WORKERS' COMPENSATION

What is Worker's Compensation?

WHAT IS WORKERS' COMPENSATION:

In the most simple terms, workers' compensation is money you receive when you are unable to work due to an injury on the job.

It is NOT the same as a personal injury claim or other type of injury claim where you are involved in an accident of some kind and you sue for your damages.  For example, outside of work, if you are involved in a car accident and as a result of the accident you break your arm and miss three weeks from work.  Under this scenario, you would seek damages from the Insurance Company that insured the vehicle that was at fault for the accident.  The damages you would seek would be for your lost wages, out of pocket expenses, medical bills and pain and suffering.

The difference with a Workers' Compensation claim is that it has to be an injury on the job and you are not entitled to any compensation for your pain and suffering.  This is one of the more difficult things for people to accept.    You are entitled to have all reasonable medical bills paid and you are entitled to collect a % of your weekly wage for every week you are out of work and that is it.  There are certain exceptions that may entitle you to other forms of compensation but that are case specific and not the typical scenario.

When you are hurt on the job your employer begins the claim process. If you need medical attention your employer must notify its workers’ compensation insurance company of the medical bills. The insurer (your employer's workers' compensation insurance company) will issue you an insurance card, with a claim number, which you will give to your doctor so the medical bills can be sent directly to the insurer. If you don’t get this card promptly after your injury, contact the insurer. Most medical providers will be looking for this number. When you see a doctor or other health-care professional make sure you inform them that you are seeking treatment for a work-related injury. If they accept you as a patient, they are agreeing to bill the insurer for your treatment. The insurer is responsible for the entire bill; there is no co-payment you need to make.

If you are disabled, unable to earn your full wages for a period of five or more calendar days, your employer has to report your incapacity to its insurance company and to the DIA on an Employer's First Report of Injury/Fatality form (Form 101). These five days do not have to be consecutive, and any day you are totally or partially disabled is counted.

Your employer must furnish this report within seven calendar days, not including Sundays and legal holidays, of your fifth calendar day of incapacity. If you report the injury to your employer after you have already been disabled for five or more days, your employer is obligated to file the Form 101 within seven days of the day you actually reported the injury to them. If your employer does not send this report to the insurer, you should report the injury to the insurance company yourself. Your employer should have displayed in the workplace a poster, with the name and address of its WC insurer, and other information. If your employer does not have this poster up, and will not tell you the name of its insurance company, the DIA’s office of insurance (x 405) will try to help you.

The insurer must begin to pay you for lost wages or send you a notice of denial that includes its reasons for the denial, within 14 days of receiving the Form 101 from your employer. This means you should start getting a check within three to four weeks after your injury. You will receive compensation for lost wages for any days you are disabled after the first five days. You are not compensated for the first five days of incapacity unless you are disabled for 21 days or more.

The insurer may pay benefits to you for up to 180 days without making a final decision on your case. This is referred to as the "Pay without Prejudice" period. During this initial period the insurer may stop or reduce your payments by giving you seven days written notice of the termination or reduction. They must give the reasons for taking this action. If the insurer continues paying you past this period, they will, in most cases, need permission from you or a judge to stop or reduce your benefits.

Please note: The 180-day “Pay Without Prejudice” period can be increased by the insurer to one year, with your written consent, on a Form 105 “Agreement to Extend 180 Day Payment Without Prejudice”. The Department must approve the Form 105. You should make sure you are aware of all your rights before giving your consent, or signing any other document.

Next: What if your claim is contested? >>