I want to discuss the basics of the worker’s compensation system. This is a primer. These are basic level principles that I want to highlight, and hopefully, they will be helpful to you as you move along in your worker’s compensation claim. I want to start by briefly explaining what we will discuss today.
First, we will discuss the importance of notifying your supervisor, your manager, and your employer of your injury immediately after it happens.
We are going to discuss the active phase of a worker’s compensation claim, and we are going to discuss the permanent phase. The worker’s compensation system has two phases: active and permanent. So, we will discuss both of those phases. You even get to discuss what benefits you are entitled to and what obligations you must follow in a worker’s compensation system.
You first must get through the notification door, which means that the worker’s compensation legal system obligates the injured worker to adequately and timely notify his employer of the work injury. So, in other words, if you get injured and fail to notify your employer in a reasonable time, your claim will be denied. So many claims die before entering the system because it was never notified. A quick point is that if you get injured on the job, notify your employer immediately. It is the law, and it is required, but also make sure you can prove that you notify your employer of the injury.
You often go to court and are asked questions about the situation you are fighting in. Was this claim notified? Moreover, of course, the time will say yes, it was announced on such and such date to such and such person, but they have no way to prove it other than their testimony, which sometimes carries the day. Sometimes, you win based on your testimony because you are credible; sometimes, it does not carry the case.
The better way to achieve notification is to do it by a written report. Save a copy of the report. If you call your employer, make sure you know we can get phone records. If you send a text message, we can also use that as proof because it is essential to notify your employer and have a way to prove that you notified your employer. If you tell your employer, make sure you bring a witness with you. Please make sure you write it down in a report and you save a report.
Also critically important is when you go to the doctor after an injury. If you go to the hospital, if you go to a clinic, let the hospital know, let the treating doctors and nurses know that you have injured yourself on the job. If a doctor includes “emergency room visit” in his report,” for instance, you have injured yourself on the job. Then, that is affirmative proof that you have notified your doctor of the injury. That is important for you to get through the door.
Let us assume you have gotten through the door. You were properly notified. The employer agrees that you inform them of the work injury. Now, you have entered the worker’s compensation system. There are two phases: the active phase and the permanent phase. The active step is the time frame or the worker’s compensation system phase when doctors try to improve you. They are doing something medically to try to improve your condition. Whether that is giving you injections, medication, or surgical therapy, whatever the case may be, they are trying to improve your medical condition because you have been injured. They want to get you to a better place. The active phase terminates once you get to a place called MMM, which means Maximum Medical Improvement, and at that point, you begin the permanent phase.
All rights determine the benefits you are entitled to, depending on your phase. A doctor is actively treating you if you are in the active phase. You are actively trying to get yourself back to work and actively trying to get you better — your benefits. Are the following first? Are you entitled to medical care that is reasonably related to the work injury? If you need surgery, you are entitled to it. If you need some epidural injection, you are entitled to it. If you need medication therapy, whatever the case may be. You are entitled to medical care; that’s the number one and probably the most crucial benefit. Number two, you are entitled to compensation. The law says you are entitled to 66% of your average monthly wage before your injury. So, if you make $1,000 a month before becoming injured and no longer working because of the damage, you are entitled to $666.66 per month.
So those are the two fundamental rights that you are entitled to. The worker’s compensation system can be very litigious. You can fight and litigate various issues in any given case. So sometimes, if a doctor recommends surgery and the insurance company hires its doctor to say that you do not require surgery, litigate in that case. You will prosecute that case if they do not want to pay you. If further down the road, another surgery can become litigated as well.
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