Workers compensation or workers comp is the branch of law for compensation for injury or occupational disease to an employee arising out of and in the course of employment. Workers compensation is paid to the worker or dependents by an employer.
The employer's strict liability for workers compensation is established by state and federal statute and case law. Workers compensation statutes include the Longshore Harbor Workers Comp Act (LHWCA), the Jones Act, Federal Employers Liability Act (FELA), and workers compensation statutes enacted by the states.
Employees are required to notify the employer of an injury or occupational within a certain number of days. Failure to give this notice to the employer may relieve the employer and its insurance carrier from liability for the claim. The employee must also file a written claim for compensation with the appropriate state agency.
The employer or its insurance carrier will normally conduct an investigation into claims. The claim can be paid or denied. Payments typically include temporary income benefits, impairment income benefits, supplemental income benefits, and life income benefits.
Most claims are denied due to non-compensability or lack of coverage. If a claim is denied, the insurance carrier must notify the claimant and file the denial with the governing state agency. The claimant can then request an administrative review of the claim with the governing state agency. The employer and claimant may be ordered to attend mediation, or agree to participate in arbitration proceedings.
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