2. How soon should you notify an employer of a workmans comp injury?

As soon as a worker realizes that a workplace injury has occurred, he or she should immediately provide notification to their employer. Notification of a workmans comp compensable injury is the first step in the workers compensation process and it allows for an injury report to be filed with the state workers compensation board (which may be known as the industrial commission, depending on the state).

It's impossible to understate the importance of notification when it comes to an injury that may be compensable for workers compensation benefits. Failure to do this can even provide justification for a workers compensation carrier to deny a worker's benefits, even if the workplace injury is very serious.

And…taking an excessively long time to inform an employer of a compensable workman's comp injury can even potentially throw up red flags regarding the illegitimacy of a claim (i.e. possible f-r-a-u-d).

However, even after an employer has been duly notified of a work accident or work injury, an individual may wish to contact their state's workers compensation board to ensure that all the necessary documents are filed to properly establish a claim.

Additionally, an injured worker should provide their employer with the following information if the injury was the result of a specific accident: the names of all witnesses and a description of how, when, and where the accident and injury took place.

Workers should also know that providing employer notification is particularly important in cases involving an employee's exposure to toxic substances and chemicals such as pesticides and asbestos.

3. If you have a workers comp case and can return to light duty, must your employer find you a job?

In most states, when a worker who has filed for workmans comp benefits is able to return to light duty, the employer must provide suitable work and return the worker to the job he or she left, or an equivalent job, provided that such a position is available.

However, going back to work in a light duty capacity may mean that an employee still needs to be paid workers compensation benefits to make up the difference for what they might earned in their regular position were they fully recovered.

Sadly, for this very reason, some employers will claim they have no light duty employment available simply to stop paying workers compensation benefits altogether.

Therefore, for this reason, injured workers should avoid being overzealous in their desire to return to work. Moreover, they should not play down their symptoms when speaking with a doctor who is overseeing their recovery. Because the unfortunate truth is, the worker who sincerely wishes to return to work may discover that their employer does not have their interests at heart.

4. How much do you get for workmans comp or workers compensation?

If you have a compensable workmans comp claim, you'll usually receive a benefit that is equal to 66 percent, or two-thirds of your regular wages or salary. This is typically a gross dollar amount (ordinarily, taxes on workers compensation benefits do not have to paid until a worker is released to work or it has been determined that a worker's injury has resulted in a level of permanent incapacity).

Hower, there are other issues that play into the process and they involve whether or not a worker's accident-or-injury-related impairments are temporary or permanent, and total or partial.

For example, a worker filing for workers compensation benefits may be found to have sustained a permanent impairment, but one that only renders the worker partially disabled. In such cases, the worker may only be able to return to his or her employment in a capacity that pays less. Workers comp, in those instances, would pay the difference between what a worker formerly earned and then later earned as a result of a job related accident or injury.

Such payments are often referred to as temporary partial disability payments and they may be limited to a maximum weekly amount which a worker can receive, as well as a maximum number of weeks for which the worker can be paid.

Workers may also receive a workmans comp lump sum settlement, based on the degree of impairment suffered (such as the loss of a finger due to a work-related accident). And, in cases where permanent and total incapacity is the end result, the lump sum settlement will typically take into account a worker's earnings and projected life expectancy.

5. How much do you receive on a weekly basis for workers compensation?

The amount an injured worker will receive in workers compensation benefits relates to two factors.

The first factor is the workers current level of income. The second factor is a percentage. Essentially, a worker who files for workmans comp will receive sixty-six percent (two thirds) of an amount equivalent to their weekly income, and, typically, this is two-thirds of a worker's gross weekly income.

Injuries or work-related illness that renders a worker permanently incapacitated regarding the ability to work may also receive a lump sum settlement.

Additionally, the families members of workers who have been killed on the job are eligible to receive death benefits from workmans comp, as well.

6. Can an employer dispute a workers compensation claim?

Yes, an employer may dispute a workmans comp claim and if this is the case, after the claim is rejected by the employer's carrier, the matter may be taken to either the industrial commission, workers compensation commission, or workers compensation board, depending on how it is referred to in the state in which you live.

If your employer decides to dispute your workmans comp claim, the state workers compensation board (or the state's industrial commission) will normally hold a hearing to arbitrate the dispute. In the event that arbitration favors the employer, one or several appeals will generally be available to the claimant.

7. What happens if you lose a workmans comp case at arbitration?

What happens if you lose a workmans comp case at arbitration? Typically, you'll be able to file an appeal and have the employer continue your workmans comp benefits.

However, the longer a workmans comp case drags on, the worse it becomes for the worker since the worker only receives two thirds of what they normally might have received from pay. It's for this reason that it is not at all uncommon for injured workers to deplete their savings after a workers compensation claim has been filed.

8. Why would an employer dispute a worker's compensation claim?

The answer to why an employer would dispute a workmans comp claim is simple and boils down to a single five letter word: money. Like any other type of i-n-s-u-r-a-n-c-e product, employers pay p-r-e-m-i-u-m-s to provide workers compensation benefits. And those amounts are directly affected when injured workers file for benefits.

Logically, the more workmans comp claims filed, the higher the costs for employers (it is for this reason, that investigative agencies are routinely used to monitor the daily activities of workers who have filed workers compensation claims).

And, unfortunately, there is another factor involved. Many employers will simply assume that a worker who has workers compensation on the basis of carpal tunnel syndrome, repetitive stress injury, or a lumbar back injury is not being completely truthful.

Such employer bias tends to be the case, of course, for injuries involving inexplicable pain that cannot be wholly verified by medical examination, or even sufficiently verified by xrays or other imaging.

Does this mean that the injured worker who has constant back pain is malingering? Definitely not. Many medical conditions are difficult to objectively verify. The bottom line is simply this: workmans comp is a benefit and employees who have become injured or sick as a result of their job should file to protect themselves. Whether or not the employer believes that the worker is legitimately injured is really irrelevant.

9. What injuries are covered by workmens compensation?

A compensable workers compensation injury is generally defined as an occupational injury that arises "out of and in the course of employment".

Translation: for the injury to be covered by workmans comp, the injury must generally have occured at work, and must also have been related to work.

Therefore, an injury that occurs in the course of one's work, or an injury that occurs while running an errand for one's employer would typically be covered by workmans comp, whereas an injury that occurs on the premises of one's job location during lunch time would not be covered by workman's comp.

Furthermore, to be covered by workers compensation, an occupational injury must generally have resulted from an accident (though some injuries, it is true, are the result of repeat or cumulative trauma, such as carpal tunnel syndrome or conditions resulting from toxic substance exposure).

Accidents, of course, are events that happen unexpectedly and without prior knowledge. And for this reason, an individual who willfully injures himself or places himself into a position for which such an outcome is likely will generally not be covered by workmans comp.

10. Can you file for workmens comp and also file for social security disability?

Yes, you can certainly file a claim for workmans comp and social security disability benefits simultaneously. The two benefit systems are completely separate and distinct (ssd is a standardized federal program while workers compensation laws may differ state to state).

However, an individual seeking both types of benefits may gain advantage from the input of a workers compensation attorney since "timing issues" (as regards an ssd claim) can, in some cases, affect a workman's comp claim.

A person seeking benefits may decide to choose an attorney who can handle both types of claims, though very often, attorneys will handle only one or the other; that is, either social security disability cases or workers compensation cases exclusively.

Of course, obtaining distinct representation on both types of claims may be a good idea since a claimant, ideally, should be represented by a specialist as opposed to someone who simply "dabbles" in various areas of practice.

11. How much of your earnings do you get in workman's comp benefits?

Workmans comp is a system that varies from state to state. However, in most states, an injured or sick worker will receive an amount equivalent to two thirds of their gross or pre-tax earnings.

However, the individual filing for or receiving workers compensation should bear in mind that there is usually a cap placed on the amount a worker can ultimately receive.

In other words, an injured or sick worker who normally earns $80,000.00 per year may find that they will receive no more in workmans comp benefits than a worker who has filed for workers compensation and who earns $50,000.00 per year.

12. When do workman's compensation benefits start?

Your workmans comp benefits should begin immediately from the time you file a claim for workers compensation.

In most states, your employer will immediately begin to pick the cost for your medical expenses as well as begin to pay you a percentage of your income.

What is the percentage of income that you will receive? Typically (that is, in most states), a worker will receive two thirds of whatever their gross weekly income was.

13. When can you file a claim for workmans comp?

You can file a claim for workers compensation benefits as soon as you become injured on the job or develop an illness that is related to your work.

And, in fact, taking any delay in filing for workmans comp benefits after you've become sick or injured on the job can pose a distinct disadvantage and can potentially allow a workers compensation carrier to deny a worker's benefits.

In fact, a substantial delay between the time a potentially compensable workmans compensation occurs and the time it is reported can throw up red flags for a carrier who suspects that a benefit claim is not wholly legitimate.

Initiating the process, of course, is a matter that involves providing notification to an employer of the worker's injury or work-related illness. Notification should be made promptly and should include pertinent details such as the time and place of the injury, as well as how the injury occurred.

A worker may also wish to provide a list of witnesses if the injury was due to a specific workplace accident.

14. What does workman's comp or workers compensation provide for?

A worker who becomes sick or injured as a result of their working environment and is approved for workmans comp benefits can generally expect to receive the following:
payment of the expenses attributable to medical care (including initial emergency care, followup treatment, and rehabilitation services);

payment of a percentage of earnings (typically 66 % of a worker's average weekly earnings);

payment of a lump sum amount in the event of permanent incapacity;

and payment of benefits in the event of death.
In many cases, a person who receives workers compensation will also find that certain benefits will be continued for the time during which they are incapacitated and unable to work.

15. What are the main benefits of workers compensation?

The primary, or main, benefits of workmans comp include indemnity payments for lost wages, payment for medical services, payment for necessary rehabilitation services, and, unfortunately, in some cases, death benefits.

Regarding the matter of wages, workers compensation can provide for lost wages for either temporary disability or permanent disability. In cases involving permanent incapacity, workers compensation will provide for a lump sum payment.

Regarding rehabilitation services, most states include provisions in their workers compensation laws for rehab programs which, of course, benefits employees since rehabilitated workers are more likely to re-enter the workforce.

16. Who decides if you get workman's comp benefits or not?

In most states, it will be the workmans comp carrier who makes this decision, i.e. approves or disapproves the workers compensation claim.

If the carrier disapproves the workmans comp claim, the claim can be arbitrated before the workers compensation board (depending on the state, it may also be called "the industrial commission).

If the workers compensation board or industrial commission denies the workmans comp claim, it can, typically, go to court for resolution.

17. Is there a statute of limitations for workers compensation claims?

Yes, workers compensation laws require an employee (or his or her family) to file a claim for workmans comp benefits and, typically, this filing for benefits must be done within one year of the date of the injured worker's accident.

18. How do you start the workman's compensation process?

Though workmans comp laws vary and differ state by state, most jurisdictions require a injured or sick worker to notify their employer of an injury within thirty days of an accident or and injury becoming known (failure to do so can potentially result in a denial of benefits).

Providing notification to an employer of a workers compensation compensable injury is typically done by giving notice to someone in a managerial position. However, in cases where a worker is unable to provide such notification (perhaps due to hospitalization), the notice requirement can generally be excused, provided that the employer is otherwise made aware of the worker's injury.

Once notification has been made to the employer, the employer can submit a report to the state worker's compensation board (or industrial commission). The employer can also notify the worker's comp carrier. At that point, the workmans comp carrier will be in the position to begin paying an injured or sick worker's medical bills, as well as a percentage of the worker's average weekly income (usually 66 percent), though payment of wages .

However, the workmans compensation carrier may reject the worker's claim, leading to arbitration with the state workers compensation board or industrial commission, and, potentially, a series of appeals if arbitration does not find in favor of the worker.

In such cases, a worker would certainly be wise to seek the assistance of an attorney who specializes in workers compensation claims.

19. What jobs are usually not covered by workmen's comp?

Typically, the following jobs will not be covered by workers comp:

- part-time domestic employees in private homes
- newspaper carriers
- real estate sales agents
- some agricultural workers
- casual workers*
- unpaid volunteers (who are not considered employees in the first place)
- sole proprietors
- partners

* A casual worker is a worker whose work is not continuous or recurrent or is below a certain monetary threshold.

20. Who actually pays workmans compensation benefits?

The workmans comp benefits that are paid out to an injured worker are, usually, paid out by the employer's workman's comp carrier.

However, in a small number of states, employers are actually given the option to self-insure.

And in instances where an employer has done so, the employer is liable for whatever workers compensation benefits an injured worker would have been entitled to receive.

21. Are mental or psychological conditions covered by workers compensation?

Mental conditions can be covered by workmans comp, but, typically, this is in the sense of a psychological or pyschiatric condition being tied to a physical condition.

For example, job related stress or tension may contribute to a heart attack. Another example might be a worker who suffers a physical injury and later develops anxiety disorder or PTSD as a result of this.

In either case, the primary condition in many cases would be the physical injury, though the worker's mental consideration would also merit consideration.

Worker's compensation claims can be won solely on the basis of mental or psychiatric impairments, but, generally, it must be shown that the condition was the result of an abnormal work environment.

22. Is an independent contractor covered by workmans comp?

It depends. Independent contractors are not eligible for workmans comp; however, some employers will classify a worker as an independent contractor when in fact the worker in question more readily fits the definition of a basic employee.

If a worker is designated as an independent contractor but is substantially "controlled" in the conduct of work duties, then the worker is an employee.

What are control issues? Basically, control issues involve a person's work schedule, whether or not they are trained for job tasks by the employer, and whether or not the performance of their job duties is largely dependent on resources made available by the employer.

In other words, if the individual is largely dependent on the employer in order for work duties to be accomplished, the individual is probably an employee…even if on paper they are designated as an indepependent contractor. Employees, of course, may file for worker's compensation.

23. Can your employer retaliate on a workmans compensation claim?

Without a doubt, many employers, if given the opportunity, would retaliate against workers who filed for workers compensation benefits. And the motivation behind this would have everything to do with money since the filing of workmans comp claims drives up costs for employers.

In fact, many employers routinely use investigative agencies to determine if a workers compensation claim is groundless (and to "trip up" even those workers who are truly injured and have solid workmans comp claim).

Legally, however, an employer is prohibited from retaliating. This includes taking action against an employee who files for workers compensation benefits (such as disciplining them or even firing them) or taking action against a worker who assists someone else in their worker's compensation claim.

24. Will my employer think my workman's comp claim is not legitimate?

From the standpoint of an employer, ideally, it would be best to never have to payout on a workers compensation benefit claim. Unfortunately, this employer-based mindset often sets up injured and sick workers up for a level of scrutiny for which the results may not be fair.

To avoid a suspicion or accusation of f-r-a-u-d regarding a workmans comp claim, a worker should be mindful of the following factors:
If no one witnessed the injury or accident, this may cause the worker's compensation carrier to have suspicions regarding the claim. For this reason, a worker will certainly want to present a list of witnesses to the accident.

If the employee's story regarding the accident changes, this may cause suspicion as well. For this reason, a worker filing a workers compensation claim should be very clear in their own mind regarding the details of a work accident or injury.

Finally, if there is an unusually protacted length of time between the occurrence of the work injury or work accident and the time that it is reported as a compensable workers compensation claim, a carrier may suspect that the claim is not wholly legitimate. For this reason, among others, a work accident or injury should be reported promptly and immediately to one's employer, typically to someone in a supervisory capacity.

25. What medical expenses will workers compensation pay for?

If you become sick or injured on the job, you may be entitled to workmans comp benefits that provide compensation for mental injuries, traumatic physical injuries, and injuries that are the result of cumulative or repetitive trauma (carpal tunnel syndrome comes to mind for such cases).

Typically, the medical expenses that are paid for by workers compensation will include expenses related to hospital and treating physician care, emergency room care, the costs associated with imaging studies (xrays), blood panels, and other testing, and even the cost of rehabilitation treatment.

If you file a workers compensation claim, you employer's workmans comp carrier will immediately start paying all your medical expenses. This also includes bills for surgery that might be necessary.

26. Does a workmans comp injury have to be from a specific accident?

If you become sick or injured on the job, you may be entitled to workmans comp benefits that provide compensation for mental injuries, traumatic physical injuries, and injuries that are the result of cumulative or repetitive trauma (carpal tunnel syndrome comes to mind for such cases).

Typically, the medical expenses that are paid for by workers compensation will include expenses related to hospital and treating physician care, emergency room care, the costs associated with imaging studies (xrays), blood panels, and other testing, and even the cost of rehabilitation treatment.

If you file a workers compensation claim, you employer's workmans comp carrier will immediately start paying all your medical expenses. This also includes bills for surgery that might be necessary.

27. Can I get workers comp even if the accident was my fault?

The nice thing about the workers compensation system is that, regardless of the state in which you live, workmans comp is uniformly designed to be a no-fault system.

So, in other words, even if a job injury is caused by a work accident that is determined to have been the fault of the worker, the worker may still be eligible for worker's compensation benefits.

The only exceptions to the no-fault workman's comp system tend to be injuries that are self-inflicted, or are the result of a worker's impairment due to drug or alcohol use on the job.

28. Do you need a lawyer for a workmans comp claim?

Whether or not you need a lawyer to assist you with a workers compensation benefit claim may depend on a number of factors.

If your work injuries are relatively minor and the expectation is that the impairments caused by the job injury will not be permanent, there may be little need to hire a workman's comp lawyer.

However, if the work-related injury is serious and the worker's compensation claim is rejected, getting an attorney involved in the case may be the best course of action.

Also, an attorney may be helpful in the following instances:
the workmans comp is accepted but the worker does not receive the correct amount

the employer retaliates against the worker after the workers compensation claim is filed, either by disciplinary action or by outright firing.

medical care is denied to the injured worker
However, since workman's comp cases may be adversarial (as regards the employer/carrier) and since consultations with workers compensation lawyers tend to be free, it's probably prudent for an injured worker to speak with a qualified attorney before doing anything independently.

Having a worker's compensation attorney handle a case can often ensure that an injured worker is treated fairly and given appropriate financial consideration with regard to their injury or illness.

29. Can I get workers comp even if the accident was my fault?

The nice thing about the workers compensation system is that, regardless of the state in which you live, workmans comp is uniformly designed to be a no-fault system.

So, in other words, even if a job injury is caused by a work accident that is determined to have been the fault of the worker, the worker may still be eligible for worker's compensation benefits.

The only exceptions to the no-fault workman's comp system tend to be injuries that are self-inflicted, or are the result of a worker's impairment due to drug or alcohol use on the job.

30. How do you choose a worker's compensation lawyer or attorney?

When it comes to something as important as a workmans comp claim, you probably want someone to handle your case who is experienced and who also has expertise.

For this reason, you may find it wise to choose an attorney who specializes in workers compensation claims, and has handled such cases for a certain length of time.

While you can locate a workers compensation attorney via advertising, the state bar association, and even the yellow pages, if you know someone who also had a worker's compensation claim, inquire as to whether or not they were represented. If they had a lawyer handling their case and were satisfied by the work their lawyer did, you may wish to seek a referral.

However, if you cannot obtain a qualified referral for a potential attorney, you may wish to consult with more than one attorney to determine who is best qualified to handle your claim.

31. How much does a workers comp attorney or workers compensation lawyer get paid?

Though workers compensation systems vary by state, attorneys who handle workmans comp cases are usually entitled to receive a fixed percentage of the compensable benefits to which a sick or injured worker is found to be entitled.

However, depending on the state in which you live and file your workers compensation claim, if your employer (or the workman's comp carrier) denies the claim in bad faith, the burden of paying the attorney fees may fall back on the employer.

32. If you have a workmans comp injury, can you choose the doctor who sees you?

This may depend on the state in which you live. Some states may require that an injured worker be seen by a doctor who has been chosen by the employer or workman's comp carrier. Other states may allow a worker to select a physician of their own choosing, subject to approval by the state workers compensation board, which in some states is known as the industrial commission.

However, in most states a worker may make an objection to the treatment provided by the employer and request that another doctor be selected. Additionally, in most states a worker will also have the right to be seen by their own doctor as well.

2. How do I enroll in Medicare when I become eligible?

If you are receiving SSDI benefits, you will automatically be enrolled in Medicare Part A and Medicare Part B in the 25th month of your disability payments. You will be enrolled sooner if you suffer from end-stage renal disease or ALS. If you are automatically enrolled, you will not pay a premium for Part A, but you will pay a monthly premium for Part B ($115.40 in 2011).

Prior to your Medicare eligibility date, Medicare will send you an initial enrollment package containing information about the program, an Initial Enrollment Questionnaire, and your Medicare card. If you choose to keep Part A and Part B, all you have to do is sign the card and keep it.

3. Will my family be covered when I become eligible for Medicare?

Unfortunately, no. Medicare is not offered as a family or dependent benefit. This means that all people must qualify on an individual basis in order to be eligible for Medicare benefits. For example, a person under age 65 does not automatically receive Medicare because their spouse turns 65 and enrolls in the Medicare program. In addition, when a parent qualifies for Medicare, this does not entitle their dependent children to Medicare coverage.

If you have a family member who needs health insurance and does not individually qualify for Medicare, you should consider contacting your State Health Insurance Assistance Program to discuss your options.

4. How much does Medicare cost?

Most people with Medicare get Part A (Hospital Insurance) premium-free because they have sufficiently worked and paid taxes into the system. If you are receiving SSDI benefits, then your Part A will be premium-free. If you do not have enough work history, you have to pay a monthly premium for Part A. Everyone has to pay a monthly premium for Part B (Medical Insurance). In 2011, the monthly premium for Part B is $115.40. Additionally, people with high incomes have to pay a higher Part B premium. Medicare Supplement, Medicare Advantage, and Medicare Prescription Drug Plans are available for an additional monthly premium.

If you have low income and assets, you may qualify for help with some of your Medicare costs. An Advocator Medicare specialist can help you determine whether you qualify.

5. What is the difference between Medicare and Medicaid?

Medicare is a federal health insurance program for people age 65 and older, people under age 65 who receive Social Security Disability Insurance (SSDI) benefits, and people of any age who suffer from ALS or end-stage renal disease. Your income does not affect your eligibility for Medicare.

Medicaid, on the other hand, is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. To qualify for Medicaid, you must have low income and limited resources.

6. I have other health insurance coverage. Do I still need to enroll in Medicare?

It depends. Medicare rules allow you to delay enrollment in Medicare Part B and Medicare Part D if you are covered by an employer group health plan with 100 or more participants, only if your health coverage is based on your or your spouse's current, active employment.

If your employer plan acts as your primary insurer and has high cost sharing, having Medicare as your secondary insurer may help pay some of your costs. However, if your employer plan includes comprehensive medical and prescription drug coverage with low cost sharing, you may decide it's not worth paying the monthly premium for Medicare Part B and/or Medicare Part D. If you choose not to enroll in Part B and/or Part D when you become eligible, you may delay enrollment only until you, your spouse, or family member stops working or is no longer covered by the employer group health plan.

If your other health insurance coverage is NOT based on the current, active employment of yourself or a family member, you should contact your employer to determine your obligations under the terms of your insurance plan.

If your other health insurance is COBRA continuation coverage, your coverage will terminate when you become entitled to Medicare.

7. Will Medicare cover my prescription drugs?

Yes. When you are eligible for Medicare, you have the option to enroll in Medicare Part D, an optional prescription drug insurance program available to everyone who has Medicare, regardless of your income or health status. Part D plans are offered by private insurance companies and require you to pay a monthly premium.

8. Can I get help paying for my prescription drug costs?

Maybe. The Low-Income Subsidy (LIS) program, also known as "Extra Help," is available to help pay for a portion of Part D costs, including premiums, copayments, and deductibles, for certain people with low incomes and minimal assets. Depending on your income and assets, the Extra Help program may provide a full or partial subsidy. Some people are automatically enrolled in the Extra Help program, while others must apply for the subsidy.

9. What is a donut hole?

The donut hole refers to a coverage gap in Medicare prescription drug coverage during which you must pay all of your drug costs out of pocket. Generally, after the total retail cost of your drugs reaches $2,840, you have to pay 100% of your costs until you reach catastrophic coverage. In all Part D plans, you will reach catastrophic coverage after the total retail cost of your drugs reaches $4,550, at which point you will pay only 5% of the costs of your drugs. In 2011, Medicare beneficiaries will receive a 50% discount on covered brand-name drugs and a 7% discount on generics while in the donut hole.