BASIC PRINCIPLES OF WORKERS COMPENSATION IN KENTUCKY To bring a successful workers compensation claim, each worker must prove: 1. You sustained an injury at work; and 2. You timely notified your employer of the work- related injury. To prevent questions of whether you hurt yourself outside of work, the best practice is to immediately report any injury in writing and to go to the doctor as soon as possible. When giving a history of the injury to the doctor, be sure to tell them that the injury happened at work. TIME LIMITS/ STATUTE OF LIMITATIONS The law requires an injured worker to file a workers compensation claim within two years from the date of the injury or within two years of the last TTD payment, whichever was later. If you have sustained a cumulative trauma or repetitive motion injury you need to consult an attorney to determine when you need to file your claim. TTD - TEMPORARILY TOTALLY DISABLED Temporarily Totally Disabled means your condition is such that you are unable to perform any type of work. If the insurance carrier has accepted your claim, you are entitled to draw 2/3 of your normal paycheck if: 1. Your doctor takes you off work; and 2. You have not reached MMI (Maximum Medical Improvement) You need to get off work slips from your doctor. If possible, you need to ask the doctor to write "Off work because of work-related injury". It is also helpful if the doctor can specify the date of injury or the body part affected. If the insurance carrier has not accepted your claim, you still need to get off-work slips from your doctor. If the Judge hearing your claim rules in your favor, you will be entitled to back payments plus interest for the time you were held off work. MMI - MAXIMUM MEDICAL IMPROVEMENT When one reaches Maximum Medical Improvement, the doctor is indicating that the injured person has recovered as much as they will. The injury has stopped healing itself and the condition is static enough to assign a permanent impairment rating. PERMANENT IMPAIRMENT RATING To obtain compensation for a permanent injury, the law requires the injured party to prove their injury merits an “impairment rating” as per the American Medical Association Guides to the Evaluation of Permanent Impairment (5th Edition). Some treating doctors will give a rating for free. If you have to go see a specialist, a rating may cost anywhere from $550 to $1500. WHAT IS MY CASE WORTH? If you are able to prove the elements of a workers compensation claim, you may be entitled to compensation for your injuries as well as past and future medical expenses. The value of your claim is based upon your impairment rating, your permanent restrictions, and the wage you made per week at the time of your injury. If you can prove that your injury has rendered you totally unable to work, the Judge may award benefits for total disability. Total disability benefits are paid weekly until the age you qualify for normal social security retirement benefits. If you cannot prove total disability, the Judge has the option of finding you partially disabled based upon your impairment rating. If you can prove you are physically unable to return to your previous type of work and you have not returned to other work making better pay than you earned at the time of your injury, your impairment rating will be multiplied by ‘3’. Vocational retraining is also a possibility, but it requires a showing that you are physically unable to perform your previous work duties and that your limited training prevents you from earning similar wages at any other job. The maximum medical coverage that a Judge can award is lifetime treatment which is reasonable and necessary for the cure and/or relief of the work injury. A workers' compensation settlement can be paid in a lump sum. An award from a Judge will be paid out weekly. HEARING WORKERS COMPENSATION CLAIMS Once a formal claim is filed with the Department of Worker’s Claims in Frankfort, the case will be assigned to an Administrative Law Judge. Each party is given time to submit evidence and take depositions. Before the case is taken under submission by the Judge, a settlement conference will be held. If the case settles, the parties can agree that compensation will be paid in a lump sum. If the parties cannot settle, the Judge will render an opinion, but any award will be granted in weekly payments instead of a lump sum. Most awards pay over 425 weeks, but some cases allow for longer periods of payments such as an award of total disability. Each award usually includes the right to future medical expenses. MEDICAL TREATMENT All bills for medical treatment and prescriptions related to a work-related injury must be turned in to the workers compensation carrier. The best way to submit bills is to ask the front desk at your medical provider to do it for you. Even if the carrier is denying payment, all bills must be submitted. Form 113 - You may be asked to designate a primary physician using a Form 113. This will be your gatekeeper doctor. If the carrier is accepting your claim, they will pay for all work-related treatment rendered by this physician and any doctor he refers you to. You can change your designated physician once without permission from the carrier. If you seek medical treatment outside the chain of the Form 113, the carrier may not have to pay those bills. Form 114 - If the carrier has accepted your claim, all expenses incurred for access to compensable medical treatment for a work-injury, including mileage shall be submitted to the carrier within 60 days on a Form 114. If the carrier has not accepted your claim, you should still keep track and submit your mileage because if you win your claim, you may be entitled to reimbursement. Medical Fee Disputes Before an award is rendered in a workers compensation case, if your doctor is recommending a treatment or procedure and the carrier is denying preauthorization, this may be resolved by filing a medical fee dispute. The first step is to have your doctor write out a statement describing the procedure he wants to do and why he thinks it is reasonable and necessary to treat your work-injury. That statement has to be turned in to the insurance carrier with a request for preauthorization. If the carrier still denies treatment, we can file the medical fee dispute and let a Judge decide if the proposed treatment is compensable. After an award is rendered, if the carrier is required to pay all future medical expenses related to the work injury, they must file a medical fee dispute if they are denying treatment as unreasonable or they risk sanctions for acting in bad faith. For the answers to more specific questions – do not hesitate to contact me! |
Call (859) 873-1001 or email: brad@bradslutskin.com |