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Workers Compensation Newsletters

Buy-In to Medicaid

The Buy-in to Medicaid program is a form of work incentive that was initiated to provide Medicaid to disabled individuals who, because of the amount of their earned income, would not qualify for Medicaid. Individual states may, but are not required, to provide this incentive by creating a new eligibility group. Currently, just over half the states offer this program with many more planning to do so. Individuals "buy-in" to the program by paying a premium or other fee. However, participating states are not required to seek such payments.

Earning Capacity

The extent to which an individual is "disabled" by workers’ compensation standards requires an examination of the individual’s earning capacity after the injury in relation to his earnings prior to being injured. Even if the individual realizes a reduction in his earnings after the injury, he must still prove a causal link between the earnings reduction and his injury. Failure to do so will result in a denial of benefits. If the individual achieves earnings after his injury is sustained, there is a presumption that he has an "earning capacity" in keeping with such earnings. However, the presumption can be rebutted by evidence that the individual, in fact, has no earning capacity or that the post-injury earnings he received are not an accurate, fair, or reasonable measure of the individual’s earning capacity.

Loss of Hearing as an Occupational Disease

Occupational hearing loss is a prevalent condition in workers employed in noisy environments such as factories and repair shops. Several states recognize the gradual loss of hearing as a compensable condition and such recognition has also taken place under the Longshore and Harbor Workers’ Compensation Act. Generally, a six-month waiting period is required prior to the filing of a hearing loss claim and the employee must be removed from the noisy environment for that time frame. The degree of impairment is generally based on speech frequencies with points ranging between total deafness and no compensable deafness. The improvement in hearing with the use of a hearing aid is not accounted for.

Post-Employment Injuries

Though it would seem to be antagonistic to the principle that an injury must arise out of the employment to be compensable, some injuries that occur post-employment are still compensable. Depending on the situation, some activities occurring post-employment are considered by the courts to be normal work activities. For example, injuries incurred while picking up a paycheck, exiting the work premises, and collecting belongings from the employer’s premises have all been held to be compensable provided that such activities are undertaken within a reasonable time after the employment relationship has ended.

Resident Employees Who Are Not On-Call

The general rule is that employees who reside on the employer’s premises are protected by workers’ compensation coverage if they are required to reside on the premises and are on-call twenty-four hours per day or the injury resulted from a risk associated with the employee’s living conditions given the requisite living arrangement. When the employee is not on-call and has specified work hours, though he is required to live on the employer’s premises, gaining workers’ compensation benefits for an injury off the employer’s premises is somewhat difficult. When the resident employee is injured outside his work hours and off the employer’s premises, he must show a strong causal link between the injury and his employment. This causation requirement is magnified and must be found more compelling than the showing required for on-call employees.