CMS Pub. 100-16, ch. mc86c17b, § 300.6.1

• A WC law or plan is a government supervised and employer supported system for

compensating employees for injury or disease suffered in connection with their

employment, regardless of whether the injury was the fault of the employer. WC

does not usually cover agricultural employees, interstate railroad employees,

employees of small businesses, employees whose work is not in the course of the

employer’s business (e.g., domestic employees), casual employees, and self-employed people. All States provide compensation for at least some occupational

diseases.

The definition also applies to the WC plans of the District of Columbia, American

Samoa, Guam, Puerto Rico, and the Virgin Islands. It also applies to the Federal

WC plans provided under the Federal Employees’ Compensation Act, the U.S.

Longshoremen’s and Harbor Workers’ Compensation Act and its extensions, and

the Federal Coal Mine Health and Safety Act of 1969 as amended (the Federal

Black Lung Program). These Federal programs provide WC protection for

Federal civil service employees and certain other categories of employees not

covered, or not adequately covered, under State WC programs (e.g., coal miners

totally disabled due to pneumoconiosis; maritime workers, with the exception of

seamen; employees of companies performing overseas contracts with the United

States government; employees of American companies who are injured in an

armed conflict; employees paid from non-appropriated Federal funds, such as

employees of post exchanges; and offshore oil field workers). The Federal

Employers’ Liability Act, which covers merchant seamen and employees of

interstate railroads, is not a WC law or plan for purposes of this provision.

Similarly, some States have employers’ liability acts. These also are not

considered WC acts for purposes of this provision.

• Workers’ Compensation Agency means any governmental entity that administers

a Federal or State WC law. This term includes WC commissions, industrial

commissions, industrial boards, WC insurance funds, WC courts and, in the case

of Federal workers’ compensation programs, the U.S. Department of Labor.

• Workers’ Compensation Carrier means any insurance carrier authorized to write

WC insurance under the State or Federal law, the State compensation fund in

which the State administers the WC program, and the beneficiary’s employer in

which the employer is self-insured.

• Lump Sum Compromise Settlement is a settlement that provides less in total

compensation than the individual would have received if the claim had not been

compromised. This may occur when compensability is contested.