Workers’ Compensation Benefits
After the occurrence of a work place injury, there are FOUR major benefits injured workers can apply for:
- Medical Benefits: workers’ compensation is designed to treat an injured worker, to help them return to work. However, under current law, insurance carriers are allowed to economically profile doctors, find doctors who are the most cost-effective when treating injured workers, and customize their own medical provider network (MPN) accordingly. Further, when the MPN doctor feels an injured worker should undergo a course of treatment, rather than schedule it, they must then seek insurance permission through a method known as utilization review (UR). As it turns out, a high percentage of treatment requests are non-certified (denied). When treatment is denied, the only recourse is appealing to an anonymous independent medical reviewing doctor (IMR), who never sees you or reveals their identity. Rather, they review the treating doctor’s request and the reviewing doctor’s denial, and then make a final decision regarding the treatment. Since the insurance carrier has a team to help them with limited medical treatment liability, it is important to have The Law Offices of Steven A. Meline to help you receive proper treatment.
- Temporary Disability Benefits: When a primary treating doctor certifies an injured worker to be temporarily totally disabled (TTD), they can apply for financial benefits equal to two-thirds (2/3) of their average weekly wages (AWW). The maximum TTD benefit injured workers can apply for is 104 weeks (2 years) within 5 years of the date of injury, unless an exception applies, subject to a doctor’s report. However, with a high number of claims denied initially, many injured workers are left seeking state disability through EDD, which pays a similar amount, but only up to 52 weeks (1 year), assuming an injured worker has paid into a state account. Typically, EDD seeks reimbursement at the conclusion of an injured worker’s claim from the party found liable for the period paid. With differing doctors’ opinions, and contested claims, it is very important for an injured worker to have The Law Offices of Steven A. Meline fighting for their maximum possible temporary disability benefit.
- Permanent Disability Benefits: After treatment for a period of time, a primary treating doctor (PTP), and also an independent evaluating doctor (AME or QME), declare an injured worker’s condition to be permanent and stationary, when looking ahead, they don’t see a major change in condition over the next 12 months. This is also referred to as maximum medical improvement. At that time, the doctors assign a percentage of disability associated with each part of the body that has a lasting disability, which is then rated to a percentage of permanent disability (PD) based on the injured workers age and occupation. Permanent disability is a dollar amount on a scale from 1 to 100 within a minimum and maximum weekly rate, dependent on an injured worker’s AWW. Since the rules, book (AMA Guides, 5 th Edition) and case law used to determine PD are complex and ambiguous at times, and some doctors are more conservative than others, it is important to call The Law Offices of Steven A. Meline as soon as possible to advocate your PD rate.
- Supplemental Job Displacement Benefit Voucher: Finally, if it is determined that an injured worker cannot return to work in the usual and customary duties, they may be entitled to a schooling voucher of $6,000, plus an additional possible $5,000 state stipend.
- Compromise And Release: Rather than itemize the FOUR benefits described above, many injured workers decide to have The Law Offices of Steven A. Meline negotiate and accept a lump-sum settlement closing all types of workers’ compensation benefits. This permissible alternative settlement is referred to as a compromise and release, or C&R. However, more often than not, this option is only available if an injured worker is off the risk for the involved insurance carrier, whether the employer where the injury occurred changed carriers, or if the injured worker is no longer on the books for that employer. Since workers’ compensation is a benefits provider system, and not a lawsuit for damages, the discussion for value of a claim as a lump sum takes the skill of an attorney experienced in the field.