Wednesday, August 7, 2019
There is and always has been a certain percentage of workers compensation claimants that think their on the job injury is a ticket to Easy Street. More often than not, however, this is not the case. And in those cases that do settle for large sums, the injured worker has suffered catastrophic injuries, been gravely disfigured, or will never be able to return to gainful employment. It's a trade off I suspect most people would not want to make. In Connecticut, by and large the value of your case is driven by your base compensation rate: BCR. This is a number that is derived by calculating your average weekly wage for the 52 weeks preceding your injury and then, using a table provided by the Workers Compensation Commission, arriving at your weekly benefit rate which is approximately 60% of your weekly wage. If your comp rate is $200 each week, the value of your case will be significantly less than a workers whose comp rate is $900 per week. It's a matter of mathematics. I took a look at a web page from a large Maryland Worker's compensation firm. They publish their case settlements and I have reported it below. In perusing the settlements, it will quickly become clear to you that worker's compensation is not a get rich quick scheme. Most cases settle for modest amounts and the injured worker heals and goes on with their life. Please know that at my office, I will always endeavor to obtain the best financial result for you and have over 30 years experience getting that done. And now, the reported settlements from Maryland: Injury: Plantar Faciatis Body Part: Left Foot Amount: $6,080.00 Employer: The Greene Turtle Location: Hagerstown, MD Claimant sustained injury after moving a heavy object. Claimant underwent surgery to repair the issue with the foot and returned to pre-injury employment. Injury: Distal bicep rupture Body Part: Arm Amount: $27,375.00 Employer: Southwest Airlines Location: Baltimore, MD Claimant sustained injury after lifting heavy objects at work. Claimant underwent surgery to repair the ruptured bicep. Claimant returned to pre-injury employment. Injury: Left knee sprain and lumbar strain Body Part: Knee and back Amount: $10,660.00 Employer: LabCorp Claimant slipped and fell on ice. Claimant was treated with therapy and medications. Injury: Torn ACL Body Part: Knee Amount: $36,015.00 Employer: A tree cutting and maintenance company Claimant sustained injury after catching himself from falling from a tree. Claimant underwent two surgeries, including a total ACL reconstruction. Claimant has permanent work restrictions. Injury: Cervical and thoracic strains Body Part: Neck and back Amount: $10,950.00 Employer: State of Maryland Location: Baltimore, MD Claimant was injured after being involved in a motor vehicle crash while at work. Claimant was treated with therapy for the injuries sustained. Injury: Tear of the peroneus brevis tendon Body Part: Ankle Amount: $12,562.50 for worsening (total award is $33,500) Location: Baltimore, MD Claimant slipped and fell at work injury the ankle. Claimant reopened the claim for surgery. Claimant had therapy following surgery. Injury: Disc protrusion Body Part: Neck Amount: $7,150.00 Claimant was injured after a heavy object struck Claimant in the head. Claimant had an injection to the neck and therapy. Injury: Calcaneus fracture Body Part: Foot Amount: $35,000.00 Employer: Stewart Sun Rooms Claimant fell from a ladder while at work causing a fracture in the left calcaneus. Claimant had surgery and was able to return to pre-injury employment. Injury: Fracture of the fourth metatarsal neck Body Part: Foot Amount: $10,950.00 Employer: Maryland State Police Claimant was in training when he fell and injured the foot. Claimant was treated with bracing and observation from the orthopedic surgeon. Injury: Post comminuted fracture, left tibia, with internal fixation using nails and screws Body Part: Leg and ankle Amount: $42,588.00 Claimant was involved in a motor vehicle collision while at work. Claimant had surgery to repair the broken leg. Claimant underwent therapy post-operatively. Injury: Lumbar strain Body Part: Back Amount: $45,000.00 Employer: Prince George’s Community Hospital Claimant was injured after moving a patient at work. Claimant was treated with therapy and injections. Claimant returned to pre-injury employment. Injury: Concussion, cervical strain, lumbar strain Body Part: Head, neck, back Amount: $7,040.00 Claimant was injured after being struck by a car while working. Claimant was treated with medication and therapy for the injuries sustained. Injury: Concussion Body Part: Head Amount: $10,000 Employer: CVS Claimant was involved in a motor vehicle crash while working. Claimant was treated with medical visits and medications. Injury: Lumbar strain Body Part: Back Amount: $4,175.00 Employer: MedStar Location: Baltimore Claimant sustained injury after pushing a patient bed at work. Claimant was treated with physical therapy and returned to pre-injury employment. Injury: Torn Labrum Body Part: Shoulder Amount: $60,025.00 Claimant was working as a machine assembly mechanic and fell off a stool. An MRI revealed a tear of the superior and posterior glenoid labrum which required surgery to repair. This was followed by physical therapy before a full duty work release. Injury: Torn Rotator Cuff, Wrist Sprain, Knee Contusion Body Part: Hand, Leg, Shoulder Amount: $53,837.50 Employer: State of Maryland Location: Baltimore City Claimant tripped and fell getting off an elevator that did not level property. This resulted in shoulder surgery, a knee injection, and physical therapy for all three body parts. Injury: Contusion Body Part: Knee Amount: $2,805.00 Location: Aberdeen, Maryland Claimant was working as a truck driver when several pallets fell out of the truck and struck the knee. Claimant was treated with anti-inflammatories and physical therapy. Injury: Sprain/Strain Body Part: Bilateral Wrists Amount: $7,320.00 Location: Sykesville, MD Claimant was at work loading boxes of bread onto a pallet and tripped and fell. Claimant was treated with wrist splinting and physical therapy. Injury: Fracture Body Part: Ankle Amount: $32,467.50 Location: Dedricktown, NJ Claimant was working as a truck driver and was injured stepping down from the truck bed. The injury required surgery in the form of an open reduction internal fixation with lateral plate and stabilization. After postoperative physical therapy subsequent procedures were performed to remove the plate and syndesmotic screw. The Claimant was able to return to preinjury employment. Injury: Sprain/Strain Body Part: Hand/Wrist Amount: $2,150.00 Employer: Southwest Airlines Location: BWI Airport Claimant sustained a hand/wrist injury handling luggage at work. Claimant was treated with medication and physical therapy. Injury: Back Sprain/Strain Body Part: Back Amount: $4,075.00 Employer: Southwest Airlines Location: BWI Airport Claimant was lifting a heavy case from a baggage cart to a transfer cart and sustained a back injury. Claimant was treated with medication and physical therapy. Injury: Ulnar Neuropathy Body Part: Elbow Amount: $2,100.00 Employer: Southwest Airlines Location: BWI Airport Claimant sustained an elbow injury handling luggage at work. Claimant was treated with medication, an elbow sleeve and physical therapy. Injury: Lateral Malleolus Fracture Body Part: Ankle Amount: $10,000 Injured worker was working as a construction worker when he slipped on a beam and fractured his right lateral malleolus. Claimant underwent conservative treatment after he was taken out of the supportive boot and went through physical therapy. Claimant was able to return to a similar job type with a different employer. Injury: Burns/Disfigurement Body Part: Back Amount: $3,780 Claimant went for treatment at Amazon facility and was subsequently burned on her back resulting in scarring to the area. Claimant was able to return to work after conservative care of her skin. Injury June 28, 2018 Body Part: Wrist/Hand Amount: $20,000.00 Location: Baltimore County Client developed carpal tunnel syndrome in non-dominate hand as a result of her work as a nail technician. Injured worker underwent a surgical release. The claim was contested. Settlement was reached with the Employer/Insurer for the an amount that covered all of her lost wages and permanent injury. Claimant returned to work in the same position for a new employer. No additional medical care is expected. Injury November 7, 2017 Body Part: Head, Neck and Back Amount: $25,500.00 for both Plaintiffs Location: Baltimore City Insurer: GEICO Husband and wife were involved in a motor vehicle collision in Downtown Baltimore. Both sustained injuries to their head, neck and back. Conservative care with no surgical indications. Claim was contested by GEICO and suit was filed in the Circuit Court for Baltimore City. After depositions, liability was admitted and the claims were settled pre-trial. Injury: November 13, 2018 Body Part: Arm Amount: AFCS for $6,400.00 Location: Harford County Client sustained a compensable accidental injury while working for the Employer at the Aberdeen Proving Grounds. Non-surgical treatment for approximately 2.5 months. Claimant returned to work for the same employer and eventually left for another job opportunity. No additional medical care is expected. Claim was settled in part due to unrelated, but significant, legal problems for the Client. Injury: April 17, 2018 Amount: $375,648.00 total death benefits, $7,000.00 funeral expenses Location: Montgomery County Dependency claim for spouse. Worker fell from a scaffolding and died ten days afterward. Worker left behind a wife and two adult children. Wife worked part-time for a drycleaner. A dependency claim was filed and hearing held where wife was deemed to be the sole dependent. Medical benefits, funeral expenses and dependency benefits were awarded. Benefits to the wife will be paid for the next twelve years and will equate to total payments of $375,648.00 ($31,394.00 per year). Injury: November 12, 2018 Body Part: Back Amount: $7,500.00 Location: Baltimore City Client sustained a twisting/lifting back injury while loading a patient into a transportation van. Claim was initially contested, but resolved prior to a hearing. After a period of treatment and being out of work, Claimant returned to work for a different employer in a similar job. Claim was settled pending a permanency hearing. No surgery was recommended and no additional medical care was foreseeable. Injury August 21, 2018 Body Part: Shoulder and Back Amount: $5,074.00 Location: Baltimore City Insurer: Allstate Client was the passenger who was involved in a motor vehicle collision. Her husband was deemed to be at-fault for the collision. She sustained injuries to her neck and back and underwent conservative care for about two months. She filed a claim against the motor vehicle insurance policy and the case was settled prior to suit being filed. Body Part: Shoulder Amount: 10% “other cases” PPD for left shoulder, 9% causally connected and 1% due to pre-existing conditions. $8,235.00 PPD Location: Howard County Employer: Vantage House Client was working in the kitchen of a residence community. Foot caught the edge of a raised rubber kitchen mat – fell into the wall and then struck the floor. Primary injury was to shoulder. Claimant sought emergency care and underwent physical therapy as recommended by his primary care physician. No surgery was recommended. After conservative care, Claimant returned to work as a cook for another location. Claim was tried for permanency and not settled because of the concern that Claimant may need additional medical care in the future. Injury August 28, 2018 Body Part: Fingers/Hand Amount: $20,093.25. 5% index finger; 82% middle; 72% ring; 11% pinky. Location: Anne Arundel County Employer: 84 Lumber Co. Client sustained injuries and partial amputation to four of the fingers on his left hand. His hand was caught in, and cut by, a router blade. He was taken to the emergency room where surgery was performed to repair and stabilize the damage. After a few months of post-surgical hand therapy, the Claimant returned to work for the same employer in the same job. The Claimant’s permanent injuries were examined and a hearing on the permanency disability was scheduled. The Insurer wanted to pay the claimant’s permanency as a “hand” claim, but we negotiated a stipulation for permanency for each individual “finger” as “finger” injuries can be more lucrative to a Claimant than a “hand” injury. This increased the value of the permanency assessment 280%. Injury November 28, 2001 Body Part: Pulmonary/Lungs, Kidneys, Hypertension. Amount: $82,232.40. 340 weeks of PPD at $241.86 per week. Location: Baltimore City Employer: Mayor & City Council of Baltimore Client was a firefighter for Baltimore City. As a result of his work, he developed asthma and hypertension. After a period of time and despite active medical care, the Claimant’s asthma developed into chronic obstructive pulmonary disease (COPD). His hypertension caused him to developed stage III kidney disease. The Mayor & City Council challenged the causal connection of the additional medical conditions, but the Commission ruled in the Claimant’s favor. The Commission also awarded the Claimant a “serious disability” permanency award. The M&CC was able to claim an offset due to Claimant’s pension because both conditions were “presumed” to be caused by his exposure to toxic substances during his 30+ year firefighting career. The Claimant had originally been granted permanency just for asthma and hypertension. This was a “reopening” for worsening of his permanent condition due to the development of the new medical conditions.
Sunday, July 21, 2019
UPS Workers Compensation Lawyer for Work Injury Claims in Connecticut United Parcel Service (UPS) is the largest package delivery company in the world. With more than 400,000 employees, UPS, also referred to as “Brown” because of its trademark brown delivery trucks and uniforms, is everywhere. If you’re looking for a UPS workers compensation attorney in Connecticut with experience helping injured UPS employees, please consider the Connecticut Injury Attorney at the Law Offices of James F. Aspell, P.C.. We are here to help you through this difficult time – from formally filing your UPS claim with the Connecticut Workers Compensation Commission all the way through the negotiation of your permanency award, post permanency 31-308a orders, and if desired, the negotiation of a full value settlement of your Connecticut UPS work injury claim. If you’re ready to hire a workers compensation attorney, but want to learn more about UPS workers compensation claims, we offer free in person and telephone consultations for you to give you accurate advice on what to do if you’re hurt in a UPS work accident. UPS Workers Compensation Insurance Can provide Help for Injured Employees In Connecticut all employers must carry workers compensation insurance for their employees. This insurance coverage is available to employees who sustain an injury by accident arising out of and in the course of the employment that either causes a new injury or aggravates a pre-existing condition. Yes – you can receive Connecticut workers compensation benefits for the aggravation, acceleration, or exacerbation of a preexisting condition. This is good news for UPS employees with physically demanding jobs who may have been hurt in the past. Connecticut workers compensation law also covers occupational illnesses, such as carpal tunnel syndrome and hearing loss. UPS employees who use their arms and hands to move and deliver packages, or who are exposed to loud noises in the plane or warehouse, may receive benefits for their work-related disease. If you prove that your injury or illness is covered under the Connecticut Workers’ Compensation Act, then you may receive the following benefits: • Payment of medical expenses for treatment for your UPS work injury. This includes mileage to and from appointments, surgeries, prescription medication, and many other treatment modules. Contact us now if your workers compensation medical bills are being sent to collections. • Wage loss benefits including temporary total disability, temporary partial disability, and permanent and total disability benefits if you are unable to return to work following your UPS work accident or suffer wage loss because you’re restricted to light duty. • If you suffer the loss of or loss of use of a body part, or if a burn injury or surgical scar leaves you disfigured after a UPS accident, then you may qualify for permanent partial disability or scarring benefits under the Workers Compensation Act. • Vocational rehabilitation if you’re unable to return to your UPS job because of your work accident or occupational illness. Vocational rehabilitation may include payment of school-related expenses if you enroll in classes to switch careers. Though the workers compensation system is supposed to be efficient and less litigious than civil courts, it is often not. Don’t be surprised if UPS or Liberty Mutual, which manages UPS’s workers compensation claims in Connecticut, refuses to accept your claim right away. That’s why you should contact an experienced UPS workers comp lawyer like James F. Aspell right away. Our office will take all of the necessary steps to file your claim, obtain and argue the medical evidence, and present your case to the Commissioner at a workers comp hearing,. With the assistance of experienced workers compensation attorney James F. Aspell, you have a better chance of getting the workers comp benefits you need after your UPS work accident. Common UPS Workers Compensation Claims UPS has several subsidiaries, including: The UPS Store; UPS Supply Chain Solutions; UPS Capital; UPS Airlines; UPS Express Critical; UPS Freight; UPS Logistics; UPS Mail Innovations; UPS Professional Solutions; and, UPS I-parcel. This is a long way of saying that UPS has many types of employees with different occupations and job responsibilities. If you are a package handler or delivery driver, then you probably do a lot of heavy lifting, walking, and climbing. This can lead to injuries such as: • Herniated disks • Cervical strains and sprains • Lumbar strains and sprains • Shoulder injuries, including rotator cuff tears • Knee injuries, including ligament tears Those of you who are UPS truck drivers face additional workplace dangers. You may be involved in a motor vehicle accident while completing your route. Common UPS tractor-trailer truck driver accident injuriesI nclude: • Amputation injuries and crushed bones • Broken bones and fractures • Burns • Concussions and traumatic brain injuries, which can lead to depression, anxiety, and memory loss • Deep cuts requiring stitches • Neck injuries and whiplash • Spinal cord injuries No matter your job at UPS or your job responsibilities, you may be entitled to workers compensation benefits as an employee of UPS. These benefits can pay for medical expenses and lost income. You may also be entitled to additional damages, including pain and suffering, through a third-party personal injury claim if your on-the-job injuries were caused by someone else’s negligence. Injured While Working for UPS in CONNECTICUT ? UPS workers compensation lawyer Jim Aspell is ready to help if you were hurt while working in Connecticut . We help all UPS employees in the state, including those who work at the following UPS locations: UPS Customer Center 90 Locust Street Hartford, CT 06115 UPS Customer Center 84 Insurance Lane Windsor Locks, CT 06096 UPS Supply Chain Services 1 Choice Rd Windsor Locks, CT 06096 UPS Freight 130 North Plains Industrial Rd Wallingford, CT 06492 UPS Customer Center 8 Mountain View Rd Watertown, CT 06795 As a UPS employee, you deserve a lawyer with experience not only in workers compensation claims but also in obtaining Social Security Disability Insurance (SSDI) benefits and negotiating personal injury settlements when the motor vehicle crash is caused by a third-party. The Law Offices of James F. Aspell P.C. can help. As a Social Security disability lawyer and Hartford personal injury attorney, Mr. Aspell has helped hundreds of employees injured on the job, including those hurt in UPS work accident claims, recover related benefits through other available legal systems. An Experienced UPS Workers Comp Lawyer You Can Count On We’re here to guide injured UPS employees through the Connecticut workers compensation system. This includes UPS employees who are members of labor unions like the International Brotherhood of Teamsters, as well as those who do not belong to a union. There is no fee unless we get you approved for benefits or negotiate a settlement on your behalf. Our initial consultation is always free and at no obligation to you.
Monday, June 10, 2019
NEW SPOTLIGHT ON NURSE WORKPLACE INJURIES “Nursing: A Profession in Peril,” a five-part series of reports by consumer watchdog group Public Citizen being released over the spring and summer 2015, explores injuries to healthcare workers, potential methods to reduce these injuries, the policy positions of stakeholders and potential solutions. Occupational Safety and Health Administration (OSHA) data show healthcare workers perennially suffer more injuries — requiring time away from work — than those of any other profession, and many of these injuries result from handling patients. Public Citizen released part one, “The Health Care Industry’s Castoffs: Nurses Injured at Work Often Find Themselves Out of Work and Suffering from Chronic Pain,” on June 9 and part two, “Taking the Burden Off Their Backs,” a week later. NUMEROUS INJURIES In 2013, the healthcare and social assistance industry reported 629,500 cases of injury and illness cases to the Bureau of Labor Statistics. That’s 152,000 more cases than in manufacturing, the next highest industry sector. Nearly half (48 percent) of injuries that resulted in days away from work were due to over-exertion or bodily reaction, which includes motions such as lifting, bending, or reaching. Musculoskeletal disorders (MSDs) accounted for 33 percent of all injury and illness cases in 2013, and workers who sustained MSDs required a median of 11 days to recuperate before returning to work, compared with 8 days for all types of cases. PAYING THE PRICE When a healthcare employee gets hurt on the job, hospitals pay the price in many ways: workers’ compensation for lost wages and medical costs; temporary staffing, backfilling, and overtime when injured employees miss work; turnover costs when an injured employee quits; and decreased productivity and morale as employees become physically and emotionally fatigued. Workplace safety also affects patient care. Manual lifting can injure caregivers and also put patients at risk of falls, fractures, bruises, and skin tears. Caregiver fatigue, injury, and stress are tied other problems. Nationwide, workers’ compensation losses result in a total annual expense of $2 billion for hospitals. “Taking the Burden Off Their Backs” outlines a number of recommended technologies and policies to reduce injuries to nurses and other caregivers. It describes devices that assist in lifting, transferring and repositioning patients. Because most musculoskeletal injuries in the hospital setting are cumulative, any steps to minimize risks during patient handling tasks will offer substantial benefits for hospital caregivers. Even if patient handling equipment is available, experts concur that successful patient handling programs rely on management directives to succeed, such as written policies and committees governing patient handling practices, methods for employees to report concerns or incidents without fear of retribution, reliable systems to measure incidents and injuries, and the existence of policies that align physical stress demands with employees’ capabilities. According to the report, only a fraction (between 3 and 25 percent) of hospitals have comprehensive safe-patient handling programs. THE RIGHT SUPPORT “It’s unconscionable that so many caregivers on the front lines are relegated to using archaic technology to perform their jobs,” said Taylor Lincoln, research director for Public Citizen’s Congress Watch division and author of the report. “Hospitals should provide the necessary equipment and management support to ensure that caregivers are spared lifting requirements that jeopardize their health.” When properly implemented, safe-patient handling programs work. For example, the New York State Department of Health Veterans Home at Batavia reports that it saw a reduction from having an average of nine FTE employees out of work per day due to patient handling injuries to just 0.5 employees after instituting a program that minimized manual lifting. If you are a Nurse in Connecticut and have been hurt on the job, and have questions about your rights and obligations, feel free to call us. Note that no attorney client relationship is established until a signed retainer agreement is on file with the firm. This blog post is offered as free advice only.
United Technologies employs thousands of employees in Connecticut. UTC workers get injured at the main plant in East Hartford, at Pratt & Whitney Middletown, at Hamilton Sunstrand in Windsor Locks and at Otis Elevator in Farmington and Plainville. Common East Hartford Job injuries at Pratt and Whitney include back sprains, herniated discs, neck injuries, torn rotator cuffs, shoulder injuries and knee and hip claims. We have over 30 years' experience working with injured Pratt and Whitney workers to get you your benefits and your treatment. If you work for Pratt and Whitney in a manufacturing or aircraft mechanic role, you may encounter a number of dangers while at work. These common industrial workplace hazards can lead to accidents and injuries including: Severe burns when working near heat sources or using corrosive cleaners Permanent respiratory problems from exposure to paint fumes and harsh chemicals Disc injuries in the neck and back after lifting heavy materials Hand, wrist or finger Joint damage from repetitive, daily movements while assembling parts Deep cuts or broken bones if machines malfunction Hand and arm injuries Forklift accidents When you work for Pratt & Whitney, you may be entitled to receive workers' compensation benefits. These benefits will help you with your recovery regardless of your job title or the type of on-the-job injuries you receive. Call our Hartford Workers Comp Law office today for a free consultation. There are important time limitations that need to be followed in order to protect your rights. Be sure to k now these or hire a knowledgeable Connecticut work injury lawyer to help you. Pratt and Whitney job injury settlements: We can negotiate your Connecticut workers compensation settlement. We have extensive experience working with injured workers in resolving their serious Connecticut work injury claims as quickly as possible. We can resolve eye claims, back claims, shoulder and knee claims, foot, leg and hip injuries, as well as all sorts of contested Connecticut work injury claims. Call our Hartford work injury lawyer today for a free evaluation of your matter.
Thursday, June 6, 2019
Repetitive trauma injuries accumulate over time and often result in severe injuries for construction. Construction workers operate in hostile environments where life-changing accidents are common, but cumulative stress injuries caused by repetitive motion, exposure to toxins, vibrations, loud noises, or sustained positions can be just as debilitating. Cumulative Trauma Explained Cumulative trauma refers to a series of small injuries or prolonged exposure to a hazardous environment or physically demanding work that can accumulate into life-altering injuries. Cumulative trauma usually coalesces in the muscles, bones, joints, nerves, tendons, spinal cord, and other vulnerable areas. Cumulative stress injuries can result in long-term pain or disability, increased medical costs, and lost wages if the worker is unable to perform his duties due to the injuries. Sources of Cumulative Injuries Cumulative injuries result from exposure to regular duties in construction. For example, construction workers who are exposed to loud noises on a persistent and prolonged basis can suffer injuries to their hearing and other vulnerable body parts over time. Workers who engage in repetitive activities also suffer from serious injuries. Specifically, electricians and trim carpenters are vulnerable in their hands, joints and shoulders because the repetitive motion wears out their joints and tendons. Continuous exposure to toxins, even those that are “safe” or in “low-doses” can damage the brain and cause other injuries. Moreover, construction employees who regularly stand or sit on vibrating surfaces also incur significant wear and tear on their bodies. Workers who regularly perform awkward- or heavy-lifting also suffer damage to their hips, knees, and back – even if they lift properly. Exposure to loud noises, heavy lifting, and repetitive motions can cause subtle but detectable injuries which, over time, can result in disabilities which could require the worker to take an extended leave from work to recover. Possible Injuries Exposure to various incidents can result in a broad range of injuries, including but not limited to: Carpal tunnel in the joints (particularly wrists); Tendon and joint problems (such as tendonitis, bursitis, and arthritis); Deafness; Cancer; Lung problems; and Hand-arm vibration syndrome which is significant nerve damage in the hands and arms due to vibration exposure.
Monday, May 20, 2019
Did the injury occur at work? The answer to why an employer would dispute a workers' comp claim is simple and boils down to a single five letter word: money. Like any other type of insurance product, employers pay premiums to provide workers' compensation benefits to workers (in most states, this is mandatory). Premium amounts are directly affected when injured workers file for benefits. Premium Costs Logically, the more workers' comp claims that are filed, the higher the costs for employers. Workers' comp insurance premiums increase when more workers than estimated file for claims, or when an employee has a particularly expensive claim (for instance, requiring back surgery). It is for this reason that employers and their insurance companies routinely use investigative agencies to monitor the daily activities of workers who have filed workers' compensation claims. Employer Bias Unfortunately, many employers don't believe that some injuries are serious or even valid, especially cumulative trauma injuries. They assume that a worker who files for workers' compensation benefits on the basis of carpal tunnel syndrome, another repetitive stress injury, or a lumbar back injury is not being completely truthful (or is "malingering," the industry term for feigning sickness or disability for financial gain). Employer bias is particularly strong against injuries involving inexplicable pain that cannot be wholly verified by medical examination, or even sufficiently verified by x-rays, other imaging, or nerve conduction studies. Does this mean that the injured worker who has constant back pain is malingering? Definitely not. Many medical conditions are difficult to objectively verify. Reasons for Denial of a Claim If your employer or its insurance company denies your claim, or any part of it, it should inform you in writing. Typical reasons given for denying a claim are: You didn't suffer a serious injury. Your injury didn't take place during work, or within the scope of employment. You don't need medical treatment for your injury. You don't need time off work for your injury. Fighting a Denial of Benefits If you receive a notice that your claim has been denied, call or write to your employer's workers' comp insurance carrier. If this doesn't solve the problem, hire a workers' comp lawyer and request a hearing with the state workers' comp board. The bottom line is this: employees who have become injured or sick as a result of their job should file for workers' comp to protect themselves, and if their claim is denied, they should fight the insurance company, with the help of a lawyer. Whether or not the employer believes that the worker is legitimately injured will turn out to be irrelevant, and the worker shouldn't worry about whether the employer holds the employee in contempt for filing a claim. It is the worker's right to have time off work and medical treatment paid for; the worker has given up the right to sue the employer in exchange for the workers' comp benefits and should not feel guilty about using them.
Saturday, May 18, 2019
I was injured at work in Connecticut. There was a witness. My contact at human resources assisted me with completing an incident report. I was on the clock and on the employer's premises when I was injured. Why won't the insurance company pay my benefits? Why am I waiting for medical treatment to be authorized? What appear to be the most frequently asked questions by injured workers immediately following a work injury become increasingly more difficult to answer as time moves on during the pendency of a claim. The Workers' Compensation Act has evolved a long way since its' inception in 1913. However, several themes remain true and stand the test of time. First, Connecticut's Workers' Compensation Act (the "Act") is meant to compensate the injured worker for their finanical loss and in particular - the weekly rate of pay that the employee lost as a result of the injury. If you are unable to perform any gainful employment as a result of the injury the Act protects against that loss. The inability to work must be substantiated by a physician. Once submitted, the employee gets paid her base compensation rate (a percentage of her average weekly rate) which happens to be non-taxable under the Act. Where is my check? Well, upon further review the insurance carrier's responsible adjuster is not volunarily paying until they hit a few items on their checklist. Wages verification from the employer. Obtain confirmation from the first call center as to loss of work capacity. Are there restrictions? Can the employer accomodate the injured employee's circumstances? Has the employee completed the proper forms to determine an average weekly wage or base compensation rate? Making matters more difficult, the injured worker's focus should be on getting better. The process of obtaining authorization for initial medical treatment from the responsible workers' compensation carrier can be an extremely difficult task especially for an individual and her family that did not expect to be thrust into difficult circumstances in an instant. Who is the carrier? Who is the adjuster? How difficult is it to get me a claim number? Why is this nurse calling me and why is he allowed to walk into my doctor's office with me? How come I have to go to this urgent call center so many times without getting a referral to a specialist physician? Another theme that stands the test of time is that the Act ensures the injured worker access to "reasonable and necessary" medical treatment. Again, this seems like an easy problem to solve. I'm hurt at work. Get me to a doctor. I have spent more time litigating an injured worker's right to proper care than I care to divulge. Why? It is costly. The process between physician office and responsible adjuster is cumbersome. The insurance carrier, much like the verifications made before making payment of lost earnings also needs to confirm several aspects of your medical picture before authorizing treatment. Has the injured worker signed the proper forms to obtain treatment? Was there a pre-existing injury or accident causing the need for treatment? Does the injured worker have private insurance to process the cost of medical treatment during our investigation? Has the doctor's office submitted the proper codes and documentation. Do you see the common theme here? Navigating your claim has become increasingly difficult given the delays involved from the onset with respect to payment of benefits and rendering of medical care. The cost of benefits and treatment to the carrier often drive the contest of any claim. Even in "accepted" claims, the carrier will often litigate matters of import throughout the course of the claim. Setting the tone early with the responsible workers' compensation carrier and claims adjuster when you have a serious work injury is important. Not every case necessitates the involvement of an attorney. However, it's extremely prudent to get the advice of one before the process gets out of hand.