Workers Compensation Insurance is the result of a mutual “exchange” between employees and employers. Employees give up the right to sue their employer for injuries cause by the negligence of the employer.
In exchange, the Employer agrees to have insurance in place to pay benefits for their employees who are injured on the job. This insurance covers you regardless of who is at fault. You get the same workers compensation benefits if you, your employer, another employee, someone else, or no one at all caused your injury.
There are two types of work injuries – accidents and occupational diseases. Work accidents are injuries that can be traced to a particular incident and place in time. For example, “I was lifting this box and felt my back pop painfully.” Occupational Diseases are injuries that occur over time as a result of the conditions of employment. For example, “My repetitive constant overhead lifting caused me to develop shoulder pain over time.”
In general, workers injured on the job are entitled to three major worker’s compensation benefits and a number of minor benefits under Colorado Law. The major benefits are medical treatment, temporary disability (Lost Wages), and permanent disability. The minor benefits include mileage to and from medical appointments, disfigurement, interest, and in some case, penalties.
Medical Treatment Benefits
Medical benefits are to be provided at no cost to you. The insurance company pays all reasonable medical expenses, such as doctor’s care, physical therapy, medication, glasses, hearing aids, braces, artificial limbs, and mileage to and from the appointment. Non-prescription medicine such as aspirin is not covered.
Your employer, not the carrier, must give you a choice of physician between two designated treating physicians. Whichever clinic you choose will be your “authorized treating physician”. Your employer must give this choice of physician immediately when you tell your employer about your injury. If your employer does not – you have the right to choose the doctor.
Once a doctor is “authorized”, any other doctor that he or she refers you to for care and evaluation is also authorized. The carrier cannot, by law, tell the doctor to whom he or she may or may not send you.
People have many questions regarding medical bills. Often times a medical provider will send you a copy of the bill. This bill shows when you received the care, by code number, what care you received, and what charges are being made. Please give these itemized bills to our office. We send them to the insurance company so that we know they have received them. The doctors are responsible for billing the insurance carriers and working with them on any medical bill questions.
PLEASE UNDERSTAND THAT UNDER NO CIRCUMSTANCES ARE YOU EVER TO PAY ANY PART OF A MEDICAL BILL FOR AUTHORIZED REASONABLE MEDICAL CARE IF YOU HAVE AN ADMITTED CLAIM. However – if you get medical care that is not recommended or referred by the authorized treating physician – the carrier will not pay for it and you may have to pay for it.
You will get medical care until the doctor places you at Maximum Medical Improvement or MMI. The doctor may also use the term discharge you from care. MMI does not mean you are cured – it only means that the doctor doesn’t know of any more treatment options that will likely improve your condition. In other words additional therapy, rest, injections or surgery will not get you any better. When the Doctor tells you that you are at MMI or will soon be at MMI – notify my office.
Temporary Disability Benefits (Lost Wages)
If your injury causes you to lose income during your medical treatment, the law provides for lost wage benefits – called temporary total and temporary partial disability benefits. The amount of the temporary disability benefits is two-thirds of your average weekly wage up to a maximum amount per week.
Your average weekly wage is determined by the date of your accident. Your average weekly wage includes more than the money (before taxes) that you are paid at work. It sometimes includes costs of group health and life insurance benefits and often times, company bonuses (but not all bonuses are included in this computation).
Temporary total disability is paid when you are unable to return to work due to your physical restrictions while treating. Temporary partial disability is paid when you are able to return to work on a reduced level.
Sometimes, if you are off work – your employer may offer you a modified job that has been approved by the treating doctor. As long as this is a good faith offer – it is helpful for you to return to work for many different reasons. You will actually receive more money working then receiving temporary disability. Staying at home for a long time can be depressing and may prolong your treatment.
In order to receive temporary disability benefits you must have physical restrictions and be treating for your industrial injury. The moment the Doctor tells you that you are at MMI or that you may return to regular duty without restrictions your right to temporary disability benefits ends.
Permanent Disability Benefits
There are two types of Permanent Disability Benefits: (1) permanent impairment (also known as Permanent Partial Disability) and (2) permanent disability also known as Permanent Total Disability).
Permanent impairment benefits are determined by the percentage of impairment the authorized treating physician determines that you have. It is important to know that the amount of impairment you have does not depend on whether you are working or not, how much pain you have, or even what your physical restrictions are. The nature of your injury and extent of the condition determines the amount you receive.
Permanent Total Disability Benefits compensate you for your inability to work after the doctor places you at MMI. However, these benefits are only available in those rare cases where a person is unable to earn any wages at all at any type of employment. If you are able to work at “McDonalds” for minimum wage for ten hours a week – you cannot get any permanent total disability benefits.
Mileage to medical appointments is to be reimbursed to you by the insurance company. We will give you sheets to keep track of mileage. Keep track of all your mileage and every few months give us those sheets and we will request the money from the insurance company to be sent to you.
Disfigurement benefits are awarded if you have a scar or other deformity as a result of your work injury or the later medical care. The disfigurement must be to a part of the body normally exposed to public view (think swimsuits) and is available not only for scars as a result of surgeries, limps, loss of range of motion, canes, walkers, hearing aids, and braces.
Interest is due for benefits that have not been timely paid.
Penalties are also available to injured workers who have been harmed by the insurance carrier or employer if they do not follow the law in paying or approving your workers compensation benefits.
The law governing what benefits you receive – and how much – is extremely complicated and detailed. It is critical for you to talk with our office so that you have an experienced lawyer working hard to make sure you get the benefits you deserve. Find out why by clicking “What You Must Know” and how we can help you by clicking “Why You Need Kaplan Morrell”