Workers' compensation

Correct answer: The employer pays the entire cost

Workers' compensation is state-mandated but employer-funded. The employer pays 100% of the cost, and employees make no contribution toward it.

Correct answer: The injured worker generally cannot also sue the employer for a covered work injury

Under the workers' compensation bargain, the worker receives guaranteed no-fault benefits and in exchange gives up the right to bring a negligence suit against the employer. Workers' compensation is the worker's exclusive remedy against the employer for a covered work injury.

Correct answer: Benefits are payable, because workers' compensation pays without regard to fault

Workers' compensation is a no-fault system. A worker hurt on the job is paid whether the employer, the worker or nobody was careless, so the worker's carelessness does not bar or reduce the benefits.

Correct answer: Workers' compensation does not apply; she should look to coverage such as disability income or health insurance

Workers' compensation covers only injuries and diseases that arise out of and in the course of employment. An injury suffered off the job, on personal time, is not covered; other coverage, such as health insurance, disability income insurance or a state disability benefits program, fills that gap.

Correct answer: They usually have no deductible, no coinsurance and no dollar limit

Workers' compensation medical benefits pay hospital, surgical, physician and prescription costs for the work injury, usually with no deductible, no coinsurance and no dollar limit, and they begin immediately.

Correct answer: About two-thirds of the worker's average weekly wage, up to a state maximum

Disability income, or indemnity, benefits replace a percentage of the worker's average weekly wage, commonly two-thirds, subject to a maximum weekly benefit set by the state.

Correct answer: It delays disability income benefits only; medical benefits begin immediately

The waiting period of a few days applies to disability income (indemnity) benefits. Medical benefits begin immediately. The waiting-period days are paid back retroactively if the disability lasts long enough.

Correct answer: Damages for pain and suffering

The four workers' compensation benefits are medical, disability income, rehabilitation and death benefits. Pain and suffering damages belong to a negligence lawsuit, which the exclusive remedy rule replaces.

Correct answer: Temporary total disability

Temporary total disability means the worker cannot work at all for the time being but is expected to recover. 'Temporary' describes duration and 'total' describes the inability to do any work.

Correct answer: Temporary partial disability

Temporary partial disability applies when an injured worker can do some work at reduced earnings while recovering. The carpenter is on light duty at lower pay and expected to recover, so the disability is temporary and partial.

Correct answer: Permanent total disability

Permanent total disability means the worker will never be able to work again. A lasting injury that prevents any employment is both permanent and total.

Correct answer: As a permanent partial disability, paid for a set number of weeks from the statutory schedule

Loss of a specific body part, such as a thumb, is a permanent partial disability. Workers' compensation statutes pay such losses from a schedule that sets a number of weeks of benefits for each member; New York's schedule, for example, lists 75 weeks for a thumb.

Correct answer: Rehabilitation benefits

Rehabilitation benefits provide medical and vocational rehabilitation to return the injured worker to employment, including retraining for a different occupation.

Correct answer: They are not taxable income to the worker

Workers' compensation benefits received by the worker are not taxable income, even though the employer pays the entire premium.

Correct answer: Because it pays whatever benefits the state workers' compensation law requires

Part One of the Workers' Compensation and Employers' Liability policy pays the benefits the state statute requires. Because the law sets the benefits, the policy states no dollar limit for Part One. Part Two, employers' liability, generally has stated limits, although for employees subject to New York law it is unlimited.

Correct answer: Part Two, employers' liability

Part Two, employers' liability, covers lawsuits against the employer that fall outside the workers' compensation statute, such as a third-party-over action. In New York, exclusive remedy blocks such a claim against the employer unless the worker suffered a grave injury, such as the amputation of an arm, or the employer agreed in writing to indemnify. Part One pays only the statutory benefits.

Correct answer: Part Two has stated dollar limits; Part One has no policy dollar limit

Part One pays the statutory benefits and has no policy dollar limit. In most states, Part Two, employers' liability, covers suits outside the statute and is written with stated dollar limits. New York is an exception: for employees subject to New York law, Part Two is unlimited.

Correct answer: A state-run fund that is the only permitted source of workers' compensation coverage

A monopolistic state fund is a state-run workers' compensation fund that is the only permitted source of coverage; private insurers cannot write the coverage there. North Dakota, Ohio, Washington and Wyoming use monopolistic funds.

Correct answer: From the state fund or from a private insurer, which compete for the business

A competitive state fund is a state-run fund that competes with private insurers. Employers may buy from either, or, if large and financially qualified, self-insure with state approval.

Correct answer: A large, financially qualified employer approved by the state

Self-insurance is available to a large, financially qualified employer that the state approves; it then pays claims from its own funds instead of buying a policy.

Correct answer: Ohio

The monopolistic state fund states are North Dakota, Ohio, Washington and Wyoming. Of the choices, only Ohio is monopolistic.

Correct answer: The employer's payroll and the job classification of the work

Workers' compensation premium is computed on the employer's payroll and the classification of the work performed, then adjusted for the employer's own loss record through experience rating.

Correct answer: The premium will be adjusted upward to reflect its worse loss record

Experience rating adjusts an employer's workers' compensation premium according to its own loss record compared with others in its classification. A worse-than-average record raises the premium; a better one lowers it.

Correct answer: Yes, as an occupational disease arising out of the employment

Workers' compensation covers both accidental injuries and occupational diseases that arise out of and in the course of employment. A lung disease caused by workplace dust and fumes is an occupational disease.

Correct answer: Because state law requires the coverage and sets the benefits it must pay

Workers' compensation is government insurance because the state mandates it and the statute defines the benefits. The state writes the benefit rules even when the employer buys the policy from a private insurer.

Correct answer: Periodically, like wages, directly to the worker, without waiting for a formal award

Where the right to compensation is not controverted, compensation is paid periodically and promptly in like manner as wages, as it accrues, and directly to the person entitled to it, without waiting for an award by the board.

Correct answer: The state workers' compensation board or agency

Disputed workers' compensation claims are decided by the state's workers' compensation board, which has full power to determine all questions about payment of claims presented to it, after investigation and, on request, a hearing.

Correct answer: It conflicts with it, because the employer must bear the entire cost of the coverage

Workers' compensation is paid entirely by the employer. Deducting any part of the premium from employees' wages conflicts with that rule, regardless of the amount or any employee agreement.

Correct answer: The suit is generally barred, because workers' compensation is the exclusive remedy against the employer

Workers' compensation is the employee's exclusive remedy against the employer for a covered work injury. Even where the employer was negligent, the worker generally receives statutory benefits instead of suing the employer.

Correct answer: Workers' compensation, because the injury arose out of her employment

A job-related injury is the province of workers' compensation, which pays medical benefits with no deductible or coinsurance. Health insurance, disability income insurance and state disability programs fill the gap for injuries and illnesses that are not job-related.

Correct answer: His benefit was limited by the state's maximum weekly benefit

Disability income benefits are commonly two-thirds of the average weekly wage, subject to a state maximum. For a high earner, two-thirds of wages can exceed the maximum, so the benefit is capped and replaces a smaller share of his pay.

Correct answer: The medical bill, but no disability income benefit

Medical benefits begin immediately, so the clinic bill is paid. Disability income benefits begin only after the waiting period, and a two-day absence ends before the waiting period is met, so no income benefit is payable.

Correct answer: Permanent partial is a lasting partial loss; temporary partial is reduced capacity expected to end with recovery

Both are partial disabilities, so the worker retains some capacity to work. The difference is duration: a permanent partial disability is a lasting loss, such as a lost finger, often paid from a schedule; a temporary partial disability is reduced capacity, such as light duty at lower pay, that is expected to end when the worker recovers.

Correct answer: Buying a group disability income policy for its employees

An employer complies through a private insurer, a state fund or approved self-insurance. A group disability income policy pays income benefits under its own terms and does not provide the statutory workers' compensation benefits.

Correct answer: Through the Wyoming state fund

In a monopolistic state, the state fund is the only permitted source of workers' compensation coverage. Wyoming is one of the four monopolistic states, so an employer that must cover its Wyoming employees does so through the state fund. Wyoming requires coverage for listed employments and lets other employers elect it; either way, the coverage comes from the fund.

Correct answer: Employer-paid, no-fault coverage for job-related injury and disease that replaces the worker's right to sue the employer

Workers' compensation is state-mandated, employer-paid, no-fault coverage for injuries and diseases arising out of and in the course of employment, and it is the employee's exclusive remedy against the employer.