Top Ten Things to Know in a Workers’ Compensation Claim

Laura Beth York, Rainwater, Holt & Sexton Attorney:

Often times when an employee is injured at work it is hard to know exactly what to do or if the decisions that you are making are the best ones. Here is a list of things that are important to know if you are filing a workers’ compensation claim.

(1) ALWAYS REPORT YOUR INJURY IMMEDIATELY.

Even if you think that your pain is minimal or will go away with time, you need to report the injury to your immediate supervisor. It is important that your employer knows that you were injured, so they can provide you with the appropriate paperwork. If you do not immediately report your injury, it may not be a bar to recovery, but it may provide the insurance company with enough reason to deny your claim, and therefore make it harder to get the benefits to which you are entitled.

(2) ALWAYS TELL YOUR DOCTOR HOW YOU GOT HURT AND WHERE IT HURTS

Medical providers are documenting everything that you tell them. It’s important that you tell your doctor or medical provider that the injury occurred on the job. This way, there will be no question about how you got hurt. Also, make sure to tell your doctor or medical provider each part of your body that is injured, even if it is just sore or bruised at the time. An injury can get worse over time, and the insurance company may deny part of your claim if you did not tell the original treating physician all the parts of your body that were inured as a result of the on-the-job accident.

(3) BE CONSISTENT WITH YOUR STATEMENTS

Whether you are telling the medical provider, your boss, or the insurance company how you got hurt or what parts of your body hurt, be consistent. If you cannot identify exactly how you were hurt or what parts of your body were injured, you will have a hard time getting the insurance company to pay for your benefits. Remember, the insurance company may record your statements as well, so if something changes in your workers’ compensation claim, they may be able to listen to all of your prior statements.

(4) KEEP A COPY OF YOUR WORK RESTRICTIONS WITH YOU AT WORK

When a medical provider gives an injured worker restrictions, you must take those restrictions to your employer after each medical appointment. Your employer is given the opportunity to determine if they have work within your restrictions. If your employer can accommodate those restrictions, you need to keep those restrictions with you at all times. Employers can forget that you are on restricted work-duty, and they may order you to do something outside of your restrictions. You will need to remind your employer of your restrictions, and never, ever perform any work outside of your restrictions. If you perform work outside of your restrictions, this could result in a loss of benefits.

(5) ALWAYS ACCEPT AN OFFER OF WORK THAT IS IN YOUR RESTRICTIONS

If your employer is able to accommodate your work restrictions, you need to perform the work that is being offered. If you decline any work within your restrictions, your workers’ compensation checks may stop. That means that you won’t get paid for your time off of work. Additionally, motivation is always a factor with the Administrative Law Judges. If the Judge feels that you are not motivated to return to work, your case may be worth a lot less money.

(6) ATTEND ALL DOCTOR APPOINTMENTS

It is important to attend all of your medical appointments. If you do not attend, you are essentially telling your employer that you no longer need any more medical treatment. This could cause you to lose both medical benefits and any payment that you are receiving.

(7) CHANGE OF PHYSICIAN REQUESTS ARE A TIME DEAL

You may not like the doctor that the workers’ compensation insurance company is sending you to see. Unfortunately, if medical treatment is being provided, you do not have the opportunity to choose your own doctors. However, there is a one-time Change of Physician request that can be made to “any doctor of your choosing.” This sounds great, but it doesn’t necessarily mean that you just get to choose anyone. First, this medical provider must be in the insurance company’s network. Second, the medical provider must agree to accept you as a patient. Third, the medical provider must agree to accept payment in accordance with the medical fee schedule as set forth by the Arkansas Workers’ Compensation Commission. Fourth, the insurance company only really has to allow you one visit with that medical provider. You need to know when it is a good time to utilize this one time request. An attorney can help you to make those strategic decisions.

(8) YOU ARE NOT ENTITLED TO LOST WAGES

In Arkansas, the Judges will not award you what is generally referred to as “Lost Wages.” Lost wages are generally described as the money you would have earned if you had continued at that job until retirement.  While you cannot get Lost Wages, you may be entitled to Wage Loss. The law distinguishes these two benefits. Wage loss is criteria (i.e. age, education, medical treatment, work history) that a Judge uses to determine how much additional money you may be entitled to after you have completed your treatment. An attorney will be able to help you understand the value your wage loss claim.

(9) OTHER BENEFITS MAY AFFECT YOUR WORKERS’ COMPENSATION AWARD

You may have access to Unemployment benefits, Social Security Disability or Retirement benefits, or Short Term and Long Term Disability benefits. Filing for some or all of these benefits may have an adverse effect on your workers’ compensation claim. Before filing for any additional benefits, you need to speak with an attorney who can help you to determine which benefits you could or should apply for and how each one of these may affect your workers’ compensation benefits.

(10) CONSULT AN ATTORNEY

Little details can make a big difference in your case. If the insurance company does not properly calculate your benefits, they could be underpaying your weekly benefits. It may not seem like much, but over time, these little amounts can add up to a lot of money. It’s important to consult an attorney who can make sure that you are not only paid correctly, but who can make sure that all your medical needs are being properly addressed. Rainwater, Holt & Sexton has a dedicated team that can work on your Workers’ Compensation claim.

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