Workers Compensation – A Short Explanation By Attorney Robert L. Noa
Most people have heard the term ‘Worker’s Compensation’. Many, however, probably do not know exactly what it can do for you should you have an injury or accident while in the course of your employment. Workers comp is a system of wage replacement for people who have an injury or accident at work and are disabled for a period of time. It’s important to keep in mind that workers comp is not merely for people who have a physical “accident”. Individuals who have some sort of a occupational exposure in the workplace also have a right to claim workers comp benefits. Think of somebody exposed to asbestos many years ago who developed lung cancer or a utility worker who becomes exposed to Lyme disease because of a tick bite. These workers have a right to claim workers comp benefits as well. A healthcare worker who may accidentally be ‘stuck’ by an infected needle and develops hepatitis or other disease is, similarly, entitled to benefits. Also, purely mental health-based disabilities are compensable if an event or series of events in the workforce lead to a mental health disability. Here, for example, think of a store clerk who was robbed at gunpoint and develops posttraumatic stress disorder as a result of the event. That person is entitled to claim workers compensation benefits the same as somebody who may fall on a job site break their leg. Workers comp at its simplest is a system of wage replacement that is designed to get the injured worker from point A where they are hurt and disabled to point B where they can go back to work.
The good news is that the vast majority of folks who are hurt at work experience a full recovery and are able to get on with their lives in a productive fashion.
There are several ‘rights’ a workers compensation claimant can assert. These are;
1.) Disability compensation: – Total disability: For somebody who is ‘temporarily totally disabled’ compensation is paid at 60% of the persons average wage. An easy example is somebody making $1,000.00 per week is paid compensation at $600 weekly. Somebody making $500 per week is paid at $300 weekly and so on. Massachusetts law has a statutory maximum of three years for payment of temporary total disability. – Partial disability: For someone who is ‘temporarily partially disabled’ benefits are paid at 60% of the difference between what the person was making at the time of injury and what they are actually capable of earning because of limitations caused by their disability. Example; an individual earning $1000 per week when injured returns to work at a lighter duty job only making $400 per week because of limitations imposed by their accident. Partial disability in that example would be $1000 (prior earnings) – $400 (current earnings) = $600 x 60% = $360 per week partial disability compensation.
2.) Medical care: A person hurt at work is entitled to have the workers compensation insurance carrier pay for their reasonable necessary medical expenses. That can be anything from an ambulance to the emergency room, surgery, diagnostic tests, postoperative therapy and needed office visits. Occasionally difficulties arise because workers compensation insurance carriers are only required to pay medical providers at a statutorily set rate. Sometimes a physician will not accept a workers compensation patient because they would be paid less than their normal rate. Most physicians do, however, accept workers compensation patients. Injured individuals are also entitled to be reimbursed for mileage back and forth to medical care, as well as, any out-of-pocket costs incurred such as co-pays for medication.
3.) Vocational Rehabilitation: Sometimes an individual’s accident is severe enough that it will prevent them from returning to the occupation performed when they were hurt. In these instances a workers compensation claimant may apply for vocational rehabilitation. In order to apply for these benefits the person must have a high school education or GED to be considered for vocational benefits. Depending on the individuals personal circumstance vocational benefits can be anything from assistance with resume preparation and interview skills up to classes and schooling for a new occupation. 4.) Loss of function and/or disfigurement:
Sometimes an injury does not allow for a full and complete recovery. Regrettably, it happens from time to time that an injured body part simply will not be as good as it previously was. For example an individual that slips and falls on a hip at work and requires joint replacement surgery will generally not have is fully functional a hip joint as the one they had before their injury. If the person’s physician says that because of the injury and necessity for surgery there is a (for example) 20% loss of function according to the American Medical Association guidelines the individual may claim a monetary payment of loss for function benefits from the workers compensation insurance carrier. The amount of money is, of course, going to vary from individual to individual. The simple fact remains that if the persons attending physician says there is a measurable loss of function that person has the right to file a claim for monetary compensation. The foregoing is a simple list and explanation of the rights a workers compensation claimant can exercise. A workers comp insurance company always retains the right to question or say ‘no’ to the employees assertion of disability or claim for medical care. In those situations the injured worker must file a claim for disability benefits and take the insurer to court. It is important to keep in mind that workers comp insurance companies pay claims because they must under the terms of a contract. Generally speaking they would rather not have to pay. While most insurers and certainly claims adjusters are good people there is an inherent conflict with the insurance company, adjuster, claimant relationship. Because of that there are times where an adjuster may not disclose to an injured worker the full extent and nature of their rights. It is also why you should always consult a trained and qualified workers compensation attorney. Only YOUR lawyer will protect your rights to the fullest extent possible under the law. Workers compensation attorneys are paid on a ‘contingent fee’ basis which means we never get paid unless we are successful.
A workers compensation attorney will never, ever send you a bill based on an hourly rate they charge. There is NO CHARGE for an initial consultation. Therefore, there is no reason not to get a legal opinion about your work accident even if you think it is the simplest and most straightforward situation imaginable. For 30 years we have successfully been representing men and women injured while in the course and scope of their employment. During that time we have recovered tens of millions of dollars in compensation benefits and settlements for our clients. We would be happy to speak with you about your own circumstance.