Frequently
Asked Questions about Workers Compensation
(Note: the following questions
and answers provide generalized comment on Bankruptcy
law and procedure in Colorado and may not apply in all
fact situations. They are not a substitute for
consultation with an experienced attorney.)
1.
Can I receive
benefits under Workers Compensation?
2.
Are there rules regarding
notifying the employer of an Injury?
3.
What medical
benefits am I entitled to?
6.
What permanent
benefits are available to an injured worker?
7.
Can I appeal the
impairment rating given by my treating physician?
You may
receive Workers Compensation benefits if you are injured
in the course and scope of your employment. It doesn't
matter how the accident happened, even if it is your
fault, unless you have clearly gone outside the scope of
your job.
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There
are many rules that affect a worker's case. You are
required to report an injury to you employer, in
writing, within 4 days of the injury, or risk loss
of benefits. The statute of limitations for filing a
claim for benefits is two (2) years and you
should respect this limit. However, in some special
circumstances the time period may be extended. For
example, in a case where a worker is unaware
immediately that he has been injured by his job, the
limitation period may extended.
In any
event, notify the employer or supervisor as soon as you
are aware of an on-the-job injury. You should also
obtain the names and contact information of any
witnesses to the accident in case your clam is
challenged.
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If
injured in the scope of your employment, you are
entitled to 100% coverage of your reasonable and
necessary medical care, without co-pays or limits, until
you reach maximum medical improvement (MMI). If you are
determined to be Permanently Totally Disabled, medical
care continues.
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Generally, No. The employer has the right to name the
initial treating physician, another reason why you need
to notify the employer of your injury as soon as
possible. In certain cases, such as an emergency or
where the employer fails to name a physician, you can
seek your own medical care. However, the employer or
its insurer might refuse to pay for unauthorized medical
care, so you should beware in this circumstance.
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A.
Temporary Total Disability (TTD)
Temporary Total Disability generally is payable when,
due to your injury, you are unable to perform your
usual job while you are undergoing medical treatment,
unless your employer provides "light duty" work which
your treating physician says you can perform.
Initially, you do not receive temporary benefits for the
first three days of disability, but after you are
disabled for ten days, you are reimbursed for the first
three days.
TTD
is paid at the rate of two-thirds of your average weekly
earnings, to a current maximum of $ 659.12 per
week for injuries after 7/1/2003. The maximum is lower
for injuries before that date.
You
are not entitled to TTD if your employer provides
medically approved light duty work at your normal
average weekly wage. Caution: if you unreasonably
refuse an offer of light duty, your employer may cut off
your disability payments.
B.
Temporary Partial Disability (TPD)
If
you are able to work part-time, or at a lower rate of
pay while you are treating, you are eligible for
Temporary Partial Disability (TPD) payable at the rate
of two-thirds of the money you have lost (the difference
between what you make now and what you made before).
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A.
Permanent Partial Disability (PPD)
Permanent partial disability is only determined after
you have become medically permanent and stationary
(reached maximum medical improvement or MMI) and are
able to return to some form of work, even if it is not
your customary occupation.
When your treating physician determines that you are at
MMI, and believes that you have sustained some permanent
physical impairment, he will arrange for you to receive
an impairment rating under the Colorado statutory
system.
The
impairment rating will be converted to a monetary sum
under formulas and charts within the Workers
Compensation statute. This money (PPD) is then paid to
you over time, bi-weekly, unless you request a lump sum
payout. Lump sum payouts are subject to a discount for
early payment using a 4% discount factor.
There is a cap on the total of the PPD and TTD/TPD paid
paid to a worker of $60,000 for impairment ratings of
25% whole person or less, and $120,000 above 25%.
B.
Permanent Total Disability (PTD)
An
award of Permanent Total Disability is rare as it must
be proven that you are incapable earning any wages at
all. Certain conditions such as the loss of use of both
arms or both legs or the loss of use of both eyes are
presumed to be PTD. PTD is paid at the temporary
disability rate for life, or until you are is no longer
so impaired and are able to return to work.
C.
Death Benefits
Death benefits are paid to the dependents of a worker
who dies as a result of the work-related injuries. The
calculation of death benefits is not covered here
D.
Disfigurement
A
maximum of $2,000 is payable to a worker who is
permanently, visibly disfigured by a work-related
injury.
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Yes, there is a procedure for contesting the impairment
rating by obtaining a Division Of Workers Compensation
Independent Medical Examination. The exam must be
arranged within a short period of time of obtaining the
initial rating. The use of this procedure is not
without risk, however, and an experienced attorney
should review your rating, compensation file and medical
file before this procedure is used.
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The
workers compensation laws were created to encourage
employers to carry insurance on their employees for
injuries on the job. The trade-off given to the
employer is that if it carries workers compensation
insurance, it is immune from suit for injuries sustained
by its employees. This immunity also extends to
co-workers. There are some narrow exceptions for
intentional, willful types of conduct by an employer
resulting in injury.
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A
typical workers compensation case consists of two
parties. The injured worker and the employer. Workers
Compensation is a "no fault" system which means that it
does not matter how you got hurt at work so long as you
were hurt at in the course of your job. However, if you
are injured through the negligence of a "third party"
(someone other then your employer and co-workers or
yourself), then you may still have a claim against that
third party based on that party's fault. If the other
party has caused you injury and caused your employer to
have to pay for your medical care or pay you benefits,
then the employer has also been damaged by the third
party and also has a claim against that other person or
entity.
For example, if
you have an accident with another vehicle through the
negligence of the driver of that other vehicle while you
are working, you are entitled to workers compensation
benefits. However, since you are also injured through
the negligence of another driver who is not employed by
your employer, (a "third party"), you and your employer
may make a claim against that other driver. If that
other driver is also driving in the course of her
employment and he is working for a company, then you and
your employer also have a claim against the company
which employs the other driver.
In this case,
the workers compensation case and the "third party" case
are separate. The "third party" case is handled in
civil court just like every other car accident case.
But you must inform the Workers compensation insurance
carrier if you believe that you have a third party
claim.
While you can
waive your rights under workers compensation and pursue
the claim strictly as a negligence case, you would be
giving up of the benefits which you could have through
the workers compensation claim such as temporary
disability and medical benefits. In most cases it is
preferable to take the workers compensation benefits
while developing the negligence case.
The employer
does, however, have a lien upon the third party case for
the disability benefits paid to you. Therefore, the
pursuit of the third party must generally include the
participation of the employer who will want
reimbursement of its lien. Usually, a deal is worked
out between the injured worker and the employer to make
it worthwhile for both parties to pursue the third party
defendant.
However, these
third party lien cases can be very complex legally, and
the advice of counsel is essential in obtaining a proper
result.
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PLEASE FEEL
FREE TO CONTACT US FOR FURTHER EXPLANATION OR
INFORMATION REGARDING THE SPECIFICS OF YOUR SITUATION.
