I. YOUR RIGHTS IN A WORK'S COMP CASE

Your employer, (or its worker's compensation insurance company), is obligated to provide coverage for all accidents and injuries which occur on the job as well as occupational diseases which are caused by employment.

II. BASIC BENEFITS

Three major benefits are available to you if you were injured on the job, including:

(1) medical benefits, without deductibles or co-pay;

(2) wage loss benefits after you miss three days from work, until you reach "maximum medical improvement, or are able to return to work;

(3) permanent impairment benefits, if you don't get back to 100% (there are caps of $60,000 - $150,000 for combined wage loss and permanency, depending on your date of injury); and

(4) disfigurement benefits (max. $8000, if applicable).

To get any of these benefits you must prove that you are entitled to these benefits.

III. REPORTING INJURIES

The worker's compensation law requires that the injury be reported in writing to the employer within 4 days of the accident. Do not rely on other people. Write the report yourself, file it with the Division of Worker's Compensation, and keep a copy. Failure to report could cost you money. We strongly recommend that you report the accident in writing even if more than 4 days have elapsed, unless you have already received a General Admission of Liability.

IV. THE DOCTOR IS PICKED BY THE INSURANCE COMPANY

In most cases, the employer is allowed to select the doctor in the first instance. That doctor is authorized to refer you to any other doctors for treatment or testing. If the employer does not select a doctor, then the employee can chose the doctor.

Under a new law passed in 2007, you have the right to request an automatic change in physician, within 90 days of your injury by requesting it from your employer or its insurance company.

In some cases, you may be able to change physicians by presenting sufficient evidence to a Judge at a hearing.

Regardless of how pleased you are with your medical care, you must follow all of your doctor's instructions. The law allows the insurance company to stop paying your disability benefits if you miss even one appointment which is rescheduled and then missed by you. Your benefits are stopped without notice or a hearing, SO YOU MUST KEEP ALL MEDICAL APPOINTMENTS.

You should also attend all testing or therapy appointments, do all home exercise programs, and live within the physical limitations set by the doctor. If you are unhappy with the care you are receiving, it is even more important that you follow the doctor's instructions, and that you keep your own records regarding such things as how long the doctor spent talking with you and examining you, what the doctor said, what you said, and what the doctor recommended. You may be asked to testify about some of these issues later, so do not rely on your memory alone. You should not be surprised if it seems that the doctor cares more about the insurance company than about your injury or your life. Some doctors have practices that are largely dependent on insurance companies for referrals and sometimes this shows in the way they treat their patients. You should always treat the doctor with respect and report any problems to your attorney.

V. RETURN TO WORK IF RELEASED BY A DOCTOR

Even though you may have serious doubts about your ability to perform the requirements of your former job, if any doctor clears you to return to work - even with restrictions, such as "light duty" - you must try to return to work. You should report to your supervisor, advise him of the restrictions the doctor gave you, and offer to return to work under these restrictions. If they refuse to accept your offer, advise us. If you return and find that you cannot do the job due to your injury, then you should (1) inform your supervisor; (2) call and make an appointment with the doctor; and (3) notify your attorney.

VI. IMPORTANT FACTS REGARDING WAGE LOSS BENEFITS

You are entitled to payment of wage loss benefits while you are receiving medical care and are unable to perform your duties at work. Temporary wage loss benefits are paid when you are unable to work due to a doctor's orders. You must obtain a written excuse from work from the doctor and keep a copy.

Wage loss benefits are paid at the rate of 2/3 of your average weekly wage up to maximum weekly amount, which depends on the cap in place at the time of your injury.

Employers and insurance companies are required to pay wage loss benefits every two weeks. At the beginning, however, it generally takes longer to get your first check.

Wage loss benefits may stop for any of the following reasons:

1. When you are released to full duty (even if you are still in treatment);

2. When you reach maximum medical improvement;

3. If you refuse an offer oflight duty within your physical restrictions;

4. If you miss multiple medical appointments;

5. If your employer fires you after you have been injured for any violation of the employer's workplace rules, such as no-call/no-show, failed UA testing, bad attitude.

VII. AVERAGE WEEKLY WAGE

Your wage loss benefits are based on your actual wages. If you are separated from employment, fringe benefits including the cost of continuing health insurance should be added to your average weekly wage.

Insurers frequently admit for an average weekly wage that is lower than the amount established by your wage records. You should obtain as many pay check stubs as you can locate for the six months before the accident. Your income tax returns for the two years before the accident may also help establish your pay rate. If you were employed under a written contract, a copy of the contract is helpful. If any portion of your income came from overtime or tips, it is important that you provide us with all the documents you have that show the amount of tips or overtime you earned. To be eligible for inclusion in average weekly wage, tips must have been reported to the I.R.S. Fringe benefits information should also be gathered including any COBRA letters from your employer.

VIII. TERMINATION OF EMPLOYMENT

It is not uncommon for employers to fire injured workers. A recent change in the law in 1999, was VERY unfavorable to injured workers. If an injured worker is "responsible for separation from employment" the insurance company and the employer do not have to pay wages while the worker recuperates from the effects of his or her injury, even if the injured worker is unable to do his or her job. You should do everything you can to keep your job. Any reason for getting fired is a reason to deny workers compensation benefits, including on or off the job drug use, no call/no show, and excessive absenteeism. Many employers have a zero tolerance for drug use and will fire an injured worker for a urine analysis that is positive for illegal drugs.

IX. SURVEILLANCE

In nearly every case, employers or their insurance companies will hire a surveillance company to follow you. The purpose is to find out what you are doing and to test your credibility.

At all times, you should follow your doctor's instructions regarding restriction of your physical activities. You should be aware that when you are in public, you are in a position where you might be photographed or filmed, and you should conduct yourself accordingly.

If you think you are under surveillance, make a note of the vehicle and the license plate number of the vehicle and the vehicle description. If the surveillance vehicle is parked in your neighborhood, and following you as you leave your home, do not hesitate to contact police.

X. CLOSING YOUR CASE

Once your doctor tells you that you are as good as you are going to get, you have probably reached maximum medical improvement. This stops your wage loss benefits even if you are still unable to return to your usual line of work. Your doctor will give you an impairment rating and the insurance company may file a "Final Admission of Liability."

If you have received a Final Admission of Liability, the clock is running. To protect your rights it is critical to respond in a legally appropriate way to any legal documents submitted by your employer or insurance carrier. The deadlines are often 30 days, so there isn't much time to make decisions, and it is easy to make a mistake that can take a long time to fix.

XI. INDEPENDENT MEDICAL EXAMINATION (IME)

The Division of Worker's Compensation runs an independent medical exam program. The person requesting the exam pays for it - $675.00 in most cases. If your assets are less than $1,500, you may apply for indigency in order to have the insurance company pay for the second opinion.

The process of selecting the doctor to do the exam is complicated. You must know the background and reputation of the doctors on the list. A poor choice of doctor for the IME can ruin your case. A good IME can get you more medical care or more medical impairment money. We recommend getting an attorney before applying for an IME.

XII. LAWYER INVOLVEMENT

Insurance adjusters, employers and even some co-employees suggest that a lawyer is not necessary to help you protect your rights. This is wrong. Money is at stake. In fact, a study commissioned by the Division of Insurance indicates that workers without attorneys receive benefits that are only half of those received by workers with attorneys. The insurance adjuster's job is to make sure that the interest of the company are protected and that its liability is limited. Given the complexity of the work comp law most individuals lack the ability to competently defend their rights. You are strongly advised to consult an attorney.

XIII. DECIDING CASES

Disputed issues are resolved either by negotiation with the insurance company or by hearing at the Division of Worker's Compensation. Unfortunately, there is little that can be done to speed up the hearing process. The first step is to file an Application for Hearing. Ten to twenty days after filing the Application, the Division of Worker's Compensation sets a date for the hearing. Typically, this is about three to four months later. These are trials. The insurance company/employer is always represented by an attorney.

XIV. CALLING THE WORK COMP ADJUSTER

You must remember that anything you say to the insurance company may be used against you at a later date. Be professional, courteous and polite inyou're your communications. In responding to questions to which you don't know the answer, we strongly recommend that you do not guess or speculate. Rather, answer only those questions about which you have first hand knowledge.

XV. EMPLOYER CONTACT

There is no legal requirement that you call your employer every day about your case. You should be aware that anything you say to your employer may well be passed on to the insurance company and may be used against you later. Keep in mind that if your employer requires you to call in every day because you are missing time from work, a failure to call in may cause a termination of employment and will likely cause you to lose wage loss benefits.

XVI. MILEAGE TO AND FROM DOCTORS AND THERAPY VISITS

You have to document these miles and submit them to the insurance company. This office has a form to help you keep track of your mileage in connection with all medical treatment, including physical therapy or chiropractic visits which you attend as part of your worker's compensation case. We can submit this forms and request mileage compensation for you at the rate of $.31/mile.