Worker's Compensation is a system of laws designed to provide injured workers with specific benefits and legal forum in which disputes can be resolved between injured workers, employers and insurance companies. A workers' compensation claim is not a lawsuit against your employer; it is simply a request for insurance benefits.
What are the Benefits?
There are four basic benefits:
- You have the right to select your treating doctor.
- You have the right to all medical treatment reasonably necessary to cure or relieve the effects of your injury, potentially for life.
2. Temporary Disability:
- This is a partial income substitute while you are off work and undergoing active medical treatment.
- The weekly amount is usually two-thirds of your average weekly gross pay, with certain maximum and minimum limits; it is paid every two weeks.
3. Permanent Disability:
- If you don't completely recover from the effects of your injury, you may be entitled to a monetary award.
- The amount of the award (and the weekly rate at which it is paid) depends mainly on how your injury limits your activities; your age, your occupation, and your earnings also affect it at the time of injury.
4. Vocational Rehabilitation:
- If your permanent disability prevents you from returning to your job, you may be entitled to assistance in finding another job. While you are participation in vocational rehabilitation you will receive a partial income substitute which is similar to Temporary Disability, although the weekly amount may be less.
- For injuries on or after 01/01/94, there may be a $16,000 limitation on these benefits.
- A valid offer of modified or alternate work from your employer may replace your right to these benefits.
- You must report your injury to your employer. If possible, do so in writing and keep a copy of the report.
2. Complete a Claim Form
- As soon as your employer learns of your injury (from any source), the employer must give you a CLAIM FORM. Complete it, listing all body parts that were or may have been injured and return it to your employer right away, keeping a copy for your records. Your employer must then immediately identify, and notify its workers' compensation insurance carrier and send you to a doctor.
If your doctor verifies your inability to work, you should receive your first temporary disability check within 14days. A worker's compensation judge ultimately decides disputes about temporary disability.
Who decides what medical treatment I receive?
You have the right to choose the doctor you want to treat you 30 days after your injury, although in some cases you may be able to choose your doctor earlier.
The insurance company must authorize all reasonable and necessary treatment recommended by your doctor. What is "reasonable and necessary" treatment depends, mostly, on what your doctor (not the insurance company) decides you need.
If the insurance company unreasonably delays or denies your medical treatment, the insurance company is required to pay you a penalty.
How will my Permanent Disability Award be decided?
Your award will be determined by a doctor's description of your permanent condition. Factors include current symptoms and limitations you have because of your injury. This is true even if you have returned to the job that you were doing when you were injured.
Who describes these factors of disability?
Initially, your treating doctor must describe your disability. Either you or the insurance company may disagree with this description. How this disagreement is resolved depends on whether you are represented by an attorney. If you are represented, you and your attorney may select a doctor to provide an opinion about your disability. Attorneys are experienced in choosing the best doctor for your claim.
If an attorney does not represent you, you will receive a list of three doctors from which you pick one to give an opinion about your permanent disability.
This is a very important decision. If you pick one of the three doctors from the list and you are dissatisfied with that doctor's opinion you will not be able to obtain another medical opinion, even if you later decide to hire an attorney.
What happens after the medical evaluation(s)?
The medical description of your disability will be "rated" using a schedule. This rating is then used to determine the monetary amount of your permanent disability award. The rating process is very complicated, depends on many factors, and varies greatly on the interpretation of the medical description of your disability.
You have the right to challenge the rating. A workers' compensation judge will decide disputes about your disability, your rating, and/or your award.
What if I can't return to my job?
If your doctor says you can't, then you should receive vocational rehabilitation benefits, including the assistance of a counselor to help you find another job. This may include returning to another job with the same employer, placement services, or retraining.
You have the right to dispute a denial of vocational rehabilitation services and whether you are being provided with appropriate services and benefits; a workers' compensation judge may decide such disputes.
What if my employer fires or discriminates against me for filing a claim or requesting benefits?
This is illegal. If you can prove it, you will receive additional benefits.
What happens if my claim is denied and I am receiving no benefits?
You have the right to challenge this decision and to have a hearing before a workers' compensation judge.
How can an attorney help?
There are many questions, issues, and disputes that may arise regarding each of the above benefits, such as:
- Is the insurance company paying you the right amount of money?
- Are you receiving all the medical treatment you need?
- How can you make the insurance company approve your medical treatment?
- Who are the best medical specialists in your area?
- How do you change doctors?
- What can you do about delays in your benefits?
- Is your permanent disability rating correct?
- Are you entitled to vocational rehabilitation?
- How much is your case worth?
- Should you settle your right to medical treatment?
- Are there any other benefits available to you other than workers' compensation?
- Did the insurance company follow the correct procedure in sending you to an evaluating doctor?
- Has your employer treated you improperly because you filed a claim?
- Did your employer cause your injury through some serious and willful misconduct?
- Did someone other that your employer negligently or intentionally cause your injury?
Should I hire an attorney?
This is a decision only you can make. An attorney who is experienced in workers' compensation cases can give you advice about your case and can make sure that you receive all the benefits to which you are legally entitled.
How much do I have to pay for an attorney?
- There is no fee for a consultation with a workers' compensation attorney. It is unethical for an attorney to charge a fee in a workers' compensation case unless and until:
- you hire the attorney by signing a written agreement;
- you receive an award or settlement from which a fee is deducted, and;
- a workers' compensation judge approves the fee.
The attorney's fee is usually 9 - 15 percent of your permanent disability award, but may be more or less depending on the complexity of the case.
REMEMBER: Your employer and the insurance company have attorneys advising them about your case. You are entitled to do the same.