Ala. Admin. Code r. 355-8-1-.03

Current through Register Vol. 43, No. 1, October 31, 2024

Section 355-8-1-.03 - Benefits For Accidental Occupational Injuries

(a) Compensation, according to the schedules hereinafter contained, shall be paid by the employer, in every case of personal injury or death of his or her employee caused by an accident arising out of and in the course of his or her employment, without regard to any question of negligence. Notwithstanding the foregoing, no benefits shall be allowed for an injury or death caused by the willful misconduct of the employee, by the employee's intention to bring about the injury or death of himself or herself or of another, his or her willful failure or willful refusal to use safety appliances provided by the employer or by an accident due to the injured employee being intoxicated from the use of alcohol or being impaired by illegal drugs.

(b) A positive drug test conducted and evaluated pursuant to standards adopted for drug testing by the U.S. Department of Transportation in 49 C.F.R. Part 40 shall be a rebuttable presumption of impairment resulting from the use of illegal drugs. No benefits shall be allowed if the employee refuses to submit to or cooperate with a blood or urine test as set forth above after the accident after being warned in writing by the employer that such refusal would forfeit the employee's right to recover benefits under this chapter.

(c) No benefits shall be allowed if, during the time of employment or in the course of entering into employment or at the time of receiving notice of the removal of conditions from a conditional offer of employment, the employee knowingly and falsely misrepresents in writing his or her physical or mental condition and the condition is aggravated or reinjured in an accident arising out of and in the course of his or her employment. Willful failure of an employee to abide by physician-directed physical activity restrictions arising from a covered injury, or willful misrepresentation by an employee of his or her physical activities while under physical activity restriction, will result in termination of benefits.

(d) In the event an injury covered by this program results in temporary or permanent total disability the employee or the employee's representative must elect in writing either to utilize accumulated sick and/or annual leave or to accept employee injury compensation benefits as set forth in Rule .04. Such election shall be made by the employee and received by DORM or its agent before any benefits are paid. An employee who elects to utilize sick and/or annual leave may later change his election in writing prospectively but not retroactively. When the employer no longer pays the employer's portion of retirement or the employee's health insurance premium, said portion will be paid by DORM or its agent directly to the employee as set forth in Rule 04.

(e) DORM or its agent may direct an injured employee to specific medical providers, and shall monitor the progress of the injured employee to encourage and facilitate his/her return to work. The injured employee must cooperate with DORM or its agent; failure to cooperate will result in termination of benefits.

(f) All of an employee's medical costs which are directly attributable to injuries by an accident arising out of and in the course of employment will be paid by DORM or its agent.

(g) For the purposes or this article and Article 3 of this program, minors shall have the same power to contract, make settlements and receive compensation as adult employees.

(h) For fiscal year 1995-96 and thereafter, the Departments of Transportation and Public Safety will pay benefits through and will be subject to the SEICTF rules for injuries occurring on or after October 1, 1995.

(i) The employer and employee may settle all matters of benefits, whether involving compensation, medical payments, or rehabilitation, and all questions arising under this program between themselves, and every settlement shall be in amount the same as the amounts or benefits stipulated in these rules. No settlement for an amount less than the amounts or benefits stipulated in these rules shall be valid for any purpose, unless the Review Board determines that it is for the best interest of the employee or the employee's dependent to accept a lesser sum and approves the settlement. The Review Board shall not approve any settlement unless and until it has first made inquiry into the merits of a claimant's claim and the Review Board may hold a hearing thereon.

(j) An agency, department, board or commission may, with the approval of the Risk Manager and upon payment of the assessed costs, elect to cover employees as defined by this program subject to the following limitation: SEICTF wage replacement benefits, defined in this program as "compensation," paid to a contract employee, combined with salary payments made to the contract employee pursuant to the contract, may not exceed the total amount payable to the contract employee under the terms of the employment contract.

P. Maddock

Ala. Admin. Code r. 355-8-1-.03

New Rule: Filed September 30, 1994; effective November 4, 1994. Amended: Filed June 6, 1995; effective July 11, 1995. Amended: Filed October 30, 1995 effective December 4, 1995. Amended: Filed September 12, 1997; effective October 17, 1997. Amended: Filed March 23, 1998; effective April 27, 1998.

Statutory Authority:Code of Ala. 1975, §§ 36-29A-1, et seq.