Workers’ Compensation FAQ

Posted on behalf of Phillips Law Group on May 29, 2013 in Workers' Compensation

Have questions about workers compensation? Refer to these frequently asked questions to find the answers you need. Want to discuss the details of your potential case with one of the professionals at Phillips Law Group? Fill out the Free Case Review form to your right to get started now.

Frequently Asked Questions about Workers Comp

What is workers compensation insurance?

Workers compensation insurance is a form of assured, limited coverage that provides wage replacement and medical benefits to employees who are injured, contract a disease, or suffer fatality on-the-job. An employer who is covered by workers compensation cannot be sued by his employees.

Also known as workmans comp, this type of insurance can pay out in several ways. Weekly payments to replace wages function as a form of disability insurance, while payments for medical expenses serve as health insurance, and further still, payouts to surviving family members serve as life insurance.

Can I be fired for hiring a lawyer?

No, you cannot be fired for hiring legal counsel. If you believe you were terminated because of your injury, you are entitled to file a retaliatory discrimination complaint with the Department of Labor. Our legal professionals can assist in filing your paperwork and represent you in such matters.

Can I get a second opinion on my diagnosis?

Yes, you are allowed to seek a second opinion. In most cases, you will be required to submit a written request for a second opinion that will then need to be approved by the insurance carrier. The regulations concerning second opinions for workers compensation beneficiaries vary by state, and can govern who selects the healthcare provider and what party is responsible for the bill.

Can I select my healthcare provider?

The ability to select your healthcare provider depends upon the state in which your file is claimed. The requirements for a doctor to receive payment for treating injured workers are stringent. Therefore, certain physicians handle workers compensation treatment, whereas many general practitioners will not.

Some states select doctors for you while others allow you to select from a network. There are also variations between states that allow you to choose your healthcare practitioner for your initial visit, but not for continuing treatment.

In most states, if you are not satisfied with your treatment, you can switch to another practitioner. The procedures for this vary by state as well.

Can I still contact the adjuster after retaining legal representation?

No, you cannot. Once you have hired a lawyer, they will become responsible for your case. If you have further issues with adjuster, you should inform the Paralegal or Attorney assigned to your case immediately and they will address the problem.

Does the Medical Rehabilitation Nurse have to accompany me to doctors appointments?

Yes, the medical rehabilitation nurse must be present during your trip to the doctor. However, he or she does not have to be in the exam room if you dont feel comfortable or would like to speak with your treatment provider privately.

If a doctor provides a work release, am I required to resume immediately?

Yes, if your treating practitioner releases you for work, you must attempt to resume your work duties, and under any restrictions prescribed (the doctor should be informed of the duties required by your position by reading a job description). If you are unable to fulfill your duties, you should consult your treating practitioner to see what options are available to you.

If an employer refuses to acknowledge a claim, what happens next?

An employer must fill out a form to deny your claim. In such circumstances, the Commission, the claimant and his or her legal representation, along with any involved healthcare providers, will be notified promptly. Forms worded in general terms will not be accepted; the exact reason for denial must be expressed.

If you have been denied a claim, you may request a hearing for appeal. You cannot be billed for any medical services until a final determination is made that you are ineligible for compensation.

If I return to work while receiving benefits, will payments continue?

Whether you will continue to receive benefits after returning to work depends upon your wages. If you receive a lower hourly rate upon returning to work (because of your injury), you may continue to receive benefits.

If my employer fails or refuses to report my injury, what should I do?

The injured worker should file a claim with their states Industrial Commission if a case is not reported by the employer. The statute of limitations for filing this claim varies by state.

Is an employee eligible for damages for pain and suffering?

No. Pain and suffering, and other such damages, are not allowed in workmans comp claims. Pain and suffering would fall under an outside lawsuit, and employees who are covered by workers compensation cannot bring a lawsuit to their employer.

Is chiropractic care covered?

A patient can visit a chiropractor if permission is granted by the employer. In most states, there will be a maximum number of visits allowed. To exceed this limit, the practitioner or employee may need to submit paperwork requesting additional visits.

What are Defendants Interrogatories?

Defendants Interrogatories are written questions that are drawn up by the defendants for discovery purposes. The claimant has 30 days to answer the questions and provide any requested documentation to the defendants legal team.

What benefits are provided?

Workers compensation provides benefits to pay for the costs of medical care incurred by your workplace injury, but may also cover many other expenses. Depending upon the circumstances of the accident, an injured worker could be entitled to compensation for lost wages if the injury renders them unable to work. The amount and type of benefits will be specific to your case.

What happens if an employer fails or refuses to provide emergency medical care?

If the employer does not provide for medical attention immediately following your injury, you may seek treatment from the hospital or doctor of your choice. You will need to promptly fill out the relevant paperwork to submit to the states Industrial Commission in seeking approval.

What if a third-party is at fault for my work-related claim?

You could still be eligible for workers compensation if a co-worker or other person was responsible for your injury while in the workplace. If another persons negligence or intentional acts caused your injury, you may also be able to file a third-party claim against that individual.

What if I get fired while receiving benefits?

If you are terminated while receiving workers compensation benefits, whether rendered completely out of work or you have returned to your job under restrictions, you are entitled to 2/3 of your regular weekly pay until you find a new job. In such cases, a vocational rehabilitation counselor is often appointed to assist in the job search. If you have returned to work full time and you believe the termination was related to your on-the-job injury, you should file a retaliatory discrimination complaint with the Department of Labor.

What if my employer does not have coverage?

Depending on the laws in your state, an employer must carry workers compensation coverage once a threshold is met for a certain number of employees. Here in Arizona, all public and private employers with 1 employee or more must carry coverage. In Utah, all employers must carry coverage, except for agricultural employers whose payroll amounts to no more than $50,000 annually.

What injuries and illnesses are covered?

Workers compensation insurance covers almost any physical injury or disease that resulted from conditions in the workplace. Some states allow claims for pre-existing conditions that were aggravated by workplace conditions.

What is a permanent disability rating?

A permanent disability rating is an evaluation of a persons level of working ability that is expressed by a percentage. A doctor will determine the rating, which is 100% for a total loss, or any lesser figure for partial loss of working ability, after all treatment options have been exhausted.

What is a repetitive stress injury?

A repetitive stress injury is trauma that occurs over time in workers who repeatedly perform the same action, such as an assembly line worker or typist. When the repetitive motion puts too much stress on a particular joint, a stress injury can occur; they are usually characterized by pain and swelling in the affected muscles and tendons.

What is my claim worth?

Each case is different. The full extent of disability must be known before the value of a claim can be estimated, and a claimant must exhaust all medical treatment before receiving a permanent disability rating.

What is NOT covered?

An injured worker is only eligible to file a claim if the incident that led to harm occurred while the individual was performing job duties. This means that not every injury that occurs at the workplace is eligible. If you are unsure whether you have a claim, one of our attorneys can help.

What is permanent partial disability?

Permanent partial disability occurs when a person has sustained permanent damage but is not rendered completely incapable of working. This happens in cases where a person has lost a body part but is still able to work, or suffered injuries that make them forever unable to attain the same rate of pay they earned prior to the injury.

What is the duration an employee is eligible for lost-time weekly benefits?

In most states, the length of time an injured worker will receive benefits coincides with the duration of time they are unable to work.

What is the rate of pay and how frequently can I expect payments?

A claimant will receive pay on a weekly basis, regardless of pay schedule provided by the employer. In most states, the employee will receive up to 2/3 of their average weekly pay, up to a maximum that is designated by state agencies.

What should an employee do following an injury?

Immediately following the incident, and no later than 30 days afterward, the employee must report the injury to the employer both verbally and in written form.

When can I collect reimbursements for sick travel?

If an injured worker travels 20 or more miles round-trip for medical treatment related to a workers compensation claim, the individual is entitled to reimbursement for each mile traveled. The rate of reimbursement varies by state, but is often close to the standard mileage rate for business miles that is established by the Internal Revenue Service.

When can I settle my case and receive compensation?

The answer depends upon how far you have progressed with treatment. Your settlement wont begin until you have exhausted all treatment options and received a permanent partial or total temporary disability rating. Only then can the settlement proceed.

When is an employee eligible for lost wages?

The first 7 days after an injury are non-payable, unless the disability exceeds 21 days. This means a claimant will receive their first payment 14 days after the incident, which includes payment for the 7 days prior. If the claim lasts longer than 21 days, the payment for the first 7 days will be disbursed at a later time.

Who determines permanent partial disability?

The state agency (sometimes the Industrial Commission) will determine whether an individual qualifies for permanent partial disability, using the ratings provided by the treating healthcare practitioners and other evidence of the individuals ability to earn wages.

Who provides medical treatment for an injured worker?

The employer or its insurance carrier, in accordance with any orders from the state agency, will provide and direct treatment. If an injured worker wishes to change the healthcare provider that was assigned to them, they should consult the state agency governing their claim.

Why do I have to record a statement if the employer is already familiar with the circumstances of my injury?

Your recorded statement is used by the claims adjuster to learn about the details of your incident and apply this knowledge in investigating your claim. The adjuster uses the information as a basis to decide whether the workers compensation agency will accept liability and disburse benefits.

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