§ 601 - Definitions
§ 601. Definitions
Unless the context otherwise requires, words and phrases used in this chapter shall be construed as follows:
(1) "Brother" and "sister" includes a stepbrother and stepsister, half-brother and half-sister and a brother and sister by adoption, but does not include a married brother or a married sister unless dependent.
(2) "Child" includes a stepchild, adopted child, posthumous child and an acknowledged illegitimate child, but does not include a married child unless dependent.
(3) "Employer" includes any body of persons, corporate or unincorporated, public or private, and the legal representative of a deceased employer, and includes the owner or lessee of premises or other person who is virtually the proprietor or operator of the business there carried on, but who, by reason of there being an independent contractor or for any other reason, is not the direct employer of the workers there employed. If the employer is insured, "employer" includes the employer's insurer so far as applicable. A person is not deemed to be an "employer" for the purposes of this chapter as the result of entering into a contract for services or labor with an individual who has knowingly and voluntarily waived coverage of this chapter pursuant to subdivision (14)(F) of this section.
(4) "Employment" includes public employment, and, in the case of private employers, includes all employment in any trade or occupation notwithstanding that an employer may be a nonprofit corporation, institution, association, partnership or proprietorship.
(5) "Grandchild" includes a child of an adopted child and a child of a stepchild, but does not include a stepchild of a child, a stepchild of a stepchild, a stepchild of an adopted child, or a married grandchild unless dependent.
(6) "Grandparent" includes a parent of a parent by adoption, but does not include a parent of a step-parent, a step-parent of a parent or a step-parent of a step-parent.
(7) "Injury" and "personal injury" includes occupational diseases, death resulting from injury within two years and includes injury to and cost of acquiring and replacement of prosthetic devices, hearing aids and eye glasses.
(8) "Insurance carrier" includes any corporation from which an employer has obtained workers' compensation insurance or guaranty insurance in accordance with the provisions of this chapter.
(9) "Parent" includes a step-parent and a parent by adoption.
(10) "Partial disability" may be held to include diminished ability to obtain employment owing to disfigurement resulting from an injury.
(11) "Personal injury by accident arising out of and in the course of employment" includes an injury caused by the willful act of a third person directed against an employee because of that employment.
(A) In the case of constables, chiefs of police, police officers, rescue or ambulance workers, and volunteer reserve police officers in any city, town, or incorporated village, disability or death from a heart injury or heart disease incurred or aggravated and proximately caused by service in the line of duty and that becomes symptomatic within 72 hours from the date of last service in the line of duty shall be presumed to be incurred in the line of duty.
(B) In the case of firefighters, as defined in 20 V.S.A. § 3151(3) and (4), disability or death from heart injury or heart disease that becomes symptomatic within 72 hours of service in the line of duty shall be presumed to be compensable.
(C) "Line of duty," as applied to firefighters and rescue and ambulance workers means one or more of the following:
(i) Service in the worker's town or district, in answer to a call of the department, including going to and returning from a fire or emergency or participating in a fire or emergency drill, parade, test, or trial of any firefighting or emergency equipment.
(ii) Similar service in another town or district to which the department has been called for firefighting or emergency purposes.
(iii) Service under orders of any department officer in any other emergency to which the department is called in the town or district where the department is established.
(iv) Activities authorized by the department for the purpose of raising funds for the department.
(D) "Line of duty" as applied to constables, police officers, or volunteer reserve police officers means either or both of the following:
(i) Service as a police officer in answer to a complaint lodged with the department, including going to, returning from, and investigating the complaint or disorder.
(ii) Service under orders from the department or in any emergency for which the employee serves as constable, police officer, or volunteer reserve police officer.
(E) In the case of a firefighter, as defined in 20 V.S.A. § 3151(3) and (4), who suffers death or disability from a cancer listed in subdivision (iv) of this subdivision (E), the firefighter shall be presumed to have suffered the cancer as a result of exposure to conditions in the line of duty, unless it is shown by a preponderance of the evidence that the cancer was caused by non-service-connected risk factors or non-service-connected exposure, provided:
(i) The firefighter completed an initial and any subsequent cancer screening evaluations as recommended by the American Cancer Society based on the age and sex of the firefighter prior to becoming a firefighter or within two years of the effective date of this act, and the evaluation indicated no evidence of cancer.
(ii) The firefighter was engaged in firefighting duties or other hazardous activities over a period of at least five years in Vermont prior to the diagnosis.
(iii) The presumption shall not apply to any firefighter who has used tobacco products at any time within 10 years of the date of diagnosis.
(iv) The disabling cancer shall be limited to leukemia, lymphoma, or multiple myeloma, and cancers originating in the bladder, brain, colon, gastrointestinal tract, kidney, liver, pancreas, skin, or testicles.
(v) The firefighter is under the age of 65.
(F) A firefighter who is diagnosed with cancer within 10 years of the last active date of employment as a firefighter shall be eligible for benefits under this subdivision. The date of injury shall be the date of the last injurious exposure as a firefighter.
(G) It is recommended that fire departments maintain incident report records for at least 10 years.
(12) "Public employment" means the following:
(A) all officers and state employees, as defined in section 1101 of Title 3, of all state agencies, departments, divisions, boards, commissions, and institutions, and the Vermont historical society;
(B) full-time state's attorneys and full-time deputy state's attorneys;
(C) officers and employees of the general assembly, provided however, that members of the general assembly shall be considered as public employees only for the periods that the general assembly is in session or while engaged in duties for which compensation is provided by law;
(D) members of the military forces of the state of Vermont while in the active service of this state ordered by competent authority;
(E) employees of towns, town school districts, incorporated school districts, incorporated villages, and fire districts;
(F) road commissioners or selectmen while actually engaged in highway maintenance or construction;
(G) policemen, firemen and other municipal employees entitled to pensions;
(H) all teachers, as defined in section 1931 of Title 16. No municipality may vote to exclude teachers from the applicability of this chapter;
(I) personnel who are engaged by the state of Vermont in forest fire suppression under the provisions of the Northeastern Forest Fire Protection Compact, while in the active service of this state ordered by competent authority;
(J) volunteer reserve police officers of towns and incorporated villages while acting in the line of duty, when the selectmen or trustees vote to have those officers covered by this chapter;
(K) other municipal workers, including volunteer firefighters and rescue and ambulance squads while acting in the line of duty, after the governing officials of such municipal body so vote;
(L) members of any regularly organized private volunteer fire department while acting in the line of duty after election by the organization to have its members covered by this chapter;
(M) members of any regularly organized private volunteer rescue or ambulance squad while acting in the line of duty after election by the organization to have its members covered by this chapter;
(N) sheriffs, full-time deputy sheriffs and county clerks, judges of probate, probate registers and clerks paid by the state of Vermont;
(O) the term "public employment" shall not include the following:
(i) public officials who are elected by popular vote, except those hereinbefore mentioned in this subdivision;
(ii) assistant judges of the superior court, high bailiffs, county treasurers, or any of their deputies or subordinates;
(iii) prisoners or wards of the state;
(iv) any person engaged by the state under retainer or special agreement.
(13) "Wages" includes bonuses and the market value of board, lodging, fuel and other advantages which can be estimated in money and which the employee receives from the employer as a part of his or her remuneration; but does not include any sum paid by the employer to his or her employee to cover any special expenses entailed on the employee by the nature of his or her employment.
(14) "Worker" and "employee" means an individual who has entered into the employment of, or works under contract of service or apprenticeship with, an employer. Any reference to a worker who has died as the result of a work injury shall include a reference to the worker's dependents, and any reference to a worker who is a minor or incompetent shall include a reference to the minor's committee, guardian, or next friend. The term "worker" or "employee" does not include:
(A) An individual whose employment is of casual nature, and not for the purpose of the employer's trade or business.
(B) An individual engaged in amateur sports even if an employer contributes to the support of such sports.
(C) An individual engaged in agriculture or farm employment for an employer whose aggregate payroll is less than $10,000.00 in a calendar year, unless the employer notifies the commissioner that the employer wishes to be included within the provisions of this chapter; the existence of a contract of insurance shall be considered sufficient notice.
(D) A member of the employer's family dwelling in the employer's house; but, if in any contract of insurance the wages or salary of such a member of the employer's family is included in the payroll on which the premium is based, then that family member shall, in the event of sustaining an injury arising out of and in the course of employment be deemed an employee and compensated accordingly.
(E) Any individual engaged in any type of service in or about a private dwelling unless the employer notifies the commissioner that the employer wishes to be included within the provisions of this chapter; the existence of a contract of insurance shall be considered sufficient notice.
(F) The sole proprietor or partner owner or partner owners of an unincorporated business provided:
(i) The individual performs work that is distinct and separate from that of the person with whom the individual contracts.
(ii) The individual controls the means and manner of the work performed.
(iii) The individual holds him or herself out as in business for him or herself.
(iv) The individual holds him or herself out for work for the general public and does not perform work exclusively for or with another person.
(v) The individual is not treated as an employee for purposes of income or employment taxation with regard to the work performed.
(vi) The services are performed pursuant to a written agreement or contract between the individual and another person, and the written agreement or contract explicitly states that the individual is not considered to be an employee under this chapter, is working independently, has no employees, and has not contracted with other independent contractors. The written contract or agreement shall also include information regarding the right of the individual to purchase workers' compensation insurance coverage and the individual's election not to purchase that coverage. However, if the individual who is party to the agreement or contract under this subdivision is found to have employees, those employees may file a claim for benefits under this chapter against either or both parties to the agreement.
(G) An individual who performs services as a real estate broker or real estate salesperson, provided:
(i) the individual is licensed to broker or sell real estate pursuant to 26 V.S.A. chapter 41;
(ii) all the individual's compensation from performing real estate broker or sales services is based on commissions from sales production or results and is not based on time worked or an hourly wage;
(iii) the services are performed pursuant to a written agreement or contract between the individual and the real estate sales or broker business or another person with whom the individual is affiliated or associated and the written agreement or contract explicitly states that the individual is not considered to be an employee under this chapter and is not eligible for coverage under this chapter; and
(iv) the individual is not treated as an employee for the purposes of federal income and employment taxation with regard to the real estate broker or sales services performed.
(H) With the approval of the commissioner, a corporation or a limited liability company (L.L.C.) may elect to file exclusions from the provisions of this chapter. A corporation or an L.L.C. may elect to exclude up to four executive officers or managers or members from coverage requirements under this chapter. If all officers of the corporation or all managers or members of an L.L.C. make such election, receive approval, and the business has no employees, the corporation or L.L.C. shall not be required to purchase workers' compensation coverage. If after election, the officer, manager, or member suffers a personal injury and files a claim under this chapter, the employer shall have all the defenses available in a personal injury claim. However, this election shall not prevent any other individual, other than the individual excluded under this section, found to be an employee of the corporation or L.L.C. to recover workers' compensation from either the corporation, L.L.C., or the statutory employer.
(15) "Average weekly wages" means the average weekly wages as computed under section 650 of this title.
(16) "Average compensation" means the current "average weekly wage" under section 1338 of this title, determined previous to the first day of July preceding the date of injury or when compensation is awarded, whichever is later.
(17) [Repealed.]
(18) "Maximum weekly compensation" shall mean a sum of money equal to 150 percent of the average compensation, rounded to the next higher dollar.
(19) "Minimum weekly compensation" shall mean a sum of money equal to 50 percent of the average compensation, rounded to the next higher dollar. However, solely for the purposes of determining permanent total or partial disability compensation where the employee's average weekly wage computed under section 650 of this title is lower than the minimum weekly compensation, the employee's weekly compensation shall be the full amount of the employee's average weekly wages. For the purpose of determining temporary total or temporary partial disability compensation where the employee's average weekly wage computed under section 650 of this title is lower than the minimum weekly compensation, the employee's weekly compensation shall be 90 percent of the employee's average weekly wage prior to any cost of living adjustment calculated under subsection 650(d) of this title.
(20) "Commissioner" means the commissioner of labor or the commissioner's designee.
(21) [Deleted.]
(22) "Health care provider" means a person, partnership, corporation, facility, or institution licensed or certified or authorized by law to provide professional health care service to an individual during the individual's medical care, treatment, or confinement.
(23) "Occupational disease" means a disease that results from causes and conditions characteristic of and peculiar to a particular trade, occupation, process or employment, and to which an employee is not ordinarily subjected or exposed outside or away from the employment and arises out of and in the course of the employment.
(24) "Evidence that reasonably supports an action" means, for the purposes of section 643a and subsections 650(e) and 662(b) of this title, relevant evidence that a reasonable mind might accept as adequate to support a conclusion that must be based on the record as a whole, and take into account whatever in the record fairly detracts from its weight.
(25) "Medical bill" means any claim, bill, or request for payment from a health care provider or employee for all or any portion of health care services provided to the employee for an injury for which the employee has filed a claim under this chapter.
(26) "Denied medical payment" or "medical bill denial" means a refusal to pay a medical bill based on the employer or insurance carrier asserting, supported by reasonable evidence, any one or more of the following:
(A) The employer or insurance carrier was not provided with sufficient information to determine the payer liability.
(B) The employer or insurance carrier was not provided with reasonable access to information needed to determine the liability or basis for payment of the claim.
(C) The employer or insurance carrier has no liability to pay a medical bill under the provisions of this chapter.
(D) The service was not reasonable or medically necessary.
(E) Another payer is liable.
(F) Another legal or factual ground for nonpayment.
(27) "Medically necessary care" means health care services for which an employer is otherwise liable under the provisions of this chapter, including diagnostic testing, preventive services, and aftercare, that are appropriate, in terms of type, amount, frequency, level, setting, and duration, to the injured employee's diagnosis or condition. Medically necessary care must be informed by generally accepted medical or scientific evidence and consistent with generally accepted practice parameters as recognized by health care professionals in the same specialties as typically provide the procedure or treatment, or diagnose or manage the medical condition; must be informed by the unique needs of each individual patient and each presenting situation; and must:
(A) help restore or maintain the injured employee's health; or
(B) prevent deterioration of or palliate the injured employee's condition; or
(C) prevent the reasonably likely onset of a health problem or detect an incipient problem. (Amended 1959, No. 222; 1965, No. 169; 1967, No. 122, § 1; 1969, No. 186 (Adj. Sess.), § 1; 1971, No. 241 (Adj. Sess.), §§ 1, 2; 1973, No. 64, § 1; No. 70, § 1; 1975, No. 177 (Adj. Sess.), § 1; No. 201 (Adj. Sess.); 1977, No. 182 (Adj. Sess.), §§ 1, 21, eff. May 3, 1978; 1981, No. 39; 1981, No. 165 (Adj. Sess.), §§ 1, 3, 4; No. 204 (Adj. Sess.), §§ 1, 2; 1983, No. 121 (Adj. Sess.), § 1, eff. March 28, 1984; 1985, No. 194 (Adj. Sess.), §§ 1, 2; 1987, No. 183 (Adj. Sess.), § 13; No. 189 (Adj. Sess.); 1993, No. 23, §§ 1, 2, eff. May 19, 1993; 1993, No. 225 (Adj. Sess.), §§ 1, 2; 1995, No. 180 (Adj. Sess.), § 38a; 1999, No. 41, §§ 2, 3; 2003, No. 132 (Adj. Sess.), §§ 4, 14, eff. May 26, 2004; 2005, No. 69, § 1; 2005, No. 103 (Adj. Sess.), § 3, eff. April 5, 2006; No. 108 (Adj. Sess.), § 2; No. 209 (Adj. Sess.), § 32; No. 212 (Adj. Sess.), § 11, eff. May 29, 2006; 2007, No. 42, § 2; 2009, No. 61, § 26.)