Employee Misconduct That Does and Does Not Deviate From Employment

When an employee engages in misconduct, his receipt of workers' compensation benefits can be jeopardized depending on whether such misconduct constituted a deviation from his course of employment. If the employee has deviated from the course of employment, and is then injured, he will generally be denied benefits. Prohibited conduct is a marker for misconduct. It is only that prohibited conduct concerning the employee's fundamental job for which he was employed that will affect compensation eligibility. Even though prohibited, conduct that merely violates the way or means that an employee uses to accomplish his job duties is still within the course of his employment.

Contract of Hire

For the workers' compensation obligation to be triggered, most state workers' compensation statutes require that the injured worker's employment be pursuant to a contract of hire. Such a contract, which can be either express or implied, is required because the workers' compensation system is based on reciprocal rights. The employee gains a measure of certainty in the recovery for his injury without resorting to litigation and the employer gains a cap on the amount that must be paid in the event an employee is injured.

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.

What is a Social Security "Disability?"

A "disability," as far as the receipt of social security benefits is concerned, is not defined the same as for other programs. Social security disability benefits are only paid for total disability; the complete inability to work is the benchmark. At its essence, a person is disabled under the Social Security Act if he is unable to engage in any substantial gainful activity due to a medically determinable physical or mental impairment that has lasted or is expected to last for twelve months or that results or is expected to result in death. A disability can result from either a physical or mental impairment, or a combination of impairments.

Impairment Meets or Equals Listing of Impairments for Social Security Disability Evaluation

In the sequential evaluation of disability by the Social Security Administration (SSA), a major step is whether the individual has a condition that meets the twelve-month duration requirement and that is represented on the Social Security Administration's Listing of Impairments (LOI) or equal to a listed impairment. The LOI is divided into two parts. One part applies to individuals over age eighteen and one part is applicable to individuals under eighteen.