Injuries at Work and Job-related Illness

In North America, workplace injuries and illnesses have observed a decreasing trend in recent years. In Canada, a total of 785,666 occupational injuries were reported in 1996, a rate of 6.5 cases per 100 workers, significantly lower than the rate observed in 1990 (8.6). In the United States, the number of workplace injuries and illnesses was 6.1 million during 1997, resulting in a rate of 7.1 cases per 100 equivalent full-time workers, compared with 8.5 in 1993. In Mexico, injuries and job-related illnesses numbered 427,284 in 1997, a rate of 3.4 cases per 100 workers in the private formal sector, which is lower than the rate observed in 1990 (5.6).

This section describes the main income support programs for workers and their dependents in case of workplace injury or occupational illness. The provisions include:

• medical care for workers accidentally injured at work; and
• income support for workers and their dependents in the event of a workplace injury or job-related illness.

In all three North American countries, workers are legally protected against wage loss due to an occupational injury or disease. They also receive compensation for medical or other expenses they incur in such cases. In Canada, there are separate workers' compensation boards for each province and territory. In the United States, each state administers its own workers' compensation program. In Mexico, the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS) administers workers' compensation programs for workers who are insured; for other workers the responsibility for workers' compensation rests with the employer.

2.1  If I have an accident doing my job or contract a job-related illness, who will pay my health and medical expenses?

Canada

Workers' compensation programs assist workers with medical and other related expenses when they are injured or become ill as a result of their job.

Benefits

You are entitled to be compensated for the full cost of the medical care and rehabilitation you receive as a result of a work-related injury or illness. Your provincial/territorial workers' compensation board pays for medical aid expenses, including medical or other services provided by licensed practitioners. Health care services are provided to an injured worker by the provincial/territorial health system with the approval of the board.

Eligibility

Employees who are engaged in employment covered by workers' compensation and have suffered an injury or illness in the course of their employment are entitled to compensation.

Who pays?

Although boards administer workers' compensation programs, employers fund the system. Contributions vary according to industry sector, based on the associated risk, number of employees, and workers' earnings. The boards generally establish and maintain rates according to past experience, charging each member of an industry group the same contribution rate.

You may contact the workers' compensation board of your province for more information or to apply for benefits.

Mexico

If you have an accident doing your job or get sick because of your job, you are entitled to receive medical and surgical attendance, rehabilitation, hospitalization, medication, and prosthetic and orthopedic supplies. You are also covered if the injury occurs while you are traveling from your home to your workplace and vice versa (accidente en trayecto).

Benefits

You have the right to receive medical care for as long as you need it. Expenses covered will also include those for medical care and treatment that continues after you return to work. You also have the right to receive rehabilitation, chiropractic care, prosthetic devices, and medication and prescriptions.

Who pays?

All employers must pay a premium to the Instituto Mexicano del Seguro Social to cover workers' risk insurance; the premium varies according to the risk associated with the industry sector as well as the amount of wages insured. Employers who have insured their employees shall be exempt from the workers' risk liabilities which are mandated by the Federal Labor Law.

United States

If you are an employee injured or ill as a result of your job, you are entitled to be compensated for your medical expenses.

Benefits

If you are injured at work, your employer or its insurance company is responsible for paying for any treatment you are diagnosed to require, even if that treatment continues after you return to work. Needed treatment costs should be paid for life; however, in some states you may trade away future medical payments for cash when you settle your case.

Medical coverage includes the cost of doctors, hospitals, nursing (including home care), physical therapy, dentists, chiropractors, and prosthetic devices.

Eligibility

In all states, with the exception of Texas, employers are required to provide workers' compensation coverage to their part-time and full-time employees. Coverage may vary from state to state. In some states, employers with small numbers of employees (three to five) are not required to carry workers' compensation coverage, and many states exclude volunteers and domestic workers from coverage.

Agricultural workers are covered in 40 states and territories.⁴  In 14 states, the coverage for agricultural workers is the same as for all other employees, and in 26 states there are limitations that are not applicable to other covered employees.

Canada

If you are engaged in employment covered by workers' compensation and suffer an injury or illness in the course of your employment, you are entitled to compensation for the duration of your illness or injury.

Benefits

Compensation benefits are based on your earnings at the time of the accident or illness. Provincial programs insure between 75 and 90 percent of net earnings, up to a maximum amount varying between $39,300 (in Nova Scotia) and $58,200 (in Ontario).

Eligible injured workers may be awarded temporary or permanent benefits in compensation for the loss of earnings. Payments can be made for life, in cases of permanent disability, or as long as disability or wage loss exists. Upon reaching the age of 65, disability pension or wage loss ceases and annuity payment commences.

Eligibility

To be eligible for compensation you must be engaged in employment covered by workers' compensation and have suffered a personal injury or disease that arises out of and in the course of employment.

Employees are eligible for compensation benefits when an injury or illness is recognized as having originated in the workplace. The conditions under which a worker may not be eligible for compensation are: if the duration of the disability is less than the minimum period prescribed under the legislation; or if the injury is due solely or primarily to the serious and willful misconduct of the worker.

The degree of partial or total disability is assessed according to a medical rating. A worker who suffers a work-related injury or illness may be compensated for the loss of earnings as well as the loss of functional capacity. Some jurisdictions have a dual award system where compensation for each loss is assessed in order to provide equitable protection against impairment or loss.

Mexico

You are entitled to receive compensation equal to the full salary you lose when you are unable to work because of a job-related injury or disease. You are covered for any injury that occurs in connection with your work, even if your carelessness contributed to your injury. You are also covered for injuries you receive while traveling to your place of work.

Benefits

If the injury results in a temporary disability, you are eligible to receive your full salary at the time the job accident occurred. If you are insured through IMSS, this institution will pay your salary; otherwise your employer shall pay your salary. For insured workers this benefit may last up to 52 weeks; otherwise the period is reduced to three months. Afterwards, if a medical examination determines that you are not able to return to work, you can continue medical treatment and receive the same compensation until your incapacity is declared either a total or a partial permanent disability and the compensation to which you are entitled is fixed.

If your disability is declared permanent, you are entitled to receive either a lump sum payment or a pension, depending on whether the disability is partial or permanent (see Question 2.4).

The calculation of the benefit or compensation you receive is based on your daily wage when the job injury occurred, plus any subsequent increments payable for the work you were doing up to the time your degree of incapacity is determined. The amount should never be less than the minimum wage in the area where you work, nor more than twice the minimum wage. If your work is performed in different geographic areas, the maximum compensation is twice the average of the minimum wages in the areas concerned.

Eligibility

To receive this benefit you must be insured by the Instituto Mexicano del Seguro Social, and you must go through all the medical exams and treatments that the IMSS requires. Workers' compensation is not payable if you were drunk or under the influence of drugs when you were injured or if you deliberately injured yourself or attempted suicide.

United States

No, you cannot receive your salary, but you are entitled to be compensated for a percentage of the income you lose while you are unable to work. You will receive a tax-free temporary disability payment that substitutes for the income you would have earned if you had not been injured. Workers become eligible for wage loss replacement benefits as soon as they have lost a few days of work because of an injury covered by workers' compensation.

Benefits

The workers' compensation benefits for temporary disability vary from state to state. Income benefits are generally 66.7 percent of an injured worker's earnings. Weekly payments are limited to a minimum and a maximum, usually a percentage of the state's average weekly wage. The duration of payments also varies among states; in some states payments are made for the duration of the disability, while others limit either the number of weeks benefits are paid or the total amount of benefits paid.

If you are under a rehabilitation program, you are entitled to receive a percentage of your former net earnings until your treatment is completed or your eligibility expires. Financial benefits may also extend to workers' dependents and to survivors of workers who are killed on the job.

Eligibility

All workers who become injured or who die on the job are eligible for benefits. With a few exceptions, any injury or disease that results from your employment is covered.

Canada

Yes. All provincial workers' compensation programs emphasize the need to help workers return to suitable employment whenever possible. In addition to medical aid services, programs fund vocational training for eligible injured workers. Other services may include vocational guidance, counseling, testing, and assistance in finding gainful employment. In some jurisdictions, workers' compensation boards are required to prepare a personal rehabilitation plan for the worker. The Canadian Human Rights Act also places a duty on employers to accommodate disabled workers.

Mexico

Yes, you are entitled to return to your same job, if you are able to perform it, on condition that you report for work within a year after your injury or disability. If you are not able to perform the job you had before your injury, you have the right to be assigned to another job consistent with your capabilities.

United States

State workers' compensation laws vary widely on this subject. In some states, the employer must make an offer of employment (not necessarily at the pre-injury job). The Americans with Disabilities Act of 1991 (ADA) requires employers to provide reasonable accommodation to employees with serious disabilities who can perform the essential functions of their jobs, regardless of whether the disability results from work-related or non-work related causes.

If the injury prevents you from returning to your job, but you are physically able to do some work, you may be entitled to vocational rehabilitation, which includes additional job training or schooling. In that case, you are entitled to receive temporary disability payments at a somewhat reduced rate. In some states, if you refuse rehabilitation you may lose your compensation.

Canada

You are entitled to compensation benefits based on your earnings at the time of the accident. A medical assessment of the injury will determine the severity of the injury and whether it resulted in a partial or total disability. Pensions vary depending on the disability, and benefits vary from one jurisdiction to another.

Benefits

Permanent total disability payments are based on 75 percent of the pre-accident average (gross) earnings or 90 percent of pre-accident net earnings, depending on the province or territory. Maximum benefits range from $1,687.50 to $3,566.25 per month, with lump sums payable in some jurisdictions. If you have a partial disability, your benefits will be equal to a proportion of the full pension, depending on your loss of earnings capacity (converted to a lump sum, in some cases, if impairment is 10 percent or less).

Workers' compensation programs also provide cash benefits to the dependent survivors of workers who have died as the result of a job-related injury. Benefits are available in each jurisdiction for fatal accidents, and the payment of those benefits can vary and can be changed depending on the circumstances. Benefits include payments made to survivors, such as funeral allowances, transportation of the body costs and, in some cases, a lump sum payment for extra costs related to the death. All jurisdictions also pay a pension to the surviving spouse. In most provinces, the pension is equal to the amount the deceased worker would have received had he or she been totally disabled, although in a few jurisdictions the payment is a fixed monthly amount.

Mexico

When your injury or occupational illness has resulted in a permanent disability, you are entitled to receive lump sum compensation depending on whether your disability is partial or total. Your dependents are also entitled to receive income support and a pension in the case of a fatal injury or disease.

Benefits

1. For permanent partial disability, the LFT mandates that workers shall receive a payment equal to the percentage indicated in the table of incapacity degrees. If you are insured by IMSS, your payment will depend on your degree of disability.

a) If your disability is considered to be more than 50 percent, the amount of your pension will be equal to a percentage of the amount you would be entitled to receive if you had a permanent total disability. This percentage will take into account your age, the degree of your disability, and your aptitude to be engaged in the same job or another similar job.

b) If your incapacity is between 25 and 50 percent, you have two options: to receive either a monthly pension or compensation equal to five times the annual pension you would be entitled to receive if totally disabled.

c) If the degree of your incapacity is between 1 and 25 percent, you will receive compensation equal to five times the annual pension you would be entitled to receive if you had a permanent total disability.

If the partial incapacity leaves you unable to perform your previous occupation, the Junta de Conciliacion y Arbitraje (Conciliation and Arbitration Board) may increase your compensation to the amount payable for a permanent total disability, taking into consideration the importance of the occupation and your capacity to perform similar work capable of providing you the same income.

2. If your injury resulted in a permanent total disability, you are entitled to receive compensation equal to 1,095 days' pay.⁵  If you are insured by IMSS, you are entitled to receive a monthly pension equal to 70 percent of your insurable salary (salario de cotización). If you have an occupational illness, the monthly pension is equal to 70 percent of your average salary during the last 52 weeks of premiums paid (or during your period of coverage if it is less than 52 weeks). In both cases, benefits will last until the worker's death. You should remember that you must purchase life insurance to ensure that your family will continue receiving these benefits after your death.

3. If you die as a result of a job-related injury or illness, your dependents are entitled to receive two months' minimum wage in the Distrito Federal to cover funeral expenses plus a lump sum equal to 730 days' wages without any deduction. If you were insured by IMSS, your spouse will receive a pension equal to 40 percent of the pension you would be entitled to receive if permanently disabled plus two months' minimum wage in the Distrito Federal to cover funeral expenses. Your children under 16 years old, and those who are between 16 and 25 years old and attend the public school system, are also entitled to receive income support.

You should remember that both regimens are not applicable to the same case; your compensation will depend whether you are an insured worker.

United States

You may receive a lump sum workers' compensation payment if you have a partial disability (that is, if you are able to perform some types of work but you are not expected to be able to fully regain your ability to earn money), or if you have a total disability and are unable to work at all. The payments you may receive vary greatly depending on the nature and the extent of your injuries. Payments also depend on state's workers' compensation law.

Benefits

If your injury results in a permanent partial disability, benefits depend on the degree of your disability. Benefits and policies vary among the states. Some states fix benefits for defined injuries. Others convert benefits to a lump sum based on a calculation of the degree of your disability, usually with a specified maximum number of weeks' wages or a maximum benefit amount.

If your injury or disease results in a permanent total disability, you are entitled to receive benefits. In most states, benefits will be equal to 66 percent of your previous earnings. Chronic care and dependents' supplements are provided in some states.

If you die as a result of a job-related injury or illness, your spouse will be entitled to receive a survivor's benefit that ranges between 35 and 70 percent of your earnings. There are also payments to cover families' funeral expenses. These payments vary among the states; half of the states pay $3,000 or more.

⁴ States and territories with equal coverage for agricultural workers: Arizona, California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Massachusetts, Montana, New Hampshire, New Jersey, Ohio, Oregon, Virgin Islands. Some of the states with limitations for agricultural workers are: Alabama, Arkansas, Indiana, Kansas, Kentucky, Mississippi, Nebraska, Nevada, New Mexico, North Dakota, Rhode Island, South Carolina and Tennessee.

⁵ It should be kept in mind that workers' pay is defined on a daily basis. Workers are paid seven times their daily rate each week.