We have heard the term Worker’s Compensation, but do we really understand it? Insurance agents sell Worker’s comp insurance, but do they understand all of the details.
After over 3 decades in law, I have learned that insurance companies do not educate their clients on the importance of covering their business and their employees.
To take it a step further, who educates the employee on their rights and the process of accessing Worker’s Compensation in an accident and or time of need.
Unlike buying an auto policy, the benefits of Worker’s Compensation are not defined by the policy; the terms of the insurance and benefit are set by law.
It is mandated, that an employer with one or more employees must buy coverage. The employee cannot choose the coverage, it’s universal. If you’re with a small or marge company, it does not matter.
What about if you are injured and you employer does not have a policy? Still file a claim.
The following steps are listed out to help you, the employee, when a job-related injury takes place.
Step 1, Part A:
The first rule of worker’ comp is that the claimant/injured worker has the duty to prove her entitlement to benefits. That means that you have to tell someone designated by your employer that there was an accident. If you are able, report the injury to your supervisor, manager or even a co-employee ASAP. It certainly helps if there were witnesses, but it’s not fatal to your claim if there weren’t any witnesses. Tell somebody that you were injured and how it happened. If there is any evidence of the accident, protect that evidence. Many employers have a “Report of Injury or “Incident Report” that you are required to fill out. The workers’ comp system calls those a C-1 form.
Step 1, Part B:
Always go to the doctor on the day of the injury. One of the biggest problems seen in the worker’s comp industry is Claimants trying to “suck it up” or “tough it out” when injured. This only makes it harder to prove the accident. Get to the doctor! Ask your employer which doctor’s office to contact. The employer’s insurance company usually has a designated occupational medicine clinic under contract. If your employer does not give you a doctor, then go to the ER immediately. At either the occupational medicine clinic or the emergency room (ER), you and the doctor must fill out a C-4 form. The medical providers have this form for you. This is the document that starts the work comp claim. Make sure to list any witness information you know, even just the name, and the date and time of injury. Without the C-4 form, there is NO worker’s compensation claim.
It is important to note that you have a very limited time to file a claim from the date of the injury. If your employer advises you not to go to the doctor, go even faster. Time is of the essence! The longer you wait to seek medical treatment, the less likely it is that your claim will be viewed as valid.
It is important to know your rights and take the moves identified in Step 1 parts A & B. Be aware of the 3 parties involved in the work comp claim: The claimant/the injured worker (that’s you), the employer and the insurance company. All three have separate legal rights in Nevada. The insurance company is not bound by the employer’s desires. The Insurance Company will frequently deny a workers’ comp claim over the objection of the employer. Each party has their own separate agenda. Know your rights and be aware of the chess moves by the other players on the board. As the injured worker, no one in the system is looking out for you. The others involved are looking after their own interest—saving money!
Step 2:
As soon as you can after you’ve filed your claim and sought medical treatment, contact an attorney. My office doesn’t charge for a workers’ comp consultation. Get in and get educated ASAP. Don’t expect the employer or insurer to help you. It’s not their job. Remember, YOU bear the burden of proving your entitlement to benefits. I work hard in claims management. The insurance company has a list of authorized medical providers, and I work with the doctors and insurance company to get your claim accepted and get you to the right medical practitioner. It’s much smoother for you if I can help manage the claim from the very beginning rather than to try to fix issues that have already arisen. Issues can seriously delay your workers’ comp benefits making an already bad situation even worse.
Step 3:
Getting better is now your top priority. Getting you the proper benefits is my top priority. Benefits like a wage replacement and its proper amount if you qualify, getting you referred to a specialist if needed, diagnostic evaluations (MRI) and prescriptions, medical equipment, appointments with medical professionals, a permanent partial disability evaluation if indicated and so much more. After you’ve been treated for your medical injury, you may be eligible for workers’ comp vocational rehabilitation benefits (Voc Rehab). Developing an approach to what Voc Rehab services you may need is very complicated. You shouldn’t be in that process without representation.
Step 4:
How does the attorney get paid for all the services provided to you? We usually get paid a percentage of your permanent partial disability (PPD) evaluation. This evaluation occurs when your treating physician determines that you have reached maximum medical improvement (MMI) or are stable and rateable (S&R). You and your doctor determine if you have reached MMI, not the insurance adjuster. MMI simply means that you are as good as you are going to get. It doesn’t mean that you are 100% back to your pre-injury old self. You have reached a medical plateau and your condition is not expected to improve, or worsen, in the foreseeable future.
Conclusion:
I’ve been practicing workers’ comp law since 1992. There’s probably no issue I haven’t seen. I’ve handled cases from sprains and strains to asbestosis and sick buildings, from explosions to dismemberment and worse. You’ll understand a lot better that workers’ comp is a complicated system and that you are almost helpless to manage it on your own. Come in and get educated. Remember that the consultation is at no charge.