YOUR WORKERS' COMPENSATION CLAIM
If you are out of work due to a work related injury there are some things to keep in mind. The first one is the waiting period. You have to be out of work for at least 5 workdays to qualify for benefits. Those benefits only begin on the 6th day. You may get those five days back if you are out of work more than 21 days.
Workers' Compensation is a system of insurance that protects you when you are hurt on the job, and your work injury can be a specific injury or a series of injures. It is important at the outset to note that Workers' Compensation does not, under any circumstances, pay you for pain and suffering. It is a wage replacement system that pays a relatively finite amount of cash benefits and pays medical expenses. In return you as an employee, under most circumstances, cannot sue your employer in tort.
After five days out of work your employer should prepare a First Report of Injury, Form 101. The employer must send this form within seven business days of the fifth calendar day of disability. The insurer must begin to pay for lost wages, or send a denial, within fourteen days after they receive the First Report. They will need a medical report from your doctor indicating you are in fact disabled from work as a result of your work related injury of _date. This is the minimum they will need. They may have other defenses to keep from paying you, but at the bare minimum they will need a disability statement which relates your injury and inability to work to your work related accident. The insurer can pay temporary total benefits at 60% of the average weekly wage. They may also pay partial incapacity at a lower rate if there is evidence of an ability to perform work in the labor force. The insurer may then pay those benefits for up to 6 months or 180 days under a pay without prejudice period, and during that period the insurer may stop or reduce payments at any time and claim any defenses, including liability, disability, and causation.
No claim for benefits can be filed until 30 days has run from the onset of disability. Claims filed before that time should be filed with the insurer's Notification of Denial. After a claim is filed you will get conciliation before the Department of Industrial Accidents. This is an informal level and is often used to resolve smaller claims, to facilitate discovery of documents or defenses from the insurance company, and to settle cases. A case may be settled before the conciliator if all parties agree to it.
No lawyer should advise you to stay out of work if you do not have medical documentation to support your disability. The decision to resume work is between you and your doctor. Even when you go out of work at the advice of your doctor there is no guarantee you will be paid. Your chances of being paid are greater with a more severe injury and a documented accident.
Your education and prior work experience is vital to your claim. That may make the difference between you receiving total or partial benefits. An administrative judge must consider your age, education, background, training, work experience, and other capabilities (Frennier's Case). Your prior injures should also be documented on paper.
Any prior accidents that are work related will show up with the Department of Industrial Accidents when a claim is filed. The insurer will be able to do an index check to see all prior accidents, be they work related, motor vehicle, or slip and fall. You should never try to hide evidence of your prior injuries.
Some of the most important documents with regard to your case are
1. Your initial date of accident medical records and reports;
2. Medical reports, police, fire, or ambulance reports;
3. And of course, disability reports from your own doctor.
It is vital that you cooperate with your lawyer and the insurance company for your Workers' Compensation. You must make all exams which are scheduled by the insurance company. They have a right to have you seen by their doctor. You should also make every effort to see your own doctors and therapists. Failure to go can make your case look bad to a Judge. A Judge may ask: why would a person who is severely injured fail to go to therapy where they may get to feel better? If you resume work you should let your attorney and the insurance company know. You should never under any circumstances receive total Workers' Compensation benefits while you are working. To do so would constitute fraud and may get you in trouble with criminal charges being filed. Under some circumstances you may be able to get partial benefits and work at a part-time job or a job making less money. You would still be required to inform all parties of your weekly checks. If you have any further questions about your case you can call me on my cell phone. The call and my time are free on your case. Aside from a small amount of your first retroactive check which the insurer can deduct pursuant to Statute, I work only on contingency. That means that I do not take your weekly checks or charge you for my time and efforts until I get you paid or your case is settled.
