Workers Compensation-Frequently Asked Questions
Q: Will my employer/workers compensation insurance accept my claim?
A: Sometimes, Yes; Sometimes, No. The employer has a choice of denying your claim or accepting your claim on a temporary basis or accepting your claim by issuing a “Notice of Compensation Payable”. A Notice of Compensation Payable is a form issued by the Bureau of Workers Compensation that indicates information about you, your injury, the employer, the insurance company, a description of your injury and information regarding your wages and benefit entitlements. It is quite important to properly evaluate this form for its accuracy and more specifically, for its description of injury.
Q: How is average weekly wage determined if my salary/income fluctuates?
A: If you have been working for the same employer for more than a year, the employer must provide information to the insurance company to create what is known as a statement of wages. They collect information of the 52 weeks of income that pre-dated your injury. They divide this up into four (4), thirteen (13) week quarters, take the highest three quarters and then add them up, divide by three (3) which gives you an average quarterly wage. This then is divided by thirteen (13) to give an average weekly wage. Your workers compensation benefit is typically two-thirds (⅔) of that amount depending upon your level of income.
Q: Once I am receiving workers compensations benefits, can the employer or the employers insurance company simply stop payment of my benefits?
A: No. If you remain out of work, unless you execute an agreement to end your benefits (ie. supplemental agreement) or by Compromise & Release (settlement of your claim), the employer cannot discontinue your benefits without filing a Petition with the Court and having a scheduled hearing before a Workers Compensation Judge.
Q: Can I settle my workers compensation case for a lump sum?
A: Workers compensation claims are frequently resolved by the Claimant, injured employee, receiving a lump sum benefit in exchange for their ongoing rights to a weekly wage benefit and medical benefits. This is known as a Compromise & Release Agreement that requires a hearing before a Workers Compensation Judge for approval. The Judge does not approve whether the Agreement is in your best interest but whether or not you truly understand the meaning of a Compromise & Release settlement.
Q: What happens if my employer will not pay my medical bills?
A: If your medical bills are reasonable and necessary and related to your work injury, the Workers Compensation Act requires an employer’s insurance company to pay these expenses in accordance with statutory rates. Failure to do so, can be determined by a Workers Compensation Judge as a violation of the Workers Compensation Act and subject them to penalties that include up to fifty (50%) percent of the unpaid sums and attorney’s fees.
Q: When do I need an attorney?
A: Even if the employer has accepted your workers compensation claim, it is a good idea to have an attorney look at some of the initial paperwork to make certain it is done correctly. There should be no charge from an attorney to do so. Attorneys are typically paid a flat rate of 20% of the employee’s benefits only when litigation has been commenced and a fee has been approved. This also includes Compromise & Release settlements.
Q: Can I sue my employer for pain and suffering?
A: No. There are a few exceptions for intentional acts. However, in return for the workers compensation benefits, the Law provides immunity and protection to an employer from lawsuits that include pain and suffering. The exclusive remedy to an employee is the Workers Compensation Act, as described.
Q: Do I have to prove the employer was negligent, causing my injury?
A: No. As long as your injury occurred while you were in the scope and course of your employment or furthering the business of your employer, then you do not need to prove that your injury was caused by the employer’s negligence. If your injuries were caused by a third party’s negligence, then you could still pursue a lawsuit against that third party, as well as your workers compensation benefits.
Q: What if I am injured outside the employer’s premises?
A: You still have a workers’ compensation claim as long as you are in the scope and course of your employment and furthering your employer’s business. People frequently do their jobs on the road or are traveling. If you are working at the time you are injured, you are entitled to workers compensation benefits.
If you have more questions or concerns, please contact us for a free consultation.
This information contained in this section, though accurate, is incomplete. If you believe you have a potential claim, please contact a lawyer to properly evaluate the elements of your claim. The above-referenced information should not be relied upon solely in pursuit of your Rights. We strongly recommend that you consult with an experienced and knowledgeable attorney who handles claims of this nature.