Workers' Compensation Lawyer FAQ

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What is workers’ compensation?

Every state has passed workers’ compensation laws that provide benefits to employees injured at work. These laws have a variety of names, such as workers’ compensation, workman’s compensation, worker’s compensation, or work comp. These laws require that employees suffering on-the-job injuries receive compensation to replace lost wages and cover medical expenses. Most state laws provide that employers must either carry insurance through a private carrier or show that they can self-insure against claims by workers injured on the job. Other states provide that employers must pay into a state workers’ compensation fund.

Workers’ compensation is a no-fault system. No matter what caused the injury – worker’s negligence, employer’s negligence, or a combination of the two – workers injured on the job receive benefits under the law.

For the most part, states, rather than the federal government, regulate workers’ compensation. However, some workers, such as maritime and railroad workers, are covered by federal, rather than state law. The Federal Employees’ Compensation Act (FECA) covers on-the-job injuries sustained by federal employees.

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Workers’ Compensation Dos & Don’ts?

If you are injured on the job…

DO…

  • Report injury immediately to employer
  • File a written claim immediately
  • Seek medical treatment
  • Give your doctor a complete and accurate history
  • Go to your doctor, not the employer’s doctor
  • Seek legal advice if:
    • Your claim is denied
    • You do not understand what is happening or
    • The insurance company wants to settle

DON’T…

  • Assume the problem will go away
  • Assume the information you get from the employer or insurer is accurate
  • Provide any false or misleading information to your doctor, employer or insurance carrier

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What are an employer’s responsibilities under workers’ compensation laws?

Employers in all 50 states have to provide workers’ compensation coverage according to their state’s laws and regulations. The laws in some states provide an exception for some very small employers and allow some large employers to be self-insuring. In addition to providing coverage, however, employers may have additional responsibilities. These include:

  • Posting notices of compliance with the workers’ compensation law of the state at each work site
  • Making sure that reports of injuries are made to the appropriate workers’ compensation office
  • Providing a written report of all accidents resulting in injury in which a worker loses a certain amount of time
  • Providing immediate emergency medical treatment for employees who sustain on-the-job injuries
  • Fulfilling all requests for further information requested by the state’s workers’ compensation enforcement agency
  • Furnishing medical attention if the worker is unable or unwilling to find a physician on his or her own

Most state laws prohibit employers from discriminating against employees who file workers’ compensation claims. Each state also provides for penalties and fines for employers who fail to fulfill their responsibilities under the law. Each state has an administrative process to make a claim of violation of workers’ comp laws against an employer. If the employer fails to defend against the claim, or, after defending against the claim, is found to have violated the law, the law provides for fines and penalties to be assessed against the employer.

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Are there time limits for filing claims?

Yes, you must file within 90 days of your injury. You should file immediately because any delay will be used to discredit your claim.

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Why was my claim denied?

Usually this is because your employer’s doctor said your injury was NOT work-related or was a PRE-EXISTING condition. This is where things can get very complicated and legal advice is important. Remember, your employer and their insurance company want to limit what they pay; they are not necessarily focused on helping you recover.

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Can I go back to work while I am under doctor’s care?

The workers’ compensation system provides very low benefits for permanent disabilities. If you can get a job that will allow you to be financially independent of the system, you should take the job. Since each situation is unique, check with us if you have any questions.

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If I receive a DENIAL, should I keep seeing a doctor?

Yes, even though your claim is denied, if you ultimately want time loss, you need to continue going to a doctor and that doctor MUST be authorizing time loss.

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What if I don’t agree with the doctor’s report?

You can select your own treating doctor by just notifying the insurance company. You can change treating doctors two times.

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Can I see a chiropractor?

Yes, from the time of the first visit for 30 days or 12 visits whichever occurs first. If an M.D. or D.O. refers you to a chiropractor you may be entitled to see one, more times. If you are currently seeing a chiropractor, it would be advisable to consult with him/her to find out where you should seek treatment.

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Am I entitled to palliative care?

Palliative care is care not directed toward curing the condition and is rendered after you reach medically stationary status. Palliative care includes physical therapy that makes you feel better but does not cure the condition. For the most part you will not be entitled to palliative care, unless your physician authorizes it as a necessity to keep you working

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If I return to work or receive other income (Unemployment, Social Security, private disability, etc.) do I need to report it to the insurance company?

Yes. You must report any income received while on time loss. If you do not report the income it can result in an overpayment. You could also be subject to criminal prosecution under some circumstances.

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What if the injury was my employer’s fault?

One of the original intentions for the establishment of workers’ compensation laws was to protect employers from the drastic effects of failing to provide safe work environments. Prior to the passage of such laws, employees who were injured due to their employers’ negligence sued the employers under traditional negligence or personal injury law. Under that system, if the employer was found negligent, the employee could recover not only medical expenses and lost wages, but also such damages as pain and suffering. The parties had a right to a trial and the awards in particular cases could be exorbitant against the employer.

Therefore, workers’ compensation systems, which are considered to be “no fault”, were instituted, giving employees a trade-off of guaranteed and supposedly quicker, establishment of benefits. Employers, on the other hand, gained in that they no longer had to defend against numerous lawsuits since they were granted virtual immunity from lawsuits for their negligence. A determination as to whether the employer’s or the employee’s negligent behavior caused the problem is irrelevant. Some, who find workers’ compensation an uneven trade-off between employer and employee, argue that, under most state workers’ compensation systems, employers often do not have to worry about the cost of possible consequential injuries, even in cases where they are more than merely negligent. However, under certain circumstances in most states, there are injuries for which the employee may either sue the employer or a third party, as in the case of injuries resulting from faulty or defective equipment. If you feel that you were injured due to your employers negligence and would like a free no-obligation consultation, click here.

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Do I have to attend their IME (Independent Medical Exam)?

Yes. During the life of the claim the insurance company can require you to attend three IME’s. If they want you to attend any additional ones they need to request permission through Workers’ Compensation Department. If you get an IME notice, we have a video tape that you can watch which will explain the Independent Medical Exam. Call your appropriate Legal Assistant and she will set up an appointment.

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What is the average Workers’ Compensation Case Worth?

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If I’m injured on the job, who pays my medical expenses?

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Do I need to have an attorney process my Workers’ Compensation Claim?

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How long does it take to process the typical Workers’ Compensation claim?

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What if the injury was my employer’s fault?

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Do I have to attend their IME (Independent Medical Exam)?

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My employers insurance company wants me to give a recorded statement. Do I have to?

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What is Permanent Partial Disability?

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What is Temporary Total Disability?

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How long does it take to determine if I have a claim?

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