Industrial Insurance

An employer-employee relationship.

The course of employment.

the worker at his employer's direction or in the furtherance of his or her employer's business which shall include time spent going to and from work on the jobsite insofar as such time is immediate to the actual time that the worker engaged in the work process in areas controlled by his employer except parking areas.

Extraterritorial coverage.

A sudden and tangible happening of a traumatic nature producing an immediate or prompt result, and occurring from without, and such physical conditions as a result therefrom.

Where an employer intentionally causes an injury, the employee will receive worker's compensation benefits plus have a cause of action as if the Act had not been enacted.

Such disease or infection as arises naturally and proximately out of the distinctive conditions of employment. Claims based on mental conditions based on stress are noncompensable.

The statute of limitations is jurisdictional and may be raised at any time.

Within one year after the day upon which the injury occurred or the rights of dependents or beneficiaries accrued.

The employee.

Too bad . . . no equity, no discretion.

Within two years of the date the worker is advised by a physician in writing of the existence of the disease and the right to file a claim of benefits.

The schedule of awards.

The schedule of awards in effect at the date of injury?

Time loss compensation, medical aid, and vocational rehabilitation.

Temporary partial disability and temporary partial disability.

Medical testimony.

By objective findings.

Duration of the benefits.

Time loss.

Pension.

The loss of both legs, or arms, or one leg and one arm, total loss of eyesight, parlysis or other condition permentally incapacitating the worker from performing any work at any gainful occupation.

A worker is permanently and totally disabled when as a result of an industrial injury or occupational disease he or she is unable to perform or obtain gainful occupation with a reasonable degree of sucess and continuity.

It is the loss of all reasonable wage earning capacity.

The whole person - weaknesses, strengths, age, education, training, experience, and any other relevant factors which contribute to the ultimate conclusion.

Whether the person is disqualified from substantial gainful employment generally available in the labor market.

Proper and necessary medical and surgical services at the hands of a physician of his own choice.

• 1. beyond the time the worker returns to full employment (unless deemed by a suerpvisor of industrial insurance to be necessary to more complete recovery)
• 2. beyond the date he is placed on the pension rolls (excep where such is deemed necessary protect life or alleviate continuing pain).

If he temporarily totally disabled as a result of an injury or occupational disease.

No, it relates to any fainful employment - not just the former work.

Full wages from all employment the Claimant would have received has the Claimant continued working.

Average the total wages earned from any representative twelve sucessive calendard months preceding the injury.

The Department may pay the costs of vocational rehabilitation and may continue time loss compensation for a period of fifty-two weeks.

52 week extension.

The Department may pay the costs of vocational rehabilitation and may continue time loss compensation and provide for tuition, books, etc., while the worker is actively and sucessfully undering a formal program of vocational rehabilitation.

Claims may not be reopened solely for vocational rehabilitation purposes.

Upon an appeal being filed within sixty days of the communication of the Department's order.

They are jurisdictional.

Within 20 days or within such time as extended by the board.

The Board shall adopt the judge's decision.

There is no appeal to superior court.

After the board renders its final decision.

Reject cases, segregation cases, direct appeals, aggravation cases

Jessie Whie aggravation and Picich/Collins aggravation

Where the Department rejects a claim entirely.

Where the worker was not employed by an employer under the act, or where the worker was not acting in the course of employment.

Where the Department allows a claim, by responsibility for a portion of the worker's conditon has been denied.

A partial denial.

Where the Department has allowed the calim, provided benefits, and then closed the claim, and the appeal is from the Department's original closing order.

Appeal of a closing order.

The issue is the condition of the worker on the date of closure.

The extent of disability, the need for treatment, and other benefits must be established by medical testimony which is directed to the date of the Department's closure.

Because the Deparment has had no opportunity to review the worker's condition after the closing date.

worsening of the industrial condition.

The claim has been closed, the worker has filed an application to reopen, alleging worsening of the condition, which has either been denied, or allowed, and closed again with alleged inadequate benefits.

Applications filed more than seven years.

Benefits are limited only to treatment and no other benefits will be awarded.

Claim is closed without permanent partial disability award and the aggravation application is denied.

Aggravation must be proved by comparative testimony.

The claimant need only rate the disability on the second terminal date as it is "res judicata" there was no disability on the first date.

Closure with or without permanent partial disability award, application to reopen granted and additonal permanent partial disability awarded by the Department.

The aggravation is admitted. The only issue is the extent of disability on the second terminal date.

Workers' claims, second injury fund cases, diminution cases.

The employer appeals the Department's adjudication of the worker's rights?

The worker and the Department have the burden of proof before the board to establish the worker's rights and the correctness of the Department's order.

The employer must proceed first with the evidence to establish a prima facie case.

To encourage employers to hire and retain disabled workers.

In the event a second injury employee sustains an industrial injury or occupational disease and suffers an industrial injury or occupational disease which produces total and permanent disability or death.

The employer will be charged only with the accident cost which would have resulted from the injury or disease had there been no preeexisting disability.

The difference between the charge thus assessed and the "total cost of the pension reserve".

The opposite of an aggravation case - the Department determines the disability of the worker has lessened.

Cases where the Department seeks to remove any worker from the pension rolls.

The Department, as the moving party, must establish capacity to engage in gainful employment.

A condition and an injury or occupational exposure.

By medical testimony.

In situations in which lay people would ordinarily relate, e.g. a layman sees a fellow worker lose a finger.

Mere acceleration of the final stages of disease.

Proximate cause rule.

The injury need not be the sole cause, but must at least be a proximate cause or a proximate contributing cause, without which the result would not have occurred.

Attenuated.

. . . legal . . . but for . . .

If a dormant, latent, or quiescent condition is activated by an injury, the Department is responsible for the condition resulting therefrom.

the injury.

It is merely a condition upon which the cause (the injury) operates.

If a preexisting conditon is active and/or disabling, the Department is not liable for the preexisting disability. The prior disability must be subtracted from the overall disability.

If a preexisting disease delays or impairs recovery from an injury, the Department is responsible for the time loss and permanent partial disability only to the extent such would have been produced had there been no preexisting disease.

The worker's compensation shall be adjusted with regard to the combined effect of his injury and past receipt of money.

No, except as provided in the ERs.

Statement for purposes of medical diagnosis or treatment and describing medical history, or past or present symptoms, pain or sensations, or the inception or general character of the cause or external source thereof insofar as reasonable pertinent to diagnosis or treatment.

Statements in published medical treatises, periodicals, or pamphlets on a subject of history, medicine, or other science or art, established as reliable authority by the testimony or admission of the witness or by other expert testimony or by judicial notice. If admitted, the statements may be read into evidence but may not be received as exhibits.

Wide latitude?

Because of "superior knowledge of the subject can create a very misleading or even dangerous witness.

Inconsistencies in testimony.

Yes.

The facts or data in a case upon which an expert bases his opinion or inference may be those perceived by or made known to the expert at or before the hearing. If of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject, the facts or data need not be admissible as evidence.

A record of an act, condition, or event shall insofar as relevant, be competent evidence if the custodian witness testifies to its identity and the mode of its preparation, and it was made in the regular course of business, at or near the time of the act, condition or event, and if, in the opinion of the court, the sources of information, method and time of preparation were such as to justify its admission. A practicing physician or psychiatrist qualifies as a business and his office charts and records made in the regular course of business properly identified and otherwise relevant will constitute competent evidence of an act, condition, or event therein recorded.

No.

All such information at any stage in the proceeding.

Special consideration.

Any order or judgment entered by an agency or tribunal with subject matter jurisdiction over the claim and personal jurisdiction over the party is final and binding. This includes orders that are erroneous as a matter of fact, or alw, or as a mixed question of fact and law. The power to decide includes the power to decide wrong.