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.

Distribution of Proceeds From Third Party Action

Once a third party action has concluded and a recovery achieved for an employee's injury, the matter of distribution arises. As a first priority, the general rule is that the party who paid the employee compensation (most likely the employer or its carrier) will be reimbursed in an amount equivalent to its compensation outlay. The employee will then be entitled to any excess funds that remain. Some states vary this by mandating that only a portion of the excess be turned over to the employee.

On-Call Employees

Professions that may require employees to reside on the premises and be "on-call" include servants, security guards, private nurses, nannies, and the like. Continuously on-call employees who reside on their work premises are generally covered under the "course of employment" principle should they be injured. If the employee is not always on-call but, rather, has only specified hours in which he is on-call, he will only be allowed compensation if the injury was due to his living conditions as a by-product of the employer's requirement that he remain on the premises.

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.

"Third Person" Entities

An employee who is injured during the course of his employment may, in addition to workers' compensation, seek damages in a third party action. Whether the employee of a subsidiary may sue the parent corporation, or vice versa, to recover damages for his injury is dependent on the jurisdiction. Though most often an affiliated corporation, such as a subsidiary or its parent, strives to maintain its independence from the other entity so as to be shielded by the corporate veil, in cases of worker injury such entities claim mutual identity to be protected from suit by the "employer's" immunity. In other words, if the injured employee works for the subsidiary, but files a third party action against the parent, the parent will argue that it stands in the shoes of the subsidiary as the employer and is thus immune from suit. This argument may very well work if the subsidiary is wholly owned and controlled by the parent.