Workers’ Comp Basics
There are several basic rights an injured worker has after suffering an accidental injury or occupational condition arising out of his/her employment – medical coverage, disability benefits while out of work, and permanent disability benefits.
Workers’ compensation laws provide for lifetime medical benefits which stem from your work-related injury. You should not have to use your health insurance for coverage, which can result in significant amounts of money for co-pays and non-covered treatments. Additionally, you have the right to be treated by doctors of your choosing, provided that they accept workers’ compensation insurance. Often, you may be required to initially see a medical provider chosen by your employer, examples of which are Occupational Health, or Mercy PSI, depending on your department. In my experience, the doctors who see injured workers on behalf of the employer or insurance company often release people back to work as quickly as possible with as little treatment as possible. Injuries sustained by officers, in particular, should be properly diagnosed and treated as thoroughly as possible – you depend on your body to perform your job duties, and keep you and your co-workers safe. What may seem like a shoulder or knee sprain could be something more serious. Sometimes, it may be necessary to see an orthopedic or other specialist to get the proper diagnostic tests and most effective treatment recommendations. If necessary, you may require time to heal. Light duty or no duty may be warranted. Returning to work too soon can sometimes result in further injury or an extended recovery time. It is not only important, but also comforting to know that your medical provider has your best interests at heart when dealing with this vital issues.
Temporary Disability Benefits
Another essential right provided for by worker’s compensation law allows for payment of wages if your injury prevents you from working. You may also be entitled to compensation if you have light duty restrictions which cannot be accommodated by your employer. Generally, you are entitled to receive two-thirds of your average weekly wage, tax free, while out of work. There are a number of departments, however, which provide additional benefits for their officers. These benefits may be referred to as “accident leave”, or “a-time”. The basic premise is that rather than receiving temporary total disability benefits from its insurance company, your department would pay your regular salary and withdraw your normal deductions (e.g., heatlh insurance, 401k). This added bonus allows for as little disruption as possible to your finances if you need time to recuperate from your injury. You can call me or check with human resources to see if your agency offers these benefits.
If you injury or occupational conditions leaves you with ongoing symptoms or problems, you may be entitled to a monetary award known as permanent partial disability benefits. This does not mean that you are unable to return to work or perform your job duties. Rather, your award is based on whether there are any differences in your physical (or sometimes mental) condition at the end of your active medical treatment, versus before your injury. The amount you receive will be determined by a number of factors, including what body part is injured, the type and extent of your injury, and disability ratings provided by both a doctor of our choosing and one selected by your employer’s insurance company. Attorney fees are based on the amount of the award, and generally do not exceed twenty percent of what you receive for your disability.
Notice Requirements/Filing a Claim
In order to ensure that you receive the substantial benefits to which you are entitled from a workers’ compensation claim, there are certain procedures which must be followed if injured on the job. Notice is the first requirement. Although there are some exceptions, you must generally provide your employer with notice of your injury within ten days of the accident. In the case of an occupational condition, notice must be provided within one year of time that you know or have reason to believe that your job has substantially contributed to your diagnosis.
Secondly, a claim must be filed with the Maryland Workers’ Compensation Commission. Even if you notify your supervisor, and even if your department’s insurance company assigns an adjuster to your claim and begins to pay for treatment, this does not constitute “filing” a claim. If an Employee Claim Form is not filed with the Commission, you will not be able to request a hearing, or have any recourse, if a disagreement arises. Disputes with insurance companies are common, and can include whether an accident took place, whether medical treatment is appropriate or necessary, whether a period of light duty is necessary, and when you should be released back to full duty. If no claim is filed, there is no forum in which to resolve these differences. Additionally, you will not be able to request a hearing in order to receive your award for permanent partial disability benefits. If injured, please contact me as soon as possible so that I may file your claim and help make sure that the process with your department and its insurance company goes as smoothly as possible.