Worker's Compensation is a wage replacement system. It is a "no-fault" system which pays benefits to injured workers for injuries "arising out of and in the course of" their employment.

2. WHO IS COVERED

For all practical purposes, all "employees" are covered. Some specific occupations are excluded. "Independent contractors" are not covered under the workers' compensation law.

3. BENEFITS AVAILABLE

The major benefits available under the workers' compensation act are "weekly indemnity" benefits and "medical payments". Weekly compensation benefits can be either total or partial. Total disability benefits are paid at a rate of 60% of the worker's "average weekly wage". For injuries occurring after 12/23/91:

1. "Total disability" benefits are payable for a maximum period of 3 years.
2. "Partial disability" benefits are payable for up to 5 years and in some case up to 10 years if the worker has lost 75% function in specified body parts or has developed a life threatening condition or illness.
3. There is a cap of 7 years of benefits between partial and total which can under certain circumstances be increased to 10 years.

Medical benefits are payable even if the worker does not lose any time from work.  These benefits are payable as long as the medical treatment is "reasonable, necessary and casually related" to the industrial injury.  In certain cases, the injured worker may be entitled to a one-time payment for scarring, if it is on the face, neck or hands.  An injured worker may also be compensated if he/she has sustained a loss of function in a particular body part as a result of his/her injury.  Finally, if the injury has left the worker with some type of disfigurement, other than scarring, such as a limp, permanent use of crutches, wheelchair, etc, additional benefits may be owed.

4. PROCEDURE AND FORUM

Workers' Compensation cases are litigated /adjudicated at the "Department of Industrial Accidents".

This is an "Administrative Court System" and is completely separate and independent from the civil and criminal court systems.

If an injured worker is denied benefits by an insurance company a "claim" is filed with the Department of Industrial Accidents. If the insurance company wishes to modify a worker's benefits it files a "complaint".

The case is initially scheduled for a "conciliation" which is an informal proceeding where the parties state their cases to a "conciliator".  The conciliator does not have the power to order the parties to take action, but merely determines if there is sufficient evidence to warrant the case going forward to an "Administrative Judge".

A "Conference Proceeding" is the first opportunity the parties have to present the case to the Administrative Judge who has the power to impose a resolution and issue an "order".

If either party is unsatisfied with the Judge's order, he/she may "appeal" and the case will be scheduled for a "hearing" which is the equivalent to a "trial".

The last level of administrative review is an appeal to the "Reviewing Board" if the parties are dissatisfied with the "hearing decision".