What is Worker's Compensation?
Worker's compensation is the benefits paid to an injured worker when they get hurt on the job. It is meant to protect the rights and benefits of injured workers, as well as to protect employers from lawsuits stemming from work related injuries. Worker's comp claims are supposed to be handled promptly through an administrative process, but since money is involved, it is sometimes necessary to go to court.
What does Worker's Compensation Cover?
There are four main benefits for worker's comp:
(1) Full coverage of medical bills;
(2) Disability benefits, or compensation for lost wages;
(3) Payment for "permanent partial disability," or an injury that restricts your ability to work permanently;
(4) A death benefit for a fatal accident.
Who pays for Worker's Compensation benefits?
The employer's workers compensation insurance carrier. In Utah, the largest worker's compensation insurance carrier is WCF Insurance (formerly the Workers Compensation Fund or just WCF). Some employers fail to obtain workers comp insurance though. In these cases, the employer will pay the claim. If the employer lacks money, is bankrupt, or out of business, then the Uninsured Employers Fund (UEF) may be required to pay the claim.
When do I get paid by Worker's Compensation?
Disability benefits are paid every two weeks and medical bills are paid as they are submitted. (Note: Medical bills must be submitted to the insurance carrier within one year from the date of treatment.) Permanent partial disability benefits are also paid every two weeks.
What can I claim Worker's Compensation for?
There are 4 main conditions you can claim worker's compensation for:
(1) Aggravation of a pre-existing condition that happens through an on-the-job injury, i.e., a slip-and-fall that aggravates a lumbar spine and requires surgery. (See our Youtube video about the "Allen" case and pre-existing conditions.);
(2) Occupational disease, or a medical condition that develops because of your job over a period of months or years, i.e., a miner developing black lung disease;
(3) A cumulative trauma, which is a repetitive use injury that develops over a period of minutes, hours, days or months, most often through repetitive lifting;
(4) An on-the-job injury where there is no contributing pre-existing condition.
Also, you can sometimes claim smaller benefits such as reimbursement for mileage when driving to medical appointments and driving to the IME (Independent Medical Exam).
Are Worker's Compensation payments taxable?
According to IRS.gov:
Amounts you receive as workers' compensation for an occupational sickness or injury are fully exempt from tax if They're paid under a workers' compensation act or a statute in the nature of a workers' compensation act. The exemption also applies to your survivors. The exemption, however, doesn't apply to retirement plan benefits you receive based on your age, length of service, or prior contributions to the plan, even if you retired because of an occupational sickness or injury.
If part of your workers' compensation reduces your social security or equivalent railroad retirement benefits received, that part is considered social security (or equivalent railroad retirement) benefits and may be taxable.
Should I settle my Worker's Compensation claim?
It depends on a case by case basis. Settlement is a tricky matter because we often do not know if you will need further medical treatment some time in the future. In one worker's comp case, a school bus driver hurt his back on the job when he fell off the steps of the school bus. He received workers comp benefits--including surgery--for his lumbar spine. He went back to work. A few years later, the bus driver was at a local festival when someone excitedly jumped on the bus driver's back, re-injuring his lumbar spine. Even though the injury was aggravated by a later accident that wasn't work-related, the Utah Court of Appeals confirmed that workers comp benefits must be paid. Settlement is a final, one time agreement, so it all depends on your situation as to whether or not settlement is wise. The best way to tell is to call us for a free consultation and see what the wisest option is for your case.
What is an IME (Independent Medical Exam)? What Impact does an IME have on my Worker's Comp Claim?
An Independent Medical Exam, or IME, is a medical examination set up and paid for by the insurance carrier. The insurance carrier has a right to have their doctor examine the injured worker and render an opinion on whether the injuries were suffered on the job and what treatment is "reasonable and necessary" for the industrial injury. This information helps the insurance carrier determine the amount of compensation they need to pay to an injured worker.
Unfortunately, IME Doctors are rarely fair towards injured workers. Because of this, IME reports spawn a lot of litigation. Tim Daniels Law Services recommends that injured workers call us before the IME exam so we can help. (This is a free consultation - no charge.)
Call Attorney Tim Daniels today for a free consultation and legal advice! (435) 592-1235