What is a Workers Compensation Case?
A workers' compensation case is a legal procedure which occurs when an employee is injured while on the job. It is designed to safeguard workers from losing their income and to pay for rehabilitation and medical treatment.
In the course of a workers' compensation case it is possible for an injured worker to receive medical care as well as wage loss benefits and even a settlement.
1. Medical Treatment
When an employee is injured on the job, their comp insurance usually covers medical treatment. This covers the first emergency treatment, which could include an ambulance ride, and ongoing care including medication and physical therapy.
Workers who are injured also have the right to travel reimbursement to help pay for transportation to and from their doctor's appointments. This is especially beneficial to employees who suffer injuries that require surgery.
Employers can opt to join a managed care organization or preferred provider plans in the majority of states to treat work-related injuries. This allows both the employer and the insurer to reduce costs by controlling the quality of medical treatment.
The choice of a medical professional to treat you is essential, as you may need an expert in treating your specific injury. Your doctor may refer you to specialists to conduct further tests or evaluations.
The list of Board-approved providers will be provided by your doctor's office. However, there are some exceptions. You should verify to confirm that your doctor's name is on this list prior beginning treatment.
It is important to follow the instructions and guidelines of your doctor once you've discovered one. If you don't, it could negatively impact your claim for workers' compensation benefits.
Also the Workers' Compensation Board frequently changes its Medical Treatment Guidelines. This is based on new information and advice from doctors. These changes can sometimes cause harm to injured workers. An experienced attorney can help you know how these changes affect your case.
A proper medical treatment is essential in a workers compensation case to prove that you suffer from an injury from work and are eligible to receive the compensation for lost wages. Your doctor will need to confirm the connection between your symptoms with the workplace. You cannot return to your previous occupation or engage in other activities, unless special work restrictions have been imposed on you.
It is also important to note that in certain states, employers must pay for diagnostic tests such as x-rays and ultrasounds. These tests are designed to determine if the symptoms are due to work and help you understand the severity of your medical condition and the steps needed to treat it. Employers are also required to pay for any reasonable and essential procedures, implantations, or injections prescribed by your doctor to help you recover from your injury.
2. Wage Loss
Wage loss is the capacity to replace income lost due to an injury. This is one of the main benefits of workers compensation. Based on the state where you work, you could be entitled to as much as two-thirds of your wages prior to injury.
The severity and age of your injury will affect the amount you are awarded. In addition there are many jurisdictions that place a cap on the total amount of wage loss per week that you are entitled to while you are receiving workers compensation.
A good way to ensure that you are getting the maximum claim possible is to submit your claim as quickly as you can. Also, you must adhere to deadlines and notify your employer as soon as possible.
An experienced attorney in worker's compensation is the best way to determine if you have a valid claim. This will guarantee you receive all benefits provided by law that include lost wages and medical expenses. You may be eligible for a higher benefit rate if your employment records show that you have been actively looking for work following the accident. This is particularly relevant if you've been out of work for a significant time or are dealing with significant medical restrictions that prevent you from returning to your former employment. The best part is that you don't need to cover any fees or out-of-pocket expenses!
3. Litigation
The first step of the litigation timeline is to submit a Claim Petition that puts your case in the court system and initiates the process of litigation. The claim petition will outline the kind of injury you suffered, when it happened, how it happened, and any other information. The insurance company or employer may or may not respond to this petition however once they do, it is then in the hands of an individual judge who will determine the amount of benefits you receive and the duration of your benefits.
The Workers' Compensation Board is able to resolve certain disputes without having to conduct an appeal. This includes disputes over whether the injury was caused by work or not, the degree of disability, monetary awards payable to you, and what medical treatment is appropriate.
For more complex disputes, it is necessary to have a formal hearing before a Workers' Compensation Law Judge. The judge will consider evidence from both sides before making a a decision regarding the amount of benefits you will receive.
During the hearing the attorneys will present written arguments to the judge. These arguments will detail the evidence they've gathered and their positions on the issues that are being discussed.
If the judge agrees with both attorneys, they will issue a written decision that outlines the outcomes of the hearing, and your workers' compensation claim is closed. You will receive a copy the Decision by mail.
If your employer or insurance company are not happy with the claims investigation, they will often request an independent medical exam (IME). This is a doctor's exam that your employer pays for in order to examine you and collect evidence.
The IME is a critical part of the litigation timeline because it gives your employer important medical evidence. The IME will review your medical records and provide a report on your injuries as well as the treatment you received.
Once your IME is completed, the employer is likely to hire an attorney to defend its side of the claim. This can be a complex procedure that requires multiple legal experts and a considerable amount of time on the part of the employer.
Workers who have suffered injuries who are taking medications for pain as part their treatment might need to be monitored carefully in the course of litigation, panelists noted. They could be addicted when they consume too much or take the wrong medications.
4. Settlement
A workers compensation settlement is a contract between your employer and the insurance company that will pay you a specific amount. This can be a lump sum settlement or it could be broken down into regular payments over time.
A workers' compensation settlement can be an effective option to stop the long process of managing your workplace injury. You shouldn't sign the settlement without consulting an experienced attorney.
You could receive a workers' comp settlement for your medical expenses, lost wages and other costs related to your injury. Settlements can help you pay for future expenses and keep you from filing a lawsuit.
Each state has its own laws on worker's compensation settlements. However you have the option of choosing whether to settle your case with a lump-sum payment or structured payments. The amount of your settlement will depend on your specific situation and the severity of your injuries.
The typical workers' compensation settlement is $12,000. But, it can vary based upon the nature and severity of your injury. The lawyer who handles your workers' compensation will estimate the amount of your settlement and assist you to make an informed decision about the time to settle.
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