Three Basic Rights of Workers Compensation Act
What is Workers Compensation?
It is a government mandated process of paying benefits to employees who are injured or become ill on the job or as a result of their job. It is essentially a workers disability insurance policy that provides financial compensation, medical services, or both to workers who are injured or ill as an immediate consequence of their jobs. Workers compensation is also known as workers' comp.
Workers Compensation Benefits
- Observance of state regulations
- Medical treatment for an injured employee
- Benefits for temporary disability
- Benefits for permanent disability
- Additional job displacement benefits
- Death benefits
What is Workers Compensation Insurance?
Workers compensation insurance provides medical, pay, and other financial rewards to employees who are injured or ill on the job. Most states mandate this coverage. Workers compensation insurance is often referred to as workman's compensation insurance or workers comp insurance.
Workers Compensation Laws
Workers Compensation laws refer to state or federal statutes intended to protect workers and their families from the hazards of workplace injury, death, or illness. It is a type of employee insurance that is accounted by the employer.
Three Basic Rights of Workers Compensation Act - Work Place Injuries
The Worker's Compensation Act secures three basic rights to injured workers: medical treatment, compensation for lost work time, and a settlement at the conclusion of your case.
Medical Treatment
For an injury, the plaintiff deserves to get the medical care available and choose their own doctors.
Through their Workers’ Compensation insurance carrier, the employer must pay for all necessary first aid, medical and surgical services, and hospital services.
However, it is limited to what is reasonably necessary to cure or relieve the effects of the accidental injury.
If the employer doesn’t dispute payment for first aid, medical, surgical, and hospital services, the employer shall make such payment to the provider on behalf of the employee.
Plaintiff has the right to all prescribed medical treatment if it aids in your recovery, or if your doctor believes it will.
The insurance company may hire their own doctor to argue that the treatment your doctor desires is not "reasonable and necessary," and thus will not pay for it.
In addition to Independent Medical Exams, the insurance company may have a doctor review the medical records or submit the claim for "utilization review." These are all different approaches to achieving the same goal, which is to dispute bills.
To summarise, your first right under the Workers' Compensation Act is to receive medical treatment. You choose your doctor, and that doctor prescribes treatment and refers you to other doctors.
Workers' Compensation insurance should cover the costs of treatment as long as it is "necessary" and "reasonably required to cure or relieve the effects of the accidental injury."
Compensation for Time off work
Compensation for periods of time when you are unable to work due to a work-related injury. It is said as Temporary Total Disability.
Although this is a weekly benefit, many insurance companies prefer to pay it every two weeks (if at all). The weekly amount is calculated as two-thirds of your average weekly wage ("AWW"), subject to maximums and minimums.
Temporary Total Disability, like all Workers' Compensation Act benefits, is tax-free. If you work regular hours, you can get a good estimate. Simply multiply the number of hours you work on a regular basis each week by the hourly rate.
Also, to be noted is generally overtime is not factored into the average weekly wage.
The important thing to remember is that the insurance adjuster will often underestimate the temporary total disability rate. So, if you believe you are being underpaid, notify the adjuster with the help of an attorney.
To be eligible for temporary total disability, you must have your doctor provide you with work status slips on a regular basis.
The doctor may order to take time off work or impose temporary restrictions that prevent you from performing your job.
In the latter case, your boss may offer you light duty within your limitations. Your temporary total disability will be terminated if you refuse to even attempt this light duty.
So, as long as you're within your limitations, show up for the light-duty job and give it you're all. If doing the job causes pain, see your doctor and have restrictions adjusted accordingly.
Settlement based on the permanency of injury
It's time to start thinking about settling your claim once your medical condition has become permanent.
Permanent indicates that, despite the fact that you may still be receiving therapy (at-home exercises, prescription medicines, and so on), your doctor has judged that you have reached Maximum Medical Improvement ("MMI").
At this stage, your doctor may refer you for a Functional Capacity Evaluation ("FCE") in order to impose permanent limitations on you.
Consider the FCE as a ready-to-wear outfit that may require minor customization. After a few months on the job, you'll have a better idea of what you can and can't do.
After the plaintiff returned to work, schedule a follow-up appointment with the doctor to adjust the limits as needed.
The worth of your case is determined by a number of factors.
The doctor may order to take time off work or impose temporary restrictions that prevent you from performing your job.
These factors include the length of time you're out of work, the type of treatment you receive, whether that treatment includes surgery if you can return to your previous job or must find a new one, whether that new employment pays as well as the old one, and what permanent limits you have.
Special requirements apply if you suffer disfigurement or an injury that causes permanent total incapacity, but this list covers the majority of circumstances.
The determination of the level of permanent partial disability on the following factors:
- The reported level of impairment pursuant
- The injured employee's occupation
- The employee's age at the time of the injury
- The employee's future earning capacity
- Evidence of disability
Reference - Mark Weissburg