What Wage Benefits Are Covered by Workers Compensation?
An injured employee is entitled to two-thirds of any wage loss caused by a work-related injury up to the statewide maximum average weekly wage as determined by the Department of Labor and Industry for the year of the injury. Many times, a dispute arises as to what is included in wages. For example, a car allowance is part of wages, but health insurance is not. Overtime worked in the past is required to be used in the calculations, not just base pay. Commissions and bonuses are included in the calculations, as is additional part-time income that by virtue of your injury you can no longer perform.
What Do You Do When Your Compensation Carrier Denies Your Claim?
If your employer/workers' compensation insurer denies a claim, you need to see an attorney to see if it is an invalid denial. You have a limited time to file a claim to overcome this denial. The sooner you act, the better off you will be.
What Do You Do When Your Compensation Carrier Tries to Stop Your Wages?
If you are receiving workers compensation wage payments, the carrier cannot stop your weekly checks without an agreement by you to do so, or by an Order from a Workers Compensation Judge. What usually happens is that the employer/carrier gets the idea that you can work, maybe not at your old job, but somewhere doing something. The first thing the carrier/employer usually does is have you examined by a physician of its choosing. If the physician states in a report that you can return to some form of work, then the employer/carrier sends you a "Notice of Ability to Return to Work." This warning notice advises you of your alleged ability to work and the legal consequences of not returning to work.
The next thing the employer/carrier might do is to make a specific job offer at the employer with or without restrictions as outlined in the medical report. If there is no offer of a specific job, then the employer/carrier might hire a vocational examiner to find work available in the marketplace, who in turn will notify you of these "job opportunities." Or the employer might choose to have the vocational examiner assess your earning capacity based on doing a labor market survey of available jobs in the regional economy that fit your medical restrictions.
Once any of these evaluations occur, the employer/carrier will likely file a petition to reduce or stop your compensation payments based on the medical or vocational opinions. This will be in the form of a Petition to Modify, Suspend, or Terminate benefits. In addition, the employer/carrier will be asking the Judge to immediately stop payments. This is called a Supersedes Request. If it is granted, then your benefits will stop. You obviously need an attorney before the Supersede hearing, which is scheduled within a 45-day period of time. You should contact an experienced workers compensation attorney in our firm as soon as the request for a medical exam occurs.
Why Else May I Need an Attorney in a Workers Compensation Case?
You may need an attorney for some of the following reasons:
- To correct the amount of weekly benefits
- To correctly describe the injury for the records
- To fight unreasonable requests for medical exams
- To defend attempts to reduce or eliminate benefits
- To reinstate previously stopped or reduced benefits
- To get medical bills paid
- To get appropriate medical treatment
- To help you negotiate the resolution of your claims to a lump sum
Lump-sum settlements are called Compromise and Release Agreements. The correct valuation of a claim for a lump sum settlement is something that needs experience and understanding of how the system works.