Checklists - Worker's Compensation Claims

Workers' Compensation Laws are laws passed by state legislatures that compensate employees for work-related injuries or illnesses. Any employee injured on the job within the scope of his employment is entitled to workers' compensation benefits. This is true even if the employee was injured because of his own negligence or for failure to follow the instructions of his employer. Self inflicted injuries are not covered. Benefits include medical expenses, lost wages, and death benefits. Most employers have insurance to cover these benefits. If they don't have insurance, they still have to pay benefits.

If a third party is responsible for the injury, such as the manufacturer of a defective machine, the employee is still entitled to workers compensation and may also recover from the manufacturer. However, any recovery would first have to reimburse the employer for benefits it had paid.

Each state has its own administrative agency that handles workers compensation issues such as whether or not an employee is entitled to compensation and the amount of compensation. As previously stated, the question of whose fault the injury is, is irrelevant. An employee can knowingly violate safety rules and still be compensated. Independent Contractors are not covered by workers compensation from the contracting party because the are not employees of the contracting party.

This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.