Workers Compensation: What to Do
WHAT SHOULD I DO IF I AM INJURED?
- Report the injury to your supervisor immediately.
- Get the names of any witnesses.
- If you cannot work, get a letter from your doctor and give it to your employer. Remember to keep a copy.
- Keep a diary of events and medical treatment.
- Obtain copies of your medical records.
HOW WILL I BE PAID?
- You must be disabled for five or more days to receive weekly benefits.
- The workers compensation insurer has 14 days after receipt of the First Report of Injury to pay or deny your claim.
- In many cases, it will take a full month for the insurance company to issue the first check or to deny the claim.
WHAT OTHER BENEFITS AM I ENTITLED TO?
- Permanent loss of function benefits
- Disfigurement of hands, face and neck benefits
- Vocational rehabilitation services
- Double compensation
WHAT ARE MY WEEKLY BENEFITS?
- Tools and temporary disability: 60 percent of your average weekly wage for three years, up to a maximum equal to the state average weekly wage. For any injuries after October 1, 1999, the maximum is $749.69.
- Partial and permanent disability: 60 percent of the difference between your average weekly and post-injury wage (if lowered as a result of injury) for five years in most cases. This amount cannot exceed 75 percent of your total disability rate.
- Total and permanent disability: 66.67 percent of your average weekly wage for life.
- Death benefits: 66.67 percent to your surviving spouse, if you die as a result of the work injury, for five years. Benefits beyond this time are paid only if your spouse is not “fully self-supporting.”
WHICH DOCTOR MUST I SEE?
You have a right to see a doctor, chiropractor or therapist of your choice.
WHAT ELSE SHOULD I KNOW ABOUT MY TREATMENT?
Your treatment will be subject to a utilization review under the Department of Industrial Accidents guidelines. The insurer has the right to have you examined by a physician of its choice.
WHAT SHOULD I DO IF BENEFITS ARE NOT PAID?
If benefits are not paid, a claim must be filed by you or your attorney at the Department of Industrial Accidents.
WHAT IS THE DISPUTE RESOLUTION PROCESS?
- A Conciliation is scheduled within 15 days at one of the offices of the Department of Industrial Accidents. If an agreement is not reached, your claim is sent to an Administrative Judge.
- A Conference is then held before a judge who orders a payment, denial or modification of benefits based on medical and other evidence presented by you and the employer’s insurance company.
- A Hearing is held when either party appeals a Conference order. You must see an impartial physician, and testify. The judge reviews the evidence and writes a decision. If you win, the insurer must pay attorney’s fees.
CAN I SETTLE MY CASE?
You can settle your claim by a Lump Sum. Once you do, you are no longer entitled to weekly benefits. Related medical benefits continue to be paid. Rehabilitation benefits also remain available to you for two years. In most cases, your employer must consent to the Lump Sum Agreement.
If you settle your case with a Lump Sum, your attorney is paid 20 percent of your settlement on an accepted case and 15 percent on an unaccepted case.
WHAT OTHER HELP IS AVAILABLE?
- Social Security Disability Income Benefits: If you are disabled from all substantial gainful employment: for a period of twelve months or longer, you may be eligible for disability benefits from the Social Security Administration. SSDI provides Medicare coverage two years after the start of benefit eligibility for the injured employee.
- Third Party Lawsuits: You may be able to pursue additional money in a civil action if you were injured as a result of a negligent third party. A third party defendant may be a person who is not your employer or co-worker or a product, tool or machine that was negligently designed. You must file a lawsuit within three years of the date of your injury in most cases.
Injuries on the job can affect you and your family. All employers are required to carry workers compensation insurance, but your claim can be denied. If so, contact a qualified attorney to represent you.