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Worker’s Compensation Discussion, Terms and Definitions

Worker’s Compensation Discussion, Terms and Definitions

Introduction. The following definitions are not intended to be absolutes or to be used as a basis for making a determination about any individual case. Every state has laws governing the terms and concerns below, and often cases go to court to seek resolution of differing opinions on the meaning of these terms. As well, this list is not intended to be exhaustive. There are numerous issues which come into play in determining worker’s compensation issues, and it would be impossible to address them all here. I encourage you to contact me to discuss your specific questions.

While state statutes govern the procedures and benefits payable to injured workers, typically these claims are handled by an administrative agency specially appointed to do so. The process of making claims includes requirements for notices to be sent, deadlines in which these notices must be sent, the potential for hearings for disputed matters, and reviews and appeals of these rulings in the event the worker is not satisfied with the results.

DUTY TO INSURE OR SELF-INSURE. States’ laws will vary, however, generally, when an employer has three or more employees, he or she is required to obtain worker’s compensation insurance for all of its employees, or to self-insure. This law is mandatory and an employer who fails to comply normally will be subject to both civil and criminal penalties.

EXCLUSIVITY OF WORKER’S COMPENSATION REMEDY. Generally, a worker has only one financial remedy if he or she is injured on the job. That remedy is set out in the various states’ laws which detail the scheme of Worker’s Compensation. The worker cannot decide to sue the employer, even if the employer was negligent. The laws are a compromise. The worker gives up the right to sue for “full damages” which include pain and suffering, and agrees to accept an amount set out by law. In so doing, the worker has more security in the certainty of payment, and he or she gets a simple and streamlined resolution. The employer gives up his or her right to defend the case, or otherwise deny responsibility, and in return avoids the possibility of having to pay potentially higher damages were the matter to go to court on a contested basis.

EMPLOYER. Someone who has the ability and the power to control the worker’s action and direct his or her work.

EMPLOYEE. Anyone, including a minor, who is in the service of another by contract of hire, whether that contract is written, verbal, or implied, and who is in the “usual course of the trade, business, occupation or profession of the employer. Contract as used means an agreement. Hire as used means some form of payment. Benefits for injuries are limited to “employees”. The term employee is thus the basis for many cases which attempt to distinguish the worker’s status, as if the worker is determined to be an Independent Contractor, the employee will not have to pay benefits. Many employers in fact attempt to label their workers as Independent Contractors, and therefore don’t pay social security taxes, don’t withhold taxes, don’t pay unemployment taxes, and don’t pay worker’s compensation insurance premiums. The law allows the deciding officer in a worker’s compensation claim to disagree with the employer’s characterization. Not paying taxes is not necessarily determinative.

INDEPENDENT CONTRACTOR. An independent contractor is someone who performs a job for another, but is free from the control of the other regarding the details of the work to be done.

ACCIDENT. An injury by accident is one which typically has three necessary parts. The first is that it must come from some identifiable incident which occurs within a specific time range. Back pain occurring on Friday after lifting heavy boxes the preceding Monday typically would not qualify. The second requirement is that there is some mechanical or structural change in the body. The third element is that there must be a causal connection between the incident and the bodily change.

OCCUPATIONAL DISEASE. A disease arising out of and in the course of employment. It is not an ordinary disease of life which the general public is exposed to outside of this worker’s employment. Many state laws have very detailed discussions of this term, and they generally concern themselves with concepts of causal relationship and exposure to the disease, which is common to the trade or occupation of the worker. Typically fire-fighters and police who suffer respiratory or heart disease are presumed to have contracted these ailments from the job, and they are covered as “occupational diseases”.

COMPENSABLE INJURY REQUIREMENT. In order for an injured worker to receive benefits, he or she must have been injured from an accidental injury or occupational disease arising out of and in the course of his or her employment.

ARISING OUT OF… EMPLOYMENT. The injury was caused by a risk to which the worker was subjected by his or her employment. The test is whether there is a connection between the injury and the conditions under which the work was to be performed.

IN THE COURSE OF (or scope of)… EMPLOYMENT. This term involves considering the time, place and circumstances of the accident in relation to the employment. If a worker is injured during the period of employment, at a place where the worker is reasonably expected to be, and while performing duties reasonably required by his employment, or if the worker is performing a task reasonably incidental to the employment, then there typically will be coverage. There are extensive court decisions which discuss issues such as coffee breaks, company picnics, and walking from the parking lot to the plant or office.

BENEFITS ENTITLEMENT.

Introductory Note: Each state has “caps” or limits on the total amount of funds that can be paid under any entitlement benefit. Please feel free to call my office to discuss the particulars of your case.

  1. MEDICAL COSTS AND VOCATIONAL REHABILITATION. Typically, all reasonable and necessary medical care costs are paid, including medications, medical appliances and prosthetic devices. Responsibility for these payments continues for as long as it takes for the worker to reach “maximum medical improvement”. Typically again, the employer’s worker’s compensation insurer can require that medical care be obtained from physicians of its choosing. As well as providing medical care costs, re-training or vocational rehabilitation must be furnished to the injured worker.
  2. TEMPORARY TOTAL DISABILITY. The worker is losing money because he or she cannot work, due to being injured on the job. Lost income benefits while the worker is out of work and under active medical care are generally paid at two-thirds of the average weekly wage the worker was earning prior to suffering the injury. Being out of work requires medical permission, and once the worker is said to have reached “maximum medical improvement”, he or she will usually be required to return to work, and benefits will stop. Disputes often arise as to whether the worker is still disabled, and whether or not he or she has reached “maximum medical recovery”.
  3. TEMPORARY PARTIAL DISABILITY. Often workers are recovered sufficiently to return to do some work, while they are still on the road to complete recovery. They are thus temporarily limited in the amount or the type of work they can do compared to their pre-injury work. Benefits here are usually paid at two-thirds of the difference between what is being earned and what was being earned prior to the injury.
  4. PERMANENT PARTIAL DISABILITY. Benefits are awarded for certain types of injuries which do not cause the worker to be totally unable to work There are many different ways in which permanent injuries are treated, and rate structures differ as well. In addition to the loss of, or the loss of the use of a specific body part (amputated leg, for example), this category includes disfigurement or scarring, and typically the disfigurement does not need to impair the worker’s ability to work.
  5. PERMANENT TOTAL DISABILITY. An injured worker must show that he or she cannot return to work in any capacity, and that the problem is permanent. Benefits are often paid to workers whose injuries allow them to work only occasionally, or whose work would be undependable because of the nature of the injury. As well, consideration is often given to a worker’s age, education, and experience in determining if he or she can return to employment.
  6. DEATH. State laws will typically define “dependents” of the deceased worker. Only these individuals are entitled to receive benefits, and typically these are calculated based on the wages the worker earned, upon which the dependent or dependents relied, and would have relied had the worker not passed. The focus of payment is not based upon mental pain and anguish, or grief, due to the passing of the worker. It’s purpose is to replace lost income. The rate and amount for dependents varies by their relationship to the worker, and dependents who are partially dependent would receive proportional payment.

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Edgar112orellana@gmail.com Edgar
Edgar112orellana@gmail.com Edgar
1727874325
Evelyn and Rocco were incredible. Rocco did his best to get me the most for my case and Evelyn walked me through the hardships and what to expect. Now Paul! I love honesty and straight fordwardness... if that's a word. Paul was great, his team made me feel safe and showed me what to expect. Thank you all for what you did. From my family to yours.
Ryan Campbell
Ryan Campbell
1727627276
I first got injured ( burned in a sensitive area) and I didn't know what to Expect or what to to next. I found Mr samakow and his group online, read.some reviews and gave them a call. Mr samakow took my call and we began the process of gathering details.Throughout this case I was anything but easy to work with - I was frustrated and upset with the insurance company often.Life was happening too fast around me to begin with, and this is without considering the stress from the case itself.However, through all of this chaos and confusion, Mr samakow remained calm, and for the most part found a way to accommodate me at every turn the case took. He was honest about his intentions, and always transparent. My case settled in roughly 15 months!Thanks to paul, and the samakow law group for your patience and professionalism!I'd use again, and I highly recommend. 👌Best regards,Ryan s.
Juan Benavides
Juan Benavides
1727256055
I got in a motor accident in the beginning of the year. had the pleasure of working with the Law offices of paul A. Samakow, and I cannot recommend them highly enough. From the moment I walked in, the staff made me feel welcome and at ease.A special shoutout to Paralegal Evelyn, who was incredibly knowledgeable and attentive throughout the entire process. She took the time to explain everything clearly, answered all my questions promptly, and truly went above and beyond to ensure I felt supported. Her professionalism and compassion made a challenging situation much more manageable.The attorneys at the firm are equally impressive, demonstrating expertise and dedication to their clients. I felt confident in their hands, and they delivered outstanding results.Thank you Evelyn, and the entire team, for your exceptional service!
T Marie Hayes
T Marie Hayes
1727214092
Ludvin Mendez
Ludvin Mendez
1726865286
Excelente abogado muy recomendable trabajo 100% garantizado
Alyncia Proctor
Alyncia Proctor
1726604291
Taina Hoyt
Taina Hoyt
1725823144
Melissa is amazing professional employee I will always come back to get services from this firm
Ashley Ruiz
Ashley Ruiz
1725621882
I had an accident by the beginning of the year, and we contacted them to represent me, they were amazing, process took less then a year, and it was super fast, Evelyn was so helpful and amazing.
Edwin Perdomo
Edwin Perdomo
1725391550
What a great law firm Mrs. Evelyn Amaya kept me notified and up to date on everything and ensured me her and her team had my back and no matter how frustrated I was they spoke with respect and dignity to me which I admire, they really know there stuff, thank you again
Joe Musso
Joe Musso
1725380434
I've been a nursing home abuse attorney for 25 years. In Virginia the legislature codified understaffing cases for attorneys like me in direct response to the case of Alcoy v. Woodbine which Paul Samakow litigated and won! In short, nursing home residents in Virginia are more protected because of Paul Samakow. Having now gotten to know him better I am moved by how caring and compassionate he is. An attorney that is brilliant and capable coupled with a loving passion for his clients is a dangerous combination. If you are considering hiring an attorney, Paul Samakow will not let you down.
Hemanta Shrestha
Hemanta Shrestha
1725377389
I was thankful for the experience with this firm, Filly came in and assisted me with my case and i appreciated it that he was always a phone call away . Thank you so much Paul and. Filly for your friendly, impressive and fastest service and co-operation. Definitely I Will recommend to friends
M DLC
M DLC
1725374258
Recomiendo a Melissa porque es una persona muy profesional dedicada inteligente amigable y muy responsable en lo que hace.Porque ganan todos los casos
Rosa Machado
Rosa Machado
1724776619
Tuve un accidente hace 5 meses atrás y fue un bendición que dios nos dio que encontré esta firma de abogados. Son muy profesionales y muy eficaces en el trabajo que hacen. Muy satisfechas y los recomiendo 100%. Muchas gracias a Melissa Rodríguez y a su firma de abogados paul samakow a quien nos ayudó en este caso.
Josephine Agyeman
Josephine Agyeman
1722280441
Melissa Rodriguez was very nice to me.She did an excellent job
Gary Njr
Gary Njr
1721150823
Love!!! They help me so much and stress free!!!! Eve help answer all my questions without hesitation. Would recommend 100%
deniz Yilmaz
deniz Yilmaz
1720732198
Mr. Samaria helped me with my case. He is a people’s person and very attentive. His office staff was very helpful as well. Thank you Mr.Samakow
Candice Wright
Candice Wright
1718329991
Paul is excellent I trust him with my life. He took on my case not even being in his own state, he had to get a special license to practice in my state just for my case. He took very good care of me and I was a pain in the butt! He assured me that I've made the right choices. He educated me on a lot of things, step by step process. The thing that got me the most was he goes above and beyond professionalism. He keeps you well informed. He's an excellent lawyer ! I can say that he did my case Justice and you'd be a fool not to hire him . Paul will have your best interest first and foremost I can tell you that is fact!
Andreina Sorto
Andreina Sorto
1717639258
I had a great experience with this law firm. They helped me in so many ways and made sure everything was taken care of. Eve is the best paralegal i’ve had and she always ensured i knew what i was going on with my case. I highly recommend this firm to anyone who has gotten into an accident and needs guidance.
Noelia Ortiz
Noelia Ortiz
1717534476
Melissa is a great person she did a wonderful job. I will forever be grateful.
Joana Juarez
Joana Juarez
1717104472
I have always cane back to them if I need them for any accident. This office I highly recommend.
Christian Marable
Christian Marable
1716506766
Eve was very helpful throughout my case, I would definitely recommend having her help you!
Mauricio Valeriano
Mauricio Valeriano
1712875456
Excelente atención.
Genesis Cleaningco
Genesis Cleaningco
1705097681
My name is Lorenzo Ventura I am very happy with the services I received from the law firm I take my case to another law firm they say my case was to small then I call Mr Paul the answer was yes will take your case thanks for everything
Hatti Chase
Hatti Chase
1702491619
It was a very long process. Having patience for the due justice was the hardest part. All the staff was always very friendly, respectful, and informative of the process. I appreciated the short videos to explain the process and birthday well wishes. I have never been through anything like this. So this hopefully is my first and last. To only receive a mere small amount in the range of $2,600 the other $3,000+ came from my job. So that was hurtful, because someone there or at the insurance company spoke on my behalf saying they did not think my injury ..."a ripped ligament in my knee" was caused by the car crash, and it was degeneration. That was not true. Even the doctor told told me, showed me, and gave me a video of my knee along with documentation for the results of my knee injury. You have it as well. It can never be repaired properly, it is a permanent injury. It will get worse over time. That part was hurtful. Thank you ALL anyway for what you have achieved on my behalf. And may your company have much more success for others. Have a wonderful holiday. Sincerely Mrs. Chase❤🎀🎉🎊
Kate Morin
Kate Morin
1701017973
Paul Samakow is a wonderful attorney! I had a horrible slip and fall accident due to my ex-boyfriend's family's negligence with a patch of ice on their patio (which they knew about but gave me no warning, still inviting me onto the patio). My ex was high as a kite! I severely broke my elbow and it required surgery. Never got an apology from the family and they never took accountability. I had to drive myself home so my mom could take me to the hospital that night. I'm still in pain every day almost two years since the injury and over a year of PT. I permanently lost 10% grip strength in my dominant hand. Paul immediately felt empathy and compassion for my situation and the emotional and mental trauma the injury caused. He took my case and fully believed in it from the start. He took all necessary steps (and more), demanded a settlement from the homeowner's insurance company, yet my ex and his family lied about the details of the accident causing them to deny the first claim. Did Paul let these people get away with that? Heck no! He demanded a settlement again and negotiated beautifully. We recently settled after over a year of hard work on this case and I will be forever grateful. I got the closure I needed. I can finally work on overcoming the emotional and mental trauma and move on! Paul is also very responsive to texts and phone calls, even on weekends. A 24/7 lawyer! I had friends and family discouraging me from taking legal action, but I knew what I needed to do. Overall, a very supportive and wonderful experience with Paul Samakow. He went above and beyond. If you ever have an injury in which someone else is liable, Paul is your guy!
Rosa Diaz
Rosa Diaz
1700107933
I rally reccomend Paul And His team they really helped me
Donna Taylor
Donna Taylor
1700087847
I couldn't be any more pleased with the way Paul handled my case. He was communicative, patient, professional, and settled my case very quickly. I am so happy with the outcome. When he tells you what he thinks he can get, believe him. He was on point, and I can't thank him enough.
Karen Colato
Karen Colato
1700007203
Paul A. Samakow has been so wonderful to me. Truly a praiseworthy lawyer! My mother always wanted me to hire Paul A. Samakow as my attorney. It has been the best decision I could have ever made. I highly recommend The Law Offices of Paul A. Samakow, P.C. I am very pleased and satisfied to have found this law firm to represent me. I am thankful from the bottom of my heart. I am also absolutely grateful for the above and beyond priority my case was given since the beginning. Franklin Winters went above and beyond to help me get back on my feet. He has done an exceptional job. I remember when I first came into the Manassas office with my mother. We didn’t know what to expect or what the next step would be. We were so confused and had many questions. I was also in a lot of pain. Franklin Winters explained everything clearly and in detail. He had an answer to all our questions. He also set me up into receiving physical therapy to start recovering. I started my physical therapy the same day that I signed the contract. He helped me throughout the whole process. He was keeping me informed on everything being done on my behalf. Franklin Winters gave piece of mind to me and my family. I can’t say enough how please I am. Franklin is an outstanding Legal Assistant. Also the wonderful staff for the hard work they put into helping me with my case. I am also very pleased with the settlement and the progress which was very rapid. The speed with which you brought this case to a finish, was just great! Thanks again for all your hard work. I’m glad I chose you to represent me. I don’t see how anyone could have done a better job than The Law Offices of Paul A. Samakow, P.C. Thank you so much. God Bless.
Kelly Herbert
Kelly Herbert
1699490522
Juana Ferrufino
Juana Ferrufino
1698512742
Someone referred me to Pa Samakow. I heard he is well known with the Hispanic community. I’m satisfied with the amount of money I got. I would highly recommend Paul to anyone who needs legal representation.
Marlon Perez
Marlon Perez
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Hilton Soto
Hilton Soto
1697646468
I got what I feel like I deserved and I hope I can be an example to trust this place and to always never lose hope. Just trusting them with there staff and I am forever grateful!
Katherine Guerrero
Katherine Guerrero
1697645469
My experience with Mr. Samakow and his team was nothing but positive. Did a great Job with my Case . Very informative during the whole process.
Aykut Yekeler
Aykut Yekeler
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rebeca alvarez
rebeca alvarez
1697234092
I had Mr.Samakow for my case and he did a fantastic job on following up and updating us and did his very best for my case. I highly recommend Mr. Samakow!
Anibal Argueta
Anibal Argueta
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Mike Jones
Mike Jones
1696259992
Great job!!
Aracely Gonzalez
Aracely Gonzalez
1695947729
Rocco and his team were extremely helpful throughout the whole process of my case and my Daughter's case. I am Extremely happy with the results! Phillip answered all the questions and concerns i had all along. I trully recommend the Office of paul Samakov!Rocco y su equipo fueron de gran ayuda durante todo el proceso de mi caso y el de mi hija. ¡Estoy extremadamente feliz con los resultados! Phillip respondió todas las preguntas e inquietudes que tuve todo el tiempo. ¡Realmente recomiendo la Oficina de Paul Samakov!
Suzan Cole
Suzan Cole
1695943837
Attorney Samakow,I‘m still trying to figure out how you turned a rock into GOLD! You handled my case lightening fast and the turnaround was smooth and quick.The best part was not having to do litigation or go through court to win. Any client who doesn’t have you on their side, is making a huge mistake!I‘m glad that we came together and you are a true professional, and a friend…Best,Dr. Cole
Latasha Thomas-Jacobs
Latasha Thomas-Jacobs
1695558757
Amazing Law Firm!! Professional and result driven!
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