What is Workers’ Compensation?
Workers’ compensation (sometimes called Workman’s Compensation) is both a type of insurance and a legally mandated benefit of employment. It is based upon the statutory law of most states, although the precise design of the required coverage may vary. For example, employers having fewer than a stated number of employees may not be required to maintain workers’ compensation insurance, but that number may vary by state. Likewise, the benefits payable may differ by state. The primary goal of workers’ compensation is to compensate employees for medical expenses and lost wages sustained in work-related accidents. There are similar laws that operate in similar ways and are applicable to state and federal government employees.
The injuries to which workers’ compensation applies can range from the relatively minor that require acute — but not ongoing — care, to catastrophic injuries that demand a wide range of clinically relevant services, rehabilitation, specialized rehabilitation and residential services to achieve the best possible outcome. Critical to an individual’s return to independence is the customized Client Goal Plan that NeuLife develops and executes for each of its clients.
Payment of the individual’s medical expenses and reimbursement of wages is provided in exchange for the employee’s relinquishment of their right to engage in litigation against the employer for negligence. “Negligence” essentially means “carelessness.” The result of this trade-off is that the employee is entitled to workers’ compensation benefits regardless of whether or not the employer was negligent in causing the occurrence that resulted in the injury. Stated otherwise, the employee does not have to prove “fault” by the employer such as would have to be done in civil litigation. However, to be entitled to benefits, the employee does have to prove that he or she was an employee of the employer at the time of the injury, and that the injury occurred “within the course and scope” of that employment. In general, that means that the injury occurred while the employee was furthering the business interests of the employer.
The proofs that are required to be made by the employee in a workers’ compensation claim can trigger defenses by the employer. A “defense” in this context is a reason why payment of benefits should not be made. The defenses can include that the individual making the claim was not, in fact, an employee but instead, was an “independent contractor.” Another possible defense can be that the injured individual was hurt while engaging in an activity that was outside the course and scope of employment, or during “horseplay.” Horseplay essentially means “goofing around” and is, therefore, generally considered to be outside the course and scope of employment. But, to make matters more complicated, if the “horseplay” was approved by the employer or ignored in the past, the result may be different. Therefore, while the entitlement to workers’ compensation benefits is generally without regard to fault, if a defense is raised by the employer, the outcome of the claim will be driven by the facts.
Another part of the trade-off for not engaging in litigation with the employer is that the workers’ compensation provider retains the right to direct the medical care, the rehabilitation and other related clinically relevant services furnished to the injured individual. Once the individual has been stabilized through acute care, post-acute rehabilitation and specialized rehabilitation usually begin, with the goal of achieving the best possible outcome and attempting to return the individual to work and to independence to the greatest extent possible. If the individual or his/her representative disagrees with the healthcare choices being made by the workers’ compensation provider, there is usually a process for challenging the provider in a court dedicated to workers’ compensation claims.
In addition to the healthcare and rehabilitation aspect of workers’ compensation, there is an element of wage loss reimbursement. Again, the formula may differ among states, but the principle is similar. It involves the payment to the individual of some percentage of his or her past average wages calculated over a period of time. In situations involving catastrophic occurrences, such as traumatic brain injuries or spinal cord injuries, future wages may be projected, reduced to present value and paid in a lump sum. Workers’ compensation benefits are funded either directly by the employer (if the employer is “self-insured”) or by an insurance company to which the employer has paid premiums for coverage. In a few states, the state, itself, maintains a workers’ compensation fund through which benefits are paid. In those states, employers that are subject to the workers’ compensation law pay the equivalent of “premiums” into the fund.
NeuLife’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting therapeutic environment where caring staff encourage, assist and support each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve maximized, sustained outcomes that exceed the expectations of all persons served.
NeuLife, in Mount Dora, Florida, is a fully accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.
2725 Robie Avenue
Mount Dora, Florida 32757
