WORKERS' COMPENSATION

First, report your injury to your employer within 30 days of when the injury happened.

Your employer must fill out a  LES Form DWC-1 , or First Report of Injury or Illness.

This is the form used by the employer to report workers’ compensation accidents or work-related illnesses to the employer's insurance carrier or designated claims office. Delays and errors may increase costs related to processing the claim. The employer's prompt involvement from the beginning is very important. 

If your injury is deemed compensable by your employer, their insurance carrier will oversee your medical treatment. In cases where the injury  is critical , some employers will assign a nurse case manager to oversee your treatment. Your employe and /or their representative will instruct you on which physician they want you to see.

If your injury is compensable, then  your employer is responsible for the following:

1. Payment of all authorized medical treatment
2. Temporary total disability (TTD) payment: this is 2/3 of your average weekly wage for the duration of time you are unable to work (as authorized by your treating physician), after the first 7 consecutive days.
3. Permanent Partial Disability (PPD) payment , based on the percentage of y9ur Disability ability (if any is assigned by your physician)
4. Payment for any visible scarring that your injury may have caused.

There may be more benefits depends upon each specific case.

If the workers compensation insurance carrier acknowledges and accepts that you sustained a work-related injury, compensable injury is the actual injury that they have accepted and will cover medical treatment for, for he rest of your life. Non-compensable injuries are those that they do not accept as being caused by the work-related incident.

No, the workers' compensation laws do not provide for payment of paint and suffering.

Yes. If you are not satisfied with the physician that your employer provided to you , you can change your physician. 

If you are released to go back to work, it is your responsibility to at least make a genuine attempt to do so. If you don’t return to work, that can seriously affect your claim. 

It is your employer’s  responsibility to find you work or tasks that fit within these restrictions. If your employer does not have such work available  and will not be able to accommodate you, then you are entitled to remain out of work on TTD benefits until you can return to your normal duties.

TTD is short for Temporary total disability. When an employee is injured on the job and can't return to work, he/she is temporarily totally disabled and entitled to receive TTD benefits during his /her convalescence. These benefits are generally two-thirds (2/3) of your average weekly wage, up to a weekly maximum. Some states also have a minimum for low-wage workers.

Temporary disability benefits through workers' compensation  are not normally considered taxable income at the state or federal level.

You cannot always rely on common sense to determine who is and who is not disabled under Social Security laws, rules and regulations. This is because Social Security’s strict definition of “disabled” calls for a hypothetical determination of your ability to work. That is, the Social Security Administration (SSA) only wants to know whether you are able to work; it does not care or even consider whether, in the real world, you can find suitable work. 

If you are unable to work because of your physical or mental condition, then it may be that your claim was denied in error. This is especially true in the early stages of the disability application and appeals process, when the decision-makers tend to rigidly apply the Social Secu-rity rules and regulations, with little consideration for the nuances of each individual case. About two-thirds of initial claims for Social Security disability benefits are denied, and many of these are denied erroneously. Depending on the facts of your case, the possibilities for error are endless. For example, your claim may be erroneously denied if the SSA decision-maker: 

• Determines (incorrectly) that your impairment is not severe; 
• Fails to consider all of your impairments; 
• Fails to consider the impact of all your symptoms; 
• Overestimates your ability to function in a work setting; or 
• Overestimates your education level. 

In most instances, there are four levels of appeal available. A claim for disability benefits proceeds from one level to the next, in this order: 

LEVEL 1: RECONSIDERATION 

The first level is a Request for Reconsideration. This is a “paper only” review of your claim. Your request will be reviewed by a team of doctors and disability specialists at the state Disability Determination Services agency. This will be a different team than the one that reviewed (and denied) your initial application.

LEVEL 2: ADMINISTRATIVE LAW JUDGE (ALJ) HEARING 

If your Request for Reconsideration is denied, the next step is a hearing before an Administrative Law Judge (ALJ). At the hearing, the ALJ considers all the evidence in your case (including your tes-timony and the testimony of your witnesses), not just the medical records and other documents filed in support of your claim. You have the opportunity to present new evidence and evidence of any changes in your condition since you first filed your application for benefits. After the hearing, the ALJ issues a written decision. 

LEVEL 3: APPEALS COUNCIL REVIEW

The Social Security Appeals Council is made up of administrative law judges who are new to your case. If the Appeals Council accepts your claim, then it will review the hearing judge’s decision to make sure the ALJ followed all required procedures and applied the law correctly. The Council will not consider any new evidence. Upon concluding its review, the Appeals Council will can affirm the hearing judge’s decision, modify it, reverse it, or remand it (send it back to the ALJ) for a new hearing. The Appeals Council also has the option of declining to review the ALJ’s decision at all. In that instance, the ALJ’s decision to deny your claim for disability benefits becomes the SSA’s final deci-sion (subject to federal court review). 

LEVEL 4: FEDERAL COURT REVIEW 

If the Appeals Council declines to review the ALJ’s decision or, upon review, affirms ALJ’s decision denying your claim, then you may appeal in a United States district court. The defendant (the party you are suing) will be the Commissioner of Social Security. If the district court affirms the SSA’s decision, you may appeal to the U.S. Court of Appeals and then to the U.S. Supreme Court, but the Supreme Court rarely grants review of Social Security Act cases.

Yes. Don’t give up on your claim, at least not until you get a hearing before an administrative law judge. The hearing is the first opportunity you have to present your case in person to the individual who will be deciding your claim. Your odds of success improve once you get a lawyer. The lawyer can assist you and hep you not only during the process but also for developing your records .

Generally, it takes about 18 months from the time you request a hearing until you actually appear before a judge. Even though your chances of success are good, the long wait can be difficult – physically, mentally and emotionally. The SSA has been making an effort to reduce this wait time by, e.g., identifying cases in which favorable decisions can be issued without a hearing; allowing ALJs to issue favorable decisions from the bench; and increasing efficiency through better use of technology (electronic filing and video hearings) . Despite these steps, the wait remains long in most cases. Still, if you cannot work because of your impairment, the smartest course of action is to pursue your case all the way to an administrative hearing.

You do not have to testify in person, but you should if you are able to. As noted above, this is your first and best opportunity to look the decision-maker in the eye and plead your case.

If the judge in your case issues a bench decision, then you should receive an approval letter confirming this decision within a few days. A bench decision is a favorable decision issued orally, at the conclusion of the hearing. Note, though, that the judge can make changes to this oral decision, which may result in a delay of your benefits. If the judge does not issue a bench decision, then your waiting time will vary, depending on the judge and the complexity of your claim. Most claimants have to wait a month or longer. Either way, your claim is not officially approved (or denied) until you receive a letter to that effect from the SSA

The answer is a qualified “yes.” Work is something of a minefield in relation to your claim for Social Security disability benefits. Do not take any work-related action without first speaking with an attorney.