It used to be that way here in MA but not anymore. You have to fight for every dime there are no set rates anymore. I know this as I have a case against a homeowner for a dog bite and my lawyer said that before they changed the rules I would have been able to get paid by workmans comp based on the size of the scare. Now I have to wait 6 months to a year and see how big the scare is and then see a plastic sergeon to get cost to fix it and then sue the homeowner.
We're not talking about the same thing here.
I'm talking about workers comp insurance coverage. You're talking about lawsuit settlements against third-parties.
(And while homeowners insurance companies may have routinely handled dog bites, it wouldn't have been anything scheduled under any law.)
When you're injured on duty, there are a number of sources of money:
1. Workers comp insurance covering actual medical expenses. It only has to be shown that it was an injury, and that the injury happened in the course of one's employment. If there is any dispute, your health insurance can pay, but they will be reimbursed by the workers comp insurance once it's determined that it was an on the job injury.
2. Workers comp also covers lost time during treatment, and rehabilitation from an on the job injury. An employer can substitute an "injury pay" benefit, as long as it offers better benefits than what's mandated by the state.
3. Once the worker has been rehabilitated as completely as practical, Workers Comp then covers any remaining "disablity". Things like missing digits or apendates (and death, too) are, in most states, "scheduled", and thus a flat rate is paid as settlement in full. Other injuries that result in partial lifetime disablities have to be rated (what percent of a disablity does one have), and then that number is used in a formula to determine the likely lifetime lost earning potential, and that is the settlement for that.
Note that the *employer* is only liable to the limits of Workers Comp. You can't get more out of your employer for your injury. But you can sue a third party, and that's where (to be a little crass), the real money is.
So if you're injured in a motor vehicle accident, you can sue the other driver (and their insurance company). However, keep in mind that Workers Comp may need to be reimbursed first, and you only get what's left after that.
So if you're injured on the job, always look for other parties to sue. If you're using some equipment, the manufacturer of the equipment is a target. If you're injured on someone else's property, the property owner and their insurance company is a target. If someone assults you, they may be a target. But targets are only good targets if you can recoup enough to reimburse Workers Comp for what they'll want back.
In the situation that started this thread, the issue is getting Workers Comp to recognise that an on-the-job injury has taken place. It sounds like we're talking PSTD, but I don't want to assume the diagnosis of the doctor. Once Workers Comp can be convinced it's an on the job injury, they will reimburse any medical costs paid out of pocket, or by health insurance. They'll also pay any lost time, reimbursing the company for any vacation, sick leave, or other paid time off taken (including STD and/or LTD), and those entitlements will be returned to the employee's balance. Once a plateau in treatment is reached, that is, no further material progress is expected, then Workers Comp will need to negotiate a level of disablity -- that is, a shortfall in potential lifetime earnings as a result of the injury. (I would expect this to be zero, or close to zero. Sorry.) But they may offer a settlement so any time there is a relapse they won't have to debate whether it's a reinjury.
The guy who pointed the gun could also be sued, but let's face it: He probably doesn't have any money, and if he did, it probably wouldn't be enough to reimburse Workers Comp. But if it was found that the gun he used was illegally bought from a dealer who didn't excercise due care in selling the gun, there's a deep pocket that could potentially be sued. (Note that they could be sued whether or not Workers Comp calls it an on the job injury. But if it wasn't an on the job injury, and health insurance fronted the money for care, they could want to be reimbursed first.)
