When you are hurt at work in an accepted case, you are entitled to receive payment of benefits for an “injury by accident” or an “occupational disease.” To be covered, an “accident” must (1) occur at work or during a work-related function; (2) be caused by a specific work activity; and (3) happen suddenly at a specific time (most injuries incurred gradually or from repetitive trauma are not covered, although diseases caused by repetitive trauma may be covered). For an occupational disease to be covered, it must (1) be caused by the work; (2) not be a disease of the back, neck, or spinal column; and (3) be supported by medical evidence. For additional information, please contact us.
When you get hurt at work and can’t immediately return due to your injuries, how much will you be paid a week? If you are temporarily unable to perform any work, you are entitled to 2/3 of your gross pre-injury average weekly wage (in an accepted case). There must be seven days of disability before benefits are payable. However, if you are disabled more than three weeks, you do receive payment for the first seven days. If you cannot return to your regular work and are given a light duty job earning a wage lower than your gross pre-injury wage, you can get 2/3 of the difference between your pre-injury wage and the wage currently being earned (subject to marketing/job search requirements if you are not under an award order). The weekly amount paid to you is limited by minimum and maximum rates; currently, the maximum rate $1,043.00, and the minimum rate is $260.75. Wage replacement benefits are payable for a maximum of 500 weeks (unless you are permanently totally disabled). For additional information, please contact us.
You may have heard your physician mention maximum medical improvement (MMI). In workers’ compensation, MMI means that your physician believes you have recovered as much as you are going to. This doesn’t mean you shouldn’t keep treating, rather it means that your physician no longer expects improvement. However, if you are in pain we recommend that you keep treating. Continuing to treat also keeps the carrier aware that you do need additional medical care related to your injury. Ongoing treatment at least a few times a year helps keep your case active with the carrier and with your physician. Once you reach MMI, your physicians may discharge you to return “PRN”, which is treatment as needed. You can (and should) still make an appointment to return to your physician periodically. Once you reach MMI, if you have an injury to an extremity (leg, arm, hand, fingers, etc.) the question of whether there is permanent impairment should arise. If you have reduced range of motion or reduced strength due to your workers’ compensation injury, there may well be permanent impairment. A permanent impairment award is a way to get more money to you, without settling or closing your case. If you are at MMI and believe you have a permanent impairment, please contact us for additional assistance.
After you report your injury (and it is an accepted injury) the employer or carrier is supposed to offer you a panel of three physicians. Picking a doctor is a very important decision because once you choose your doctor, he becomes your authorized treating physician. Many people simply look at the list and choose the one closest to them; however, it is wise to research the doctor you are selecting, as some are better than others. Sometimes an emergency room will also refer you to a physician for follow-up care. In an accepted workers’ compensation case, you are entitled to mileage reimbursement for authorized treatment, so traveling a little further is still covered. After you have selected your doctor, contact the workers’ compensation carrier (or your attorney if you are represented) to get your first appointment scheduled. The carrier will provide the doctor’s office with authorization and carrier information so that all medical billing will be sent to the carrier. If you are not provided a panel of physicians, or your case is denied, please contact us. It is important to treat promptly for your injuries.
With an established workers’ compensation claim, you are entitled to mileage reimbursement for your medical treatment. This includes trips to your authorized treating physician(s), physical therapy, and diagnostic testing. Only medical treatment is covered, so mileage to the pharmacy for prescribed medication is not reimbursed. Many people aren’t aware of their entitlement to mileage reimbursement, as the workers’ compensation carrier will not reimburse mileage without a specific request from the injured worker. The mileage reimbursement rate is currently $0.555 cents a mile. This can really add up, as it is over a dollar for two miles. To obtain mileage reimbursement, you need to send the carrier the dates of your medical treatment, the round trip mileage and where you started and ended (the carriers often check the distance themselves) and the nature of the medical treatment. We suggest making a copy of the documentation you send and give the carrier a month to respond. If after that you didn’t receive the reimbursement, contact the carrier. If you are represented by an attorney, give the mileage reimbursement paperwork to your attorney and let them know if you don’t receive the reimbursement. I have seen numerous cases where the mileage reimbursement amounts owed has been in the hundreds of dollars or even more!