1) TELL YOUR EMPLOYER:
If you are injured or have an occupational disease, tell your employer that you were hurt or have a disease, AND that the injury or disease is the result of your job.
Tell your employer that you were hurt or have a disease as soon as possible. While the law allows you 120 days from the time that you were injured or think you were injured to tell your employer, DO NOT WAIT THIS LONG.
Report your injury to your supervisor or Human Resources staff person, not a co-worker. Request that an official “Employers Report of Occupational Injury or Disease” be filed under the Workers’ Compensation Act. Ask for a copy of the report for your records.
2) TELL YOUR DOCTOR:
Specific details of your injury and how it occurred are important to establish in the medical records as soon as possible. Include details regarding your job duties. Be clear on your symptoms and honest about any prior problems or similar symptoms. Prior complaints and injuries will be discovered in the litigation of a claim for benefits.
Medical benefits under the Workers’ Compensation Act are payable for treatment that is reasonable, necessary and related to an accepted work injury.
3) TREAT WITH A PANEL DOCTOR ONLY IF NECESSARY:
If your employer has a list of 6 posted doctors, you MAY be required to treat with a provider on that list for the first 90 days of treatment. Your employer is required to explain the obligation to treat with the listed provider at the time the injury is reported. If you have not been presented with an explanation of your rights, or your case is denied, you may be able to choose the doctor you want to treat with.
4) IS YOUR INJURY ACCEPTED?
Your claim is not officially accepted until you receive a Notice of Compensation Payable or a Temporary Notice of Compensation Payable. These documents are to be issued within 21 days of the report of injury. If the Workers’ Compensation insurance carrier has not accepted or denied your claim within 21 days, see your representative.
The Notice of Compensation Payable and the Temporary Notice of Compensation Payable are the only official forms that can be issued by an insurance carrier to accept responsibility for a work injury. Make sure that these documents correctly describe your injury.
Remember, the payment of your medical bills does not mean that you have an open and recognized workers’ compensation claim.
If a Notice of Compensation Denial is issued, on it own or with a Notice Stopping Temporary Compensation Payable you have been denied benefits. You must file a Claim Petition to litigate before a Workers’ Compensation Judge and establish your right to benefits. A Claim Petition must be filed within 3 years of the injury.
At the time of your injury a Statement of Wages is prepared, establishing your Average Weekly Wage. Typically, Workers’ Compensation pays two-thirds of your gross salary for all jobs as long as you are disabled. This is a tax free payment. There are also minimum and maximum rates of wage loss that are set by the state each year. If you go back to work at a lighter job because of medical restrictions, you will be paid partial disability, which is two-thirds of the gross difference between your old wage rate and your new wage rate.
5) RETURN TO WORK ISSUES
A Notice of Ability to Return to Work is to be issued by the compensation carrier any time there is a medically documented change in your condition. If the medical information is from your own treating physician, you should make every effort to return to your employer ask for work within your retrictions. If the release is not from your doctor, you should speak to your doctor for an opinion on your ability to return to work and relay that to your employer. If there is litigation on an issue of your ability to work, a judge will decide between the two medical opinions.
If you return to work, even if with restrictions on duties and/or working hours, you will receive either a SUPPLEMENTAL AGREEMENT or a NOTICE OF SUSPENSION OR MODIFICATION to document the change in your status. If are not earning what you made before the injury, you may be entitled to ongoing partial disability payments. It is very important that these forms be correct and challenged if necessary. There are time limits to appeal the Notice of Suspension or Modification. If you receive this form, you should call your representative.
If you have any questions about workers’ compensation, you may call for a free consultation at (724) 938-1355.