You’ve been a faithful employee at a local restaurant and have dedicated 20 years to great customer service and providing fine dining. One day you go to the doctor for a routine check-up and discover that you have lung cancer; you’ve never smoked a day in your life, but the restaurant permits smoking and 20 years of second-hand smoke exposure has led to you getting sick. What are your options? What are your rights and who is responsible for your illness? Or let’s say you have a job typing behind a computer all day and you start developing carpel tunnel syndrome. Do you have any recourse against your employer for your injury? Who will pay for your treatment and medical expenses?

Workers’ compensation is a system of benefits, provided and largely governed by state law to employees for certain on-the-job injuries and occupational diseases. Generally, workers’ compensation benefits are paid regardless of fault and preclude employees from filing tort claims against their employers.

What is required for a claim under workers’ compensation? In order to open a workers’ compensation claim, you must show three things: 1) the person or company you were working for must carry workers’ compensation insurance or be legally required to do so; 2) you must be an employee of that person or company; and 3) your injury or illness must be work-related.

First, most employers are covered by workers’ compensation laws and most states require private employers with one or more employees to carry worker’s compensation insurance, but some states have an exception for small employers with less than a threshold number of employees. Most employers carry workers’ compensation insurance through private insurers, a state insurance fund, or self-insurance. If not required by state law, many employers still choose to “opt in” into the workers’ compensation insurance to reduce payouts, ensure compensation for their employees, and to make sure that if an injury does occur, no tort lawsuits can be filed against the employer.

Second, you must be an employee of the person or company where your injury occurred. While most employees are covered under workers’ compensation insurance, some workers are excluded by most states, including farm laborers, domestic servants, and casual workers, earning less than a threshold amount. Independent contractors – self-employed individuals who contract out their services, as well as volunteers, are also ineligible for workers’ compensation insurance.

Third, to be covered under workers’ compensation, you must suffer an on the job injury. What is an on the job or job-related injury? Generally, if you are doing something for the benefit of your employer and are injured or become ill as a result, your injury or illness is considered on the job, or job-related. Furthermore, there must be a causal connection between the injury/illness and employment, and states use different tests to determine whether such a connection exists. But a causal connection doesn’t always exist. For instance, tasks that are performed to benefit your employer that result in injury, but are away from the premises, are not covered under workers’ compensation, as there is no causal connection between the injury and employment. Exceptions to this coming-and-going rule include lunch breaks and travel, company-sponsored functions and related activities, and company-related entertainment, where if injuries occur, they may be compensable.

So, you’re eligible for workers’ compensation insurance. What benefits are you entitled to? While states vary on the benefits that are provided, the benefits include medical expenses, wage replacement, disability benefits, and lump-sum payments for permanent effects of an injury, vocational rehabilitation, and death benefits. In most states, the employer or workers’ compensation carrier can require that the employee submit to an independent medical exam to determine whether the injury or illness is compensable, and if so, the amount of workers’ compensation benefits. Employees cannot refuse this medical examination, but the employer or insurance carrier may have to pay for it. Workers’ compensation benefits are typically the exclusive remedy against the employer for the compensable injury, but employers may still be liable for intentional conduct, deliberately putting employees in danger in violation of a duty of care to the employee, and violations of the Occupational Safety and Health Act.

What if you’re an employer? What do you need to provide to your employees to make sure you are not breaking any laws? Typically, there are five obligations that employers have, to protect themselves and their employees’ rights after an Illinois work-related accident occurs. Employers must:

  1. Obtain workers’ compensation insurance;
  2. Post a notice that identifies the insurance carrier, employee rights, and authority contact information in an open area that all employees can easily see;
  3. Keep thorough records of all work-related injuries and report any accidents to the Illinois WC Commission that result in more than three days of missed work;
  4. Make sure not to harass, fire, refuse to rehire, or in any way discriminate against injured employees who exercise their legal rights; and
  5. Not charge employees in any way for, or deduct from their pay, any costs associated with workers’ compensation insurance premiums or benefits, as employers are responsible for this cost themselves, as a trade-off for protecting themselves and the company in the event of a catastrophic injury occurring while on the job.

In conclusion, no matter which position you are in, there are legal perimeters that must be followed to provide a safe workplace, ensure employee safety, and should an injury occur, provide protection for both parties, i.e. reduce costs and liability for the employer, while compensating the employee for injuries occurring on the job.