Most lawyers will answer this question by telling you that workers’ compensation is an administrative system designed to provide compensation to injured workers and their families. Technically correct, this answer misses the heart of the most important body of law this country has ever known.

In its essence, workers’ compensation is a compromise between injured employees and their employers. This is not to say that workers’ compensation is an agreement you reach with your boss, rather it is a compromise forced upon you and your boss by the legislature. Under workers’ compensation, both injured workers and their employers give up significant rights they would otherwise have and gain significant advantages they otherwise would not have. For an injured worker, the most significant right he or she loses is the right to sue his or her employer in court and receive full legal damages. (the most poignant difference between legal damages and workers’ compensation benefits is that workers’ compensation does not provide monetary awards for pain and suffering.) The most significant advantage an injured worker obtains is that he or she is entitled to benefits even if the accident was his or her own fault. As far as your employer is concerned, the most significant advantage conferred to it is that the amount of workers’ compensation benefits they are responsible for paying is often less than what they would have to pay if they were taken to court and lost.

It doesn’t seem fair that my employer should be allowed to get away with paying less than my injury is worth.

In many cases, we agree. It is an unfortunate fact that some employers take advantage of the workers’ compensation system and allow their workplaces to become extremely unsafe. That said it remains extremely difficult to sue your employer in court. While one is most often unable to sue his or her employer in court, this restriction does not apply to third parties who may also have contributed to your injury. Whenever praetorian law group represents an injured worker, we explore every single possible avenue in order to ensure that our clients receive the maximum amount they are entitled to by law.

What does it mean to be on workers’ compensation?

You have often heard that some one is “on comp.” This is a short-hand way of saying that someone is disabled as the result of an accepted work injury and is receiving benefits for his or her wage loss. You do not have to be completely unable to work to qualify for workers’ compensation benefits. Under workers’ compensation, you are generally considered “disabled” if you are unable to return to your time of injury position. If you are unable to return to your time of injury position and are earning less money as a result, then you are generally entitled to workers’ compensation benefits. This applies even if your employer makes light duty work available. If you are earning less money while on light duty, then you will often be entitled to workers’ compensation benefits. In the following sections, we explain the amount of wage loss benefits you should expect to receive.

If you are receiving workers’ compensation benefits, then you are within the administrative workers’ compensation system. What this means and what you can expect varies from employer to employer. What we can say at this point is that workers’ compensation benefits most often are administered by insurance companies whose goal is to spend as little on your workers’ compensation claim as possible—whether or not doing so is in your best interest. You can expect that this insurance company will pursue every mean at its disposal, legal or otherwise, to reduce the amount it pays. You can expect to be sent to doctors who may not listen to you and who may only spend five minutes or less examining you. You can expect to receive notices in the mail stating that you are capable of working and instructing you to look for work. Sometimes, and this is truly unfortunate and wrong, you can expect the insurance company to send your checks late as a method of harassment.

If you are being harassed by an insurance company, it is important to remember that you did nothing wrong and that you have rights. This book’s purpose is to advise you of your rights. If you have further questions, you can call praetorian law group. We will never charge you a fee for an initial consultation.

If you or someone you know has been hurt at work

Reporting your injury

If emergency medical assistance is required, call 911 or go to the nearest hospital. You will not lose any rights under workers' compensation if you seek immediate care in a medical emergency.

If you do not require emergency care, or if you have obtained emergency care and the urgency has passed, you must begin to protect your rights under workers' compensation. First and foremost, you must provide your employer with notice of your injury. Under workers' compensation, injured employees have an affirmative obligation to report their injuries to their employers. Failure to report your injury in a timely manner can result in the loss of substantial workers' compensation benefits. Moreover, the workers' compensation process will not begin until your employer has notice of your injury.

You should try to report your injury immediately or within 21 days to preserve all of your workers' compensation rights. In every circumstance, you must report your injury within 120 days. If you fail to report your injury within 120 days, your right to workers' compensation benefits will be lost forever.

How do I give notice of my injury?

Workers' compensation requires only that injured workers report their injuries to their employer. It is not enough that your employer knows you are hurt, you must report that your injury is work-related. By law, if you report your injury to your supervisor as being work-related, the notice requirements of workers' compensation are satisfied, even if you do so orally as opposed to in writing.

That said most employers have formal "accident reports" for reporting injuries that you may be required to complete, or that may be completed by your supervisor or other designated person. While oral notice of your injury is enough for workers' compensation benefits, we recommend that you comply with your employer's policy of completing a written report. Whenever possible, have a union representative or other witness with you when you report your injury. Always ask for a copy of the written report as well.

Even though workers' compensation only requires that oral notice of your injury be given, it is usually better if a written report is completed. It has been our experience that many employers do not take injuries seriously until a written accident report has been submitted. In addition, if a written injury report is completed, you will have evidence that you reported your accident.

What if more than 24 hours have passed since my injury?

It doesn't matter. You have the right to report your injury, and your employer is obligated to accept your report. We know of several employers who have, at least in the past, told injured workers that accident reports must be completed within 24 hours and then try to turn injured employees away. Other employers require accidents to be reported within 48 hours or 7 days. While your employer may have a policy that requires injuries to be reported immediately or within twenty-four hours, this is not the law. Under the law, you can report your work-injury at any time. If you report your injury more than 21 days after it occurred, your employer may not have to pay you for any wages you lost prior to the date you reported your injury. (if you report your injury within 21 days, then you will remain eligible for all wage loss benefits you are entitled to from the date of your injury forward.) Remember, if you report your injury more than 120 days after it occurred, you will not be eligible for any workers' compensation benefits whatsoever.

While workers’ compensation does not require you to report an accident within 24 hours, you should still comply with your employers’ requirements whenever possible. It is important to remember that workers’ compensation often operates separately from the terms of your employment. Thus while you would remain eligible for workers’ compensation benefits, you could nonetheless be subject to employee discipline if you fail to comply with your employer’s requirements.

My employer will not accept my accident report, what should I do?

Unfortunately, many employers have refused to accept accident reports from injured workers in an attempt to deter them from seeking workers’ compensation benefits. Sometimes, they will use the fact that you failed to report your accident within 24 hours as a reason. Other times, your boss might state that he or she is not the proper person to report work injuries to and walk away. For this reason, whenever possible, we recommend that you try to report your injury in the presence of a witness. If you are a member of a union, try to have your union representative present when you report your injury.

If you are unable to file an accident report with your employer, you should feel free to contact praetorian law group. When our clients’ injuries need to be reported, we send notice of our clients’ injuries by certified u.s. Mail. If you do not desire legal representation at this time, you should contact the bureau of workers’ compensation at 1-800-482-2383.

What if I have had a painful condition for more than 120 days but I did not know it was work-related until recently?

Unlike an accident resulting in injury, some conditions arise slowly (sometimes over the course of years) and are not obviously related to your employment. Common examples of such injuries include carpel tunnel syndrome, lateral epicondylitis (tennis elbow), degenerative disc disease, arthritis and shoulder pain. In situations such as these, the requirement to give notice does not begin until a medical doctor has related your injury to your employment.

After your injury has been reported

I’ve reported my injury to my employer, how will I know if my workers’ compensation claim has been accepted?

Your employer can only accept your claim for workers’ compensation benefits by issuing one of three documents. These documents are: (1) a notice of compensation payable; (2) a medical-only notice of compensation payable; and (3) a temporary notice of compensation payable. If your employer issues a notice of compensation denial, or if your employer fails to issue any document within twenty-one days, then you should consider your workers’ compensation claim denied.

If your workers’ compensation claim has been denied, then the only way you can preserve your workers’ compensation rights is to file a claim petition with the workers’ compensation office of adjudication. You must file a claim petition within three years of the date of your injury, or your right to workers’ compensation benefits will be lost forever. It is important to remember that reporting your injury to your employer is not the same as filing a claim petition to with the workers’ compensation office of adjudication. An injured employee must turn to the workers’ compensation office of adjudication after they report their injury to their employer if his or her claim for workers’ compensation benefits is denied.

I did not receive a notice of compensation payable, but my employer is paying for my medical treatment.

You should still consider your claim to be denied. Some employers may pay for medical treatment, and may even pay some form of wage loss benefits, even though they have not issued a notice of compensation payable. You should not be lulled into believing your claim for workers’ compensation has been accepted. It has not. Unfortunately, some employers take shortcuts in the workers’ compensation process. Such an employer may decide to pay your medical expenses and hope your claim goes away. Meanwhile, the three year statute of limitations you have to protect your rights continues to slip away.

If more than 21 days have passed since you reported your injury and you have not received one of the three documents an employer can use to accept your claim, you should feel free to contact praetorian law. We are happy to explain the steps you need to take to protect your rights, and we never charge fees for initial telephone or in-person consultations.

I received a temporary notice of compensation payable, what happens now?

When your employer issues a temporary notice of compensation payable, it means that your claim has been accepted on a provisional basis. If your employer takes no further action before the expiration of ninety (90) days, then your claim will be accepted in full. Employers issue temporary notices of compensation payable in order to gain additional time to investigate claims for workers’ compensation benefits. Generally, an employer must accept or deny a claim for workers’ compensation benefits within twenty-one (21) days of receiving notice of an injury. An employer can gain an additional sixty-nine (69) days to investigate a claim by issuing a temporary notice of compensation payable and paying you benefits pending the completion of its investigation. If an employer takes no further action within this time, then the temporary notice of compensation payable will convert automatically into a full notice of compensation payable and your claim will be accepted in full. However, if an employer issues a notice of compensation denial within the permitted time, then your claim will be denied. If you received a temporary notice of compensation payable and then receive a notice of compensation denial within ninety days of the date your injury was reported, then you must file a claim petition with the workers’ compensation office of adjudication in order to protect your rights.

If your employer issues a notice of compensation payable, then your employer cannot unilaterally cease paying your workers’ compensation benefits. Your employer must either obtain your consent or prove its case before a workers’ compensation judge. On the other hand, an employer can unilaterally terminate your workers’ compensation benefits if it issues a temporary notice of compensation payable as long as it does so within ninety (90) days of receiving notice of your injury. This is the most significant difference between issuing a notice of compensation payable versus issuing a temporary notice of compensation payable.

Treating for your injury

If your injury has been accepted by your employer, then your employer must pay for all reasonably and necessary medical care causally related to your work injury. Workers’ compensation, however, places several requirements onto injured workers when seeking medical treatment. First and foremost, your employer has the right to limit your choice of medical providers in many instances.

My employer requires that I go to occupational medicine, do I have to go or can I go to my own doctor?

Many employers attempt to send injured workers to a managed care facility such as concentra, corporate care or occu-med. These healthcare providers specialize in providing low cost medical services and are not known for a high quality of care. In fact, some of these organizations advertise that they specialize in sending injured workers back to their jobs as soon as possible. Many times, the doctors who treat at these facilities devote up to one-half or more of their professional time performing independent medical exam’s for insurance companies.

The good news is that you do not have to treat with these organizations if you do not feel you are receiving adequate care. The bad news is that your health treatment options will be limited for the first 90 days following the date you first treated for your injury. In an effort to control medical costs associated with work injuries, workers’ compensation allows employers to require injured workers to treat with a limited number of identified doctors and/or health care organizations. These healthcare providers are often referred to as “panel providers.” Often, one or more of the identified providers will be an occupational medicine group such as concentra.

Injured workers have the right to treat with any “panel provider” on the list. Employers cannot require injured workers to treat with just one specific provider. While employers do not have the right to require that injured workers treat with one specific health care provider, they often attempt to do so. Therefore, it is important to know your rights under workers’ compensation, especially if you suspect a serious medical condition may exist.

Also, it is important to remember that while workers’ compensation permits employers to create lists of “panel providers,” in order to do so, employers must comply with numerous statutory requirements. The following three are of primary importance. One, employers must disclose the existence of the panel list to employees at their time of hire. Two, employers must post the list of “panel providers” in a public area where all employees can see it. Three, employers must have injured employees sign an acknowledgment indicating that they have been informed of their obligation to treat with a panel physician at the time the injury is reported to the employer. If the employer fails to meet these requirements, then they do not have the right to identify which healthcare providers their employees must see for work injuries.

Finally, once ninety days have passed since the time an injured worker first treats for his or her injury with a panel physician, he or she once again has the right treat with a doctor of his or her choice.

If you have further questions, please feel free to contact praetorian law. We are happy to answer any questions, and we never charge a fee for initial consultations.

I never received a notice of compensation payable; do I still have to treat with occupational medicine?

If you have not received a Notice of Compensation Payable within twenty-one days of reporting your injury, or if you have received a Notice of Compensation Denial, then you are not required to treat with a “Panel Provider.” You can treat with a physician of your choice. One thing to consider is that because your workers’ compensation claim has been denied, your employer will often refuse to pay for your treatment. Therefore you should expect to pay for this treatment with your health insurance or with your own funds. Because your workers’ compensation claim has been denied, it is important that you remain cognizant of the three year statute of limitations in order that you do not lose important rights.

I’ve been told by a doctor that I will need surgery, am I required to have surgery under workers’ compensation?

In some circumstances you can lose workers’ compensation benefits if you refuse reasonable and necessary medical treatment. If a proposed surgical procedure has a high likelihood of improving your condition and has a low likelihood of causing adverse consequences, then you could lose your workers’ compensation benefits until such time as you undergo the proposed procedure.

It is important to remember; however, that once your injury has been accepted by your employer, your workers’ compensation benefits can only be stopped with your consent or by decree of a workers’ compensation judge. This is important to remember because proving a surgical procedure will improve your condition without presenting undue risk of adverse consequences is easier said than done. Very often, your employer will not be able to prove this is the case, and you can continue to receive your workers’ compensation benefits.

Finally, if you are still within the ninety day window following the date you first treated for your injury with a panel physician, and a “Panel Provider” has recommended an invasive surgical procedure, then you have the right to second opinion with a doctor of your choice.

I’ve been contacted by nurse who wants to schedule my appointments and attend doctors’ appointments with me. What should I do?

It is becoming and more and more common for employers and their insurance companies to retain nurse case managers. These individuals will represent to you that their purpose is to assist you in getting the best care for your injury. They will offer to schedule your appointments, and they frequently offer to attend your doctors’ appointments in order to be available for questions.

You should not allow yourself to believe that these peopl