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Workers’ Compensation laws control the insurer’s liability. The current law provides that an insurer will pay only for the following:
When a worker is injured on the job and is unable to earn wages, then they are eligible to receive lost wages from the workers' compensation insurance carrier for up to 104 weeks. The amount of these benefits varies along with the classification of these benefits. A lot of times, lost wages or the amount of lost wages are in dispute with the employer/carrier. Thus, having an attorney, like the Law Office of William R. Orr, on your side can make a tremendous difference in the outcome of the dispute.
The insurer’s potential liability for Temporary Disability Pay (TD) and related costs can be for up to 104 weeks of payments for the time off work due to the work injury that is properly certified by a doctor.
If you have been injured at work and are on a "no-work" status from your authorized treating physician, then you are eligible for lost wages under the TD classification. These benefits are paid at the rate of 2/3 of your average weekly wage. The amount of this benefit is referred to as your compensation rate. Each year, the maximum compensation rate is capped. For example, for the year 2014, the maximum compensation rate has been set at $765 per week.
Once you have been deemed Permanent and Stationary (P&S) by your physician at Maximum Medical Improvement (MMI), or you have been paid the maximum number of weeks of temporary disability benefits, then you may qualify for permanent disability benefits. In addition to several specifically listed qualifying cases, an injured worker may qualify for this benefit if they are physically unable of engaging in at least sedentary employment within a 50 mile radius of their residence. Permanent Disability (PD) payment amounts are based on the impairment identified by a qualified medical evaluator or treating doctor in a competent medical report.
The insurer may also have a potential liability for Future Medical Care (FMC). FMC costs are the costs for reasonable necessary medical treatment for the parts of the body injured on the job.
Many times, due to a work-place injury, an injured worker can no longer return to his past employment. Supplemental Job Displacement Benefit (SJDB) provides a “voucher” for qualified retraining expenses if the injured worker cannot return to their usual and customary employment and if the employer does not offer alternate or modified employment at 85% of the wages the injured worker was earning at the time of the injury on the job.
There is no provision for pain and suffering in a Workers’ Compensation case and the Workers’ Compensation Appeals Board will not issue an award based on pain and suffering.
First of all you should understand that although there although there are some limitations, the employer/carrier is required to provide the injured worker with all medically necessary medical treatment required for their injury. This includes diagnostic tests, surgeries, therapy, medications, etc.
Medical benefits are commonly in dispute as insurance carriers will at times deny or delay needed medical benefits. This can cause additional harm to an injured worker as they are trying to recover from their injury. You should consult with a workers' compensation attorney if you are being denied needed medical benefits (or these are being delayed by the insurance carrier). Claims can be filed seeking these benefits.
Injured workers should understand that although it may seem that they do not have any rights or control of their medical care, they do. Injured workers do have rights! Injured workers have the right to select their primary treating physician. However, this is a right that should be exercised very cautiously as it can slow the progress of one’s recovery. You should consult with an attorney before making such a decision. This can make a big difference in your case and in the quality of the medical care that you receive.
Insurers are allowed to investigate claims and to object to paying for any benefits they believe were not required because of the work injury. Insurers are not required to pay for treatment or disability due to events or circumstances that are not caused by the work injury.
The Workers’ Compensation Appeals Board judge is the one who will decide what benefits are due when no agreement is reached between the insurer and an injured worker. The judge will rely primarily on business records to determine the earnings on which payment rates are based unless the parties can agree to the wages earned at the time of injury. The judge will rely on medical records and will not provide any medical opinion in place of a doctor’s opinion to reach a determination about medical benefits or permanent disability.
It is important to collect the medical and other persuasive evidence in support of the claim in order to bring a dispute for determination by a WCAB Judge. Again, this is a crucial element where a good attorney can help present the “facts” of an injured worker’s case. It is the injured workers responsibility (burden of proof) to show what benefits should be provided under the law.
Settlements in workers' compensation cases are voluntary. No one can force a settlement either of an injured worker or of an insurance carrier. If an attorney for their case represents an injured worker, a settlement can be reached at any time. However, there are a lot of factors that need to be considered when discussing and negotiating a lump-sum settlement of your case. Before discussing settlement of your case, you should consult with a workers' compensation lawyer, such as William R. Orr to understand the full effect of a settlement.
Settlements in workers' compensation cases may include all future medical benefits. This means that in a settlement, you will no longer be eligible or entitled to any future medical benefits from the workers' compensation insurance carrier. This is not something to be taken lightly. You should understand that the insurance carrier's representative (i.e. adjuster, case manager, lawyer, etc.) does not represent you or your interests. We strongly advise you to be represented by a workers' compensation attorney when discussing a settlement of your case. Contact the Law Office of William R. Orr prior to discussing any settlement with the insurance carrier.
In considering any settlement, you want to make sure that the proposed settlement is in your best interests. The Law Office of William R. Orr can help you regarding settlement and help you to negotiate this, the decision ultimately is yours. As the injured worker, you want to make sure you have an expert there to help.