Workers’ compensation is designed to provide lost wages and medical care as benefits that get victims back to work and back to life after suffering an injury in the workplace.
To that extent, injured victims receive money for both rehabilitative therapy and vocational therapy. The former is designed to restore mobility and everyday functions, while the latter helps injured workers reacquire the skills they need to excel at their jobs. The former is essentially physical, while the latter is more psychological and emotional because the mental damage from an injury can be as significant as the physical damage.
Rehabilitation is almost always necessary after a serious workplace accident. Sometimes the therapy lasts for a few weeks, and other times it may last for several years. Either way, workers’ compensation pays 100% of these costs.
Procedure in Workers’ Compensation Cases
There are very strict formal and informal time deadlines in these matters, and failure to follow them could effectively derail a claim.
Injured workers must immediately report their injuries to their supervisors. Technically, oral notification is sufficient, but written notice is better, even if it is in the form of a text message, instant message, or email. Formal written notice must follow within thirty days. Many victims delay such reports because their supervisors promise to pay their medical bills if they do not report their injuries. However, if employers renege on this promise, which nearly always happens, the time deadline for filing a claim has passed and victims have no recourse. Other victims do not report their injuries because they are not in pain or do not consider the matter serious. Always report the injury, anyway, because symptoms may worsen over time.
As for the informal deadline, it is important to see a doctor as soon as possible after the incident. If there is any delay, even if only for a few hours, the insurance companies often later claim that the injury was not as serious as the victims claim them to be, and the hearing officers often reduce benefits as they see fit.
After formal notice, there is a follow-up by the Insurance Company who provides the workers’ compensation coverage for the Employer. That is why it is important to document every aspect of your claim so that the Insurance Carrier will not be able to argue that there was no evidence, notice or other requisite information that they feel was lacking in order to deny your claim.
Benefits in Workers’ Compensation Cases
Injured victims are basically entitled to three types of benefits.
As for lost wages, the insurance company typically pays two-thirds of the workers’ average weekly wage until they can return to work; victims who are permanently injured and either cannot return to any kind of work or must accept a lower-paying position usually receive fixed-sum annuity payments. Partial wage benefits are capped at 104 weeks and disability payments end at age 75. All these awards are tax free.
The formula may seem straightforward, but it is actually rather subjective. Many people change jobs frequently, and so the wages that workers earn in January and February may not be on par with their pay in May and June. However, the insurance company often simply takes an average based on the last fifty-two weeks. Attorneys are there to ensure that the calculation is accurate. Moreover, many workers receive non-regular wages, such as performance bonuses and non-cash compensation (e.g. tuition reimbursement). In most cases, occasional and non-cash compensation should be part of the wage calculation.
The second component is medical bills. In Florida, most injured workers must see doctors that the employer assigns, so most victims never see a medical bill. The insurance company usually has a pre-set schedule that determines payment in each case, and injured victims are typically not responsible for any unpaid expenses. As a bonus, this system often undercuts the argument that the doctor pursued medically unnecessary treatments because the insurance company lawyer is in a poor position to second-guess the insurance company physician.
The final component is physical therapy. As mentioned earlier, there are two types of physical therapy and workers’ compensation pays for both. Many times, the company doctors try to cut off therapy too early by claiming that the injured workers have reached their MMI (maximum medical improvement). Although seeing another treating physician may not be an option (victims do have a one-time option to see another doctor, but that new physician must also be one that the insurance company chooses), an attorney often partners with an independent physician who can review the file and render an opinion based on the latest evidence-based techniques.
In some cases, mostly those that involve a defective product, negligent co-worker, or reckless endangerment on the part of the employer, injured victims can sue outside workers’ compensation and obtain money for noneconomic losses, including pain and suffering, loss of enjoyment in life, emotional distress, and loss of consortium (companionship).
You can count on an experienced attorney from Barnett, Lerner, Karsen & Frankel to fight for maximum benefits in workers’ compensation cases.
Injured workers are entitled to compensation for lost wages, medical bills, and physical therapy. At Barnett, Lerner, Karsen & Frankel, we can help you.