QUICK GUIDE TO THE

WORKERS’ COMPENSATION ACT

What IS CONSIDEREDan injury?

●Repetitive motion injuries(example: Carpal Tunnel)

●Aggravation of pre-existing conditions

●Specific loss (loss of hearing or use of a limb or digit)

●Disfigurement(scarring on the head or neck)

●Occupational Disease(lung cancer, mesothelioma, occupational asthma, cancer, etc.)

Reporting the injury:

●An injury must be reported within 120 days of the date of injury.

If reported, one has 3 years to file a claim.

●Must report the injury to a supervisor or someone in authority

●Must state that the injury is work-related

●Best form of notice is an accident report

Accepting an injury as work related:

●Employer must decide within 21 days whether the injury will be accepted or denied

●Notice of Compensation Payable issued for accepted injury

●Notice of Temporary Compensation Payable which is only effective for 90 days

●Medical only acceptance but mere payment of medical bills is not an acceptance

●If denied than a claim must be filed before a workers’ compensation judge

Treating for the injury:

●Employer should have a list of six designated physicians or treatment groups(i.e. panel doctor)

●Must treat with a panel doctor for 90 days

●A company doctor is not a panel doctor

●After 90 days one can treat with a doctor of their choice but they must notify the insurance

carrier within 5 days of treating with a new doctor.

●There is no requirement that one has to cooperate with a rehab nurse

Workers’ Compensation Benefits:

●To be eligible for weekly benefits must be off for at least 7 days and will not receive benefits

until after the 14th day.

●Generally, the benefit amount is 2/3 of their wages

●Benefits are based upon one’s average weekly wage which is the average of one’s

wages over a one year period prior to the injury

●The benefit amount cannot exceed the maximum allowed which in 2011 is $858.00

RELEASE TO RETURN TO WORK:

  • When released to return to work there is an absolute obligation to return if work is provided
  • An employer, however, does not have an obligation to return someone to work with restrictions
  • If there are no restrictions and no work is provided workers’ compensation benefits continue
  • If returned to work to a position earning less than pre-injury earnings there is an entitlement to partial benefits
  • If there is no work available within a workers restrictions vocational rehabilitation may be initiated

Returning to work:

●Benefits can be suspended so that they can be reinstated if one again becomes disabled due

to the same injury

●Benefits can be terminated if one fully recovers from the injury

●Benefits can be resolved through a lump sum settlement

●NEVER SIGN ANYTHING WITHOUT CONSULTING A LAWYER

COMPANY DOCTOR AND REHAB NURSE

  • Company physicians and/or rehab nurses are not treating physicians
  • Company physician and/or rehab nurse cannot manage the care of the worker nor place restrictions upon that worker
  • The nurse, no matter how friendly, does not have their best interest in mind
  • A nurse should NEVER be permitted to participate in doctor’s exams
  • The nurse or MCS has no right to change, modify or manage physician appointments

MEDICAL REVIEW

  • Employer is responsible for all medical expenses related to a work injury
  • Employer has the right to challenge whether medical treatments are reasonable, necessary & related
  • This challenge is accomplished through the Utilization Review Procedure
  • By way of this procedure, through an independent third party, medical care is reviewed
  • While the review is pending employer does not have to pay the challenged medical care
  • However, employer has no right to simply stop payment before filing the review
  • Can only be sent to two Independent medical exams in a 12 month period

WORKERS COMPENSATION, FMLA &ADA

  • A work-related injury does not qualify as time off under the Family Medical leave Act
  • A work injury is not a serious health condition as defined by the Family Medical Leave Act
  • A work related injury may be so severe that the same qualifies as a qualified condition under ADA.
  • If an injured worker is not provided a reasonable accommodation or is discharged due to an injury, there may be an ADA violation

OTHER BENEFITS

  • If an employer denies workers compensation benefits apply for short-term and/or sickness and accident benefits
  • Unemployment compensation benefits may be appropriate where a worker is prohibited from returning to work
  • Social Security Benefits are appropriate if forever barred from returning to work
  • All of these benefits can be received in conjunction with workers’ compensation benefits although there may be either an offset or repayment obligation