, and soccer referees in Oregon were excluded from
In gearing up for the Winter Olympic games, Utah is providing workers'
compensation coverage for law enforcement/ public safety volunteers and
paid officers who provide public safety services.
In Idaho, infectious hepatitis and tuberculosis are now considered
"occupational diseases" in any occupation involving exposure to human
blood or body fluids.
In Nevada, if a person contracts a contagious disease during the course
and scope of his employment that results in a temporary or permanent
disability or death, the disease is deemed to be an occupational disease
and compensable if certain conditions are met.
In Georgia, the weekly maximum benefit for temporary total disability
increased to $400 and the minimum to $40 (up from $375 and $37.50,
respectively). Also in Georgia, the weekly maximum for temporary partial
disability was increased to $268 from $250. In Louisiana, the amount of
benefits paid to each surviving parent in a no-dependency death claim
was increased to $75,000 from $20,000. In Wyoming, the amount of
permanent total disability and death benefits awarded to dependent
children was increased to $150 from $100 per month. Future payments are
to be adjusted annually for inflation.
Maximum burial allowances increased to $3,500 in North Carolina.
The following is a State-by-State summary of significant changes to
workers' compensation laws.
Any party to a claim for partial disability and permanent total
disability now has 90 days (previously 60 days) from the time the
Commission mails a copy of its determination to all parties to request a
Any disease, infirmity, or impairment of a firefighter's health that is
caused by brain, bladder, rectal or colon cancer, lymphoma, leukemia, or
aden carcinoma or mesothelioma of the respiratory tract that results in
disability or death is presumed to be an occupational disease and is
deemed to arise out of the employment if certain requirements are met.
Among them are that the firefighter must have passed a physical
examination before employment and that the examination did not indicate
evidence of cancer; the firefighter was assigned to hazardous duty for
at least 5 years; and that the firefighter was exposed to a known
carcinogen as defined by the International Agency for Research on
Cancer, informed the department of this exposure, and the carcinogen is
reasonably related to the cancer.
Personnel assigned to the Workers' Compensation Fraud Investigation
Unit, upon meeting the qualifications established by the Arkansas
Commission on Law Enforcement Standards and Training, shall have the
powers of specialized law enforcement officers of the State for the
purpose of conducting investigations.
The burden of proof connecting employment with an occupational disease
is now established by a "preponderance" of evidence rather than "clear
and convincing" evidence.
A hospital, physician, or healthcare provider is prohibited from billing
or attempting to collect any fee for services rendered to an employee
due to a workers' compensation injury when a claim has been filed and
notification of filed claim has been provided. Such provider is also
prohibited from reporting to any credit reporting agency the employee's
failure to make the payment. When an injury has been found to be
noncompensable, any unpaid portion of a bill may then be pursued.
The schedule for attorneys' fees was changed from the sliding scale,
based on the amount of compensation awarded, to a set 25 percent of
compensation for indemnity benefits payable to the injured employee or
dependents of a deceased employee.
The presumption that a hernia, heart trouble, or pneumonia arose out of
and in the course of employment was extended to members of the
California Highway Patrol. For law enforcement officers and fire
department employees, the definition of "injury" was extended to include
a blood-borne infectious disease.
For active lifeguards employed for more than 3 consecutive months in a
calendar year by certain local agencies and the Department of Parks and
Recreation, the term "injury" now includes skin cancer that develops or
manifests itself during the period of the lifeguard's employment.
A healthcare provider or licensed healthcare facility can now contract
with a contracting agent, employer, or insurance carrier for
reimbursement rates that are different from the official medical fee
Whenever an employer or insurer employs an individual or contracts with
an entity to conduct a review of a billing submitted by a physician or
medical provider, the employer or insurer must make available to that
individual or entity all documentation submitted together with that
billing by the physician or medical provider.
Medical treatment for a work-related injury may be provided by a
State-licensed physician assistant or nurse practitioner. This includes
the authority to authorize the patient to receive time off from work for
a period not to exceed 3 calendar days if that authority is included in
a standardized procedure or protocol approved by the supervising
The mileage reimbursement rate for the use of a privately owned vehicle
necessary for an employee to receive medical attention will now be at
the rate equal to the Federal mileage reimbursement rate.
The State's Attorney General is now authorized to bring action in
Superior Court against any employer, carrier, or risk management agency
that fails to comply with the Second Injury Fund reporting requirements.
An employer- or insurer-sponsored medical plan must contain a list of
all pharmacies that will provide services under the plan.
The time limit for appealing a commissioner's decision was extended to
20 days, up from 10.
The time for either party to appeal a notice of award was increased to
30 days from 20.
The "cap" on attorneys' fees that can be awarded by the Industrial
Accident Board was changed from $2,250 to a sliding scale based upon the
average weekly wage as announced annually by the State's Secretary of
Labor. This presently places the "cap" at $6,744.
An employer or its carrier is to notify the Department and claimant, in
writing, of its acceptance or denial of an employee's claim within 15
days from the date of its receipt of knowledge that the employee
sustained a work-related injury. Also, all medical expenses are to be
paid by the employer or carrier within 30 days of receipt unless
notification is provided that the expenses are being contested or
further verification is required.
The definition of "employee" excludes a person who performs services as
a sports official for interscholastic sports events, or amateur sports
events sponsored by nonprofit organizations. The term "employment"
excludes services performed by state prisoners or county inmates, except
those performing services for private employers.
For a public employer to be eligible for special premium rates, they
must have a workplace safety program. If authorized by the employee,
compensation payments may be deposited directly into the employee's
account at a financial institution. Upon written request, the employee
is entitled to one change of physician during the course of treatment
for any one accident.
If lost wages from concurrent employment are used in calculating the
average weekly wage, the employee is responsible for providing
information concerning the loss of earnings from the concurrent
A claimant, represented by counsel, may waive all rights to benefits by
entering into a settlement agreement releasing the employer and carrier
from liability in exchange for a lump-sum payment to the claimant. In
such settlements, only the attorney's fee is subject to approval by the
judge of compensation claims. The exemption of workers' compensation
claims from creditors does not extend to claims based on an award of
child support or alimony.
An injury to a law enforcement officer while on duty or while going to
or coming from work in an official law enforcement vehicle shall be
presumed to be an injury arising out of and in the course of employment
unless the injury occurred during a distinct deviation for a
non-essential personal errand.
The weekly maximum for temporary total disability benefits increased to
$400 from $375, and the minimum to $40 from $37.50. The weekly maximum
for temporary partial disability was increased to $268 from $250.
Upon determining that proceedings were brought, prosecuted, or defended
without reasonable grounds, the administrative law judge or the board
may, in addition to reasonable attorney's fees, award to the adverse
party reasonable litigation expenses against the offending party.
The list of physicians the employer must maintain who are reasonably
accessible to employees increased to 6 from 4. All reasonable charges
for medical, surgical, hospital, and pharmacy goods and services are
payable by the employer or its workers' compensation insurer within 30
days from the date the employer or insurer receives the charges and
Infectious hepatitis and tuberculosis are now considered "occupational
diseases" in any occupation involving exposure to human blood or body
A limited liability partner may elect to be covered by the workers'
"Usual charge" means the amount most commonly charged by healthcare
providers for the same or similar services while "customary charge"
means the usual rates or range of fees charged by healthcare providers
in a given locale or area.
The average gross weekly wage of a person serving on a volunteer basis
as a duly authorized law enforcement officer, ambulance attendant and
driver, or firefighter, who receives no wages for such services, or who
receives wages that are substantially less than the usual wages paid for
such services, is now computed on the basis of the dollar amount closest
to but not exceeding 112.5 percent of the State average weekly wage. The
average weekly wage of any other volunteer who receives no wages for
such services, or who receives wages that are substantially less than
the usual wages paid for such services by comparable employers to
employees who are not volunteers, are to be computed on the basis of the
usual wages paid by the employer for such services to employees who are
The amount of benefits to be paid to each surviving parent in a
no-dependency death claim was increased to $75,000 from $20,000.
If upon release by a physician to return to work, the employee fails a
drug test, benefits, with the exception of reasonable and necessary
medical treatment, may be terminated subject to the terms and conditions
established in the employer's promulgated drug testing policy and
In calculating an employee's wage, any amount withheld by the employer
to fund any health insurance benefit provided by the employer, and which
was elected by the employee in lieu of taxable earnings, is to be
Constitutional challenges to the Workers' Compensation Act are now
recognized if they meet established filing procedures. An award of
temporary total disability benefits may be modified by the filing of a
motion for modification with the same court that awarded the benefits
and under the same caption and docket number without the necessity of
filing a new dispute and appearing at a mediation conference.
The time limit for filing a claim for disability arising from an
occupational disease was increased to 1 year from 6 months.
Musicians and performers who are rendering services pursuant to a
performance contract are exempt from workers' compensation coverage.
For purposes of determining an employee's average weekly wage in an
occupational disease claim, the date of the "accident" shall be the date
of the employee's last employment with the employer from whom benefits
are being claimed or the date of last injurious exposure to employment
conditions, whichever date occurs later.
The amount of medical insurance coverage required for an agricultural
employer to be exempt from workers' compensation coverage was increased
to $5,000 from $1,000.
The Supplemental Benefits Fund was created to provide reimbursement for
the payment of workers' compensation benefits in excess of 260 weeks.
Previously, these reimbursements were made from the Employment
A decision rendered by the Workers' Compensation Commission is to be
sent to each party's attorney of record or, if the party is
unrepresented, to the party.
For purposes of workers' compensation coverage, the definition of
"public safety employee" was expanded to include a Prince George's
County deputy sheriff.
If an award of permanent partial disability compensation is reversed or
modified by a court of appeal, the payment of any new compensation
awarded shall be subject to a credit for compensation previously awarded
Each employer that self-insures must establish a toll-free telephone
number through which an employee or claimant, or a representative of an
employee or claimant, may make direct telephone inquiries during regular
In response to a request that pertains to a specific employer and
includes the employer's address and the date of injury of the claim for
which information is requested, the bureau may disclose the name and
address of the insurer that, according to the records of the bureau,
provided coverage on the date of injury, but shall not disclose the
effective date or expiration date of the policy.
The Workers' Compensation Act does not apply to employment of a trainer,
assistant trainer, exercise person, or pony person who is performing
services under a license issued by the board of horseracing while on the
grounds of a licensed race meet.
The waiting period for receiving temporary total disability benefits was
reduced from 6 to 5 days, and for shift work from 48 to 40 hours.
A worker requalifies for temporary total disability benefits if a
modified or alternative position is no longer available to the worker
for any reason, except for the worker's incarceration, resignation, or
termination for disciplinary reasons caused by a violation of the
employer's policies that provide for termination of employment.
If an employee is intentionally injured by an intentional and deliberate
act of the employee's employer or by the intentional and deliberate act
of a fellow employee while performing the duties of employment, the
employee or, in case of death, the employee's heirs have a cause of
action for damages against the person whose intentional and deliberate
act caused the intentional injury.
An officer or manager of a quasi-public or private corporation, or a
limited liability company who owns the entity, operates it exclusively
from his primary residence, and receives pay for services performed, may
elect to reject coverage for himself by filing written notice with the
If a person employed in the State contracts a contagious disease during
the course and scope of his employment that results in a temporary or
permanent disability or death, the disease is deemed to be an
occupational disease and compensable if certain conditions are met.
"Contagious disease" means hepatitis A, B, and C, tuberculosis, the
human immunodeficiency virus or acquired immune deficiency syndrome.
If a treating physician or chiropractor refers an injured employee to a
specialist for treatment, the treating physician or chiropractor must
provide to the injured employee a list that includes the name of each
physician or chiropractor with that specialization who is available
pursuant to the terms of the contract with the organization for managed
care or with providers of healthcare services. The injured employee may
select someone from that list.
Scheduled permanent impairment awards can now be given for an injury to
the brain or from scarring, disfigurement, or other skin impairment
resulting from a bum or bums.
A mental injury is not compensable under the Workers' Compensation Act
if such mental injury results from any disciplinary action, work
evaluation, job transfer, layoff, demotion, termination or similar
action, taken in good faith by the employer.
Any State employee injured in the line of duty by a hostile or overt act
that causes hospitalization or renders the employee temporarily unable
to perform the duties of his or her position shall remain on active
payroll and not be charged annual or sick leave for the time lost due to
When an insurance carrier, self-insurer, or payor, acting on behalf of
such carrier or self-insurer, disputes the causal relationship of a
medical bill to the claimant's injury, and denies payment of such bill,
and is after a hearing ordered to pay or reimburse the bill by the
Commissioner, the employee shall be entitled to reimbursement of
reasonable counsel fees and costs as approved by the Commissioner.
Burial expenses were increased to $3,500 from $2,000.
An insurer that covers an employee under a health benefit plan, a
disability income plan, or any other health insurance plan is not a real
party in interest and shall not participate in any proceeding or
settlement agreement to determine compensability of a claim. The insurer
that covers an employee under a health benefit plan or any other health
insurance plan may seek reimbursement from the employee, employer, or
carrier that is liable or responsible for the specific medical charge
according to a final adjudication of the claim or an order of the
Commission approving a settlement.
The bureau may now pay for preventative treatment for significant
exposures documented by emergency medical service providers or employees
of licensed facilities, and for exposure to rabies occurring in the
course of employment.
An employer may not require an employee to use sick or annual leave, or
other employer-paid time off work, before applying for or receiving
workers' compensation benefits. However, an employer may allow an
employee to use sick or annual leave to make up the difference between
the employee's wage-loss benefits and the employee's regular pay.
For purposes of workers' compensation, a "preferred worker" means a
worker who has incurred a compensable injury that resulted in a
disability that poses a substantial obstacle to employment. The bureau
may provide assistance as deemed appropriate to employers who employ a
preferred worker, and employers who apply for and are approved as a
preferred worker employer may not be assessed premiums on a preferred
worker's salary for 3 years from the date of hiring. Also, the bureau
may not charge claims costs incurred as a result of an injury sustained
by a preferred worker against the account of the preferred worker's
employer during the first 3 years after the worker is hired.
The award for the amputation of more than one finger on one hand may not
exceed an award for the amputation of a hand. The award for the
amputation of more than one toe of one foot may not exceed an award for
the amputation of a foot.
An employer may not employ any person, or receive the fruits of the
labor of any person, in a hazardous employment, without first applying
for workers' compensation insurance coverage by notifying the bureau of
the intended employment, the nature of the intended employment, and the
estimated payroll expenditure for the coming 12-month period. An
employer who willfully misrepresents the amount of payroll upon which a
premium is based, or who willfully fails to secure coverage for
employees, is liable to the State in the amount of $2,000 plus three
times the difference between the premium paid and the amount of premium
the employer should have paid.
The name of State Insurance Fund was changed to "CompSource Oklahoma."
A person serving as a referee or assistant referee in a youth or adult
recreational soccer match whose services are retained on a
match-by-match basis is exempt from workers' compensation coverage.
Firefighters and police employees of any city having a population of
more than 200,000 that provides a disability and retirement system by
law are also exempt from coverage.
"Preexisting condition" means, for all occupational disease claims, any
injury, disease, congenital abnormality, personality disorder or similar
condition that contributes to disability or need for treatment and that
precedes the onset of the claimed occupational disease.
For purposes of determining entitlement to temporary disability or
permanent total disability benefits, "worker" does not include a person
who has withdrawn from the workforce during the period for which such
benefits are sought.
The maximum for temporary total disability was increased to 133 percent
of the State's average weekly wage, up from 100 percent. For workers
employed in more than one job at the time of injury, all the worker's
earnings will be considered in determining the temporary total
disability compensation rate. For the permanent loss of use or function
of an injured member of the body, benefits for each degree of disability
was increased to $511.29 from $454. Beginning January 1, 2002, through
December 31, 2004, the worker will receive $559 for each degree of
An offer of modified employment may be refused by a worker, without the
termination of temporary total benefits, if the offer does not meet an
established set of requirements.
An injured worker may pursue a civil negligence action for a
work-related injury that has been determined to be not compensable
because the worker has failed to establish that a work-related incident
was the major contributing cause of the worker's injury--only after an
order determining that the claim is not compensable has become final.
Such action must occur within the later of (1) 2 years from the date of
injury or (2) 180 days from the date the order affirming that the claim
is not compensable on such grounds becomes final.
Any person who is appointed a corporate officer between January 1, 1999
and December 31, 2001, and was not previously an employee of the
corporation, will not be considered an employee unless a notice is filed
to elect coverage by the workers' compensation provisions.
The penalty for an employer failing to post a summary of the workers'
compensation act provisions was increased to $250 from $100. The payment
of medical services required by the employer shall not include hearing
aids or other amplification devices.
An injured employee who accepts suitable alternative employment will
receive a weekly compensation equal to 66 2/3 percent of the difference
between the employee's average weekly wage, earnings or salary before
the injury and his/ her weekly wages, earnings, or salary from the
suitable alternative employment.
For total occupational deafness in one ear, 75 weeks of compensation
will be paid; for total occupational deafness of both ears, 244 weeks of
compensation will be paid (previously 17 and 100 weeks, respectively).
No local prisoner, State inmate, or Federal inmate providing services to
the State or any of its political subdivisions may be considered a
volunteer worker for workers' compensation purposes.
In cases where an injury occurs as the result of gradual or cumulative
events or trauma, the injured employee, or representative, needs to
provide notice to the employer of the injury within 30 days after the
employee knows or reasonably should know that he/she has suffered a
work-related injury resulting in permanent physical impairment, or is
rendered unable to continue to perform his/her normal work activities as
the result of the work-related injury, and the employee knows or
reasonably should know that the injury was caused by work-related
Before any proposed settlement is considered final in cases involving
benefits from the second injury fund, it must have the written approval
of the Commissioner of Labor and Workforce Development.
If an injury or illness requires the treatment of a physician or surgeon
who practices orthopedic or neuroscience medicine, the employer may
appoint a panel of physicians or surgeons practicing orthopedic or
neuroscience medicine for the employee to choose. The injured employee
is entitled to have a second opinion on the issue of surgery,
impairment, and a diagnosis from that same panel of physicians.
The representative of the employee, employer, or employer's insurer
attending a benefit review conference must have authority to settle any
disputes. Failure to provide such a person at the conference, without
good cause, by the employer or insurer, shall subject them to a penalty
of not less than $50 nor more than $5,000.
The requirements for being on the Commission's approved list of doctors
licensed in the State who are approved to provide healthcare services
were significantly revised. Regional Health Care Delivery Networks may
now be established by the Commission, as fee-for-service networks
designed to improve the quality and reduce the cost of healthcare. An
insurance carrier or a self-insurer, certified to provide workers'
compensation coverage in the State, may elect to participate or not
participate, by contract, in a regional network. A public employer, with
certain exceptions, are required to participate in a regional network.
An employer shall notify an employee, treating doctor, and insurance
carrier of the existence or absence of opportunities for modified duty
or a modified duty return-to-work program available through the
employer. An insurance carrier shall, with the agreement of a
participating employer, provide the employer with return-to-work
coordination services as necessary to facilitate an employee's return to
The Texas Workers' Compensation Insurance Fund was changed to a domestic
mutual insurance company and now operates as the Texas Mutual Insurance
Law enforcement and public safety volunteers and paid officers who
provide public safety services during the Olympic Winter Games of 2002
and the Paralympic Winter Games of 2002 are covered under workers'
compensation. For purposes of computing compensation, the average weekly
wage rate of a public safety volunteer is considered to be $400.
The presumption as to disability or death from respiratory disease,
hypertension or heart disease was extended to special agents of the
Department of Alcoholic Beverage Control.
Premium discounts insurers provide to employers for drug-free workplace
programs are no longer limited to 4 years.
For purposes of workers' compensation coverage, the definition of "State
employee" was clarified.
The amount of permanent total disability and death benefits awarded to
dependent children was increased to $150 per month, up from $100, for
payments made after July 1, 2001. In the future such payments are to be
adjusted annually for inflation.
Glenn Whittington is Chief, Branch of Planning Policy and Standards,
Office of Workers' Compensation Programs, Employment Standards
Administration, U.S. Department of Labor. e-mail: firstname.lastname@example.org
COPYRIGHT 2002 U.S. Bureau of Labor Statistics
COPYRIGHT 2004 Gale Group