This page provides answers to the following questions:
If you are injured and have been unable to earn five (5) or more partial or full workdays worth of wages, you must notify your employer or can notify your employer's insurance provider (should your employer have one). This can be done by filing the Employer's First Report of Injury or Fatality form. The form should be filed within seven (7) days of the fifth day of lost wages.
Your employer is not required by law to engage in a workers' compensation insurance coverage program. However, your employer is required by law to provide employees with the information of what coverage or situation concerning coverage exists. Upon notifying your employer of your injury and your inability to earn full wages or attend work for five full or partial calendar days, your employer must report your injury to the insurance company. Your employer is also expected to provide you a copy of the report made to the insurance provider. The Department of Industrial Accidents also has a searchable database where you can locate the insurance company when seeking information.
If you are unable to return to work for five (5) or more full or partial days due to a work-related injury, your employer have seven (7) days (excluding Sundays and legal holidays) from the fifth day of that time period to report your injury to your insurance provider. From that point, the insurance provider has fourteen (14) days from receiving the first report of your injury to evaluate the claim and determine whether it will accept or deny your claim. You may file an Employee Claim-Form 110 with your employer's insurance provider at any time, but the Department of Industrial Accidents may not review it for thirty days from the first date of your disability or accompanied with an Insurer's Notification of Denial-Form 104.
If your employer does not have workers' compensation insurance, you may be eligible to receive benefits from the State Special Trust Fund. You may also be capable of suing your employer in a civil action and filing a Workers' Compensation Trust Fund if your employer is not insured. Your ability to sue your employer or your entitlement to benefits through this fund will depend largely on the facts and circumstances of your claim.
The conditions that will affect your receipt of benefits will depend largely on the circumstances surrounding your case, including the scope and severity of your injury. Should your employer's insurance provider choose to consider accepting liability, you should receive benefits for lost wages after the first five (5) days of lost wages. However, a number of circumstances may terminate your receipt of benefits or preclude you for receiving them. These circumstances include, but are not limited to, a determination by an administrative official of the Department or the court; you have returned to work; you are no longer in need of medical treatment; you are encouraged to seek vocational rehabilitation and you refuse; or you are imprisoned after conviction. Again, the situations and circumstances surrounding your benefits eligibility will depend on the scope and nature of your injury.
If you are entitled to receive benefits, you will receive a payment check for the first 180 days after you initial injury, known as the Pay-Without-Prejudice period. This is the period of time the insurance provider considers whether to accept liability of your claim. After this time period, the insurer may still issue a final decision on your claim and choose to halt or lower payments. The insurance provider must give you notice of any such modifications along with reasons for taking this action. The Pay-Without-Prejudice period may be extended upon your written consent, and with the approval of the Department.
Your insurance provider may set up a number of payment schemes and benefits to be paid to you, depending on the extent of your injury, any resultant injuries, or fatalities. These benefits are categorized as the following:
- Temporary Total Incapacity: Wage benefits paid to you if your injury or illness prevents you from working for six (6) or more partial or full days. These benefits are calculated as roughly sixty percent (60%) of your gross average weekly earnings.
- Partial Incapacity Benefits: Benefits paid to you if you are able to return back to work, but in a different earning capacity. These are payments calculated as 75% of your new earning potential.
- Permanent and Total Incapacity Benefits: Benefits paid as 66.66% of your average weekly wage should you be totally or permanently incapable of working as a result of your work-related injury or illness.
- Medical Benefits: Compensation for all reasonable medical care required to in a treatment or rehabilitation plan.
- Permanent Loss of Function and Disfigurement Benefits: A one-time payment for certain scars or permanent losses of function as a result of your work-related injury. You and the insurance provider will agree on this payment at some point, usually nine (9) months to one year after the injury, to allow some progress and stabilization of your injury.
- Survivor/Dependents' Benefits: Should the employee die as a result of the work-related injury or illness, your dependents or spouse may be entitled to weekly benefits (66.67% of your average weekly wages). Reasonable burial expenses will be covered, however not in excess of $4,000.
You have four (4) years from the time you become aware of your work-related injury or condition to file a claim with your employer's insurance provided. The same is expected in circumstances where the employee dies as a result of a work-related accident.
If you receive a notification of denial from your employer's insurance provider, you also have four years to appeal the denial.
Initiating the dispute process to resolve an issue with your workers' compensation claim involves four different levels: Conciliation, Conference, Hearing, and Review Board. The process begins with Conciliation where an informal meeting is held between you and either your employer or employer's insurance provider. Any potential resolutions that may emerge from these meetings are not binding unless both parties agree that the resolution will be. The second level is the Conference, where your case is referred to an Administrative Judge to be heard. This is also an informal hearing, where the Administrative Judge can issue a temporary order if the matter cannot be settled. You or the insurance provider may appeal this temporary order within fourteen (14) days of the decision. The Hearing level is where the appeal is made. This level is a formal meeting where an Administrative Judge may hear all evidence, very much like a trial. The judge in this proceeding will issue a determination. Should the decision be unsatisfactory, either party is entitled to appeal the decision to the fourth level, the Review Board. This appeal must be made within thirty (30) days, and a decision will only be appealed should the Administrative Judge in the previous proceeding made a decision that conflicted with the law or was without justification.