Understanding the Workers’ Comp Process

Episode 6:  Louisville Workers’ Compensation attorney Scott Scheynost discusses the overall workers’ comp process.  The informal process is the initial stage during which you’re working with the adjuster and getting some treatment.  The formal process begins when the adjuster stops being cooperative (or never was) and litigation becomes necessary.

During the informal process, you may not have had to force them to do anything, so you may not think you even need an attorney.

Remember, as part of the Kentucky workers’ comp process, you’re required to give notice to your employer letting them know you were injured.  They are required to start a file, report the incident to the Workers’ Compensation Board of Claims.  You’ll be contacted by the insurance carrier.  The carrier will assign a claim number and other actions.  It’s very important you keep track of this claim number.  In Kentucky, the Department of Claims will also assign a claim number.  Keep them both.  They are separate number for separate organizations.  The informal process begins with your notification to the employer.

If you’ve been injured at work, the company owes you medical treatment, but you do not have to go to a specific doctor the company selects.  Even with an informal claim, you should probably begin with your family doctor.  He/She may be more interested in getting you healed, rather than reducing financial exposure by getting you back to work before you’re ready.

The more expensive the medical surgery or therapy, the insurance adjuster may exercise the right to review the case.  The adjuster is trying to limit expenses.  An attorney may need to file a medical fee dispute.  If it’s been denied by the workers’ comp carrier, you may decide to have your health insurance cover it.  We may be able to get these expenses reimbursed, down the road.

Receiving Your Impairment Rating

Eventually, after the medical treatments have been completed, you’ll finally reach the point of “maximum medical improvement” (MMI).  At this point, the doctors are saying there’s nothing else they can do to improve your condition.  Your temporary total disability (TTD) payments will now stop. 

This is when you’ll receive an impairment rating.  These are highly subjective.  It’s very important to let your attorney help you evaluate the rating.  He may decide to send you to a different doctor, which is called an Independent Medical Exam (IME).  Once the MMI is fair, your attorney will work to prepare an evaluation and begin negotiating for your benefits.  It’s basically the point he begins arguing what your case is actually worth and what level of financial benefits you should receive, along with other benefits.

Workers’ Comp Litigation Begins

If a settlement cannot be agreed to by the workers’ compensation adjuster, the formal workers’ comp process begins.  It’s more detailed.  This is when you and your attorney files a formal claim with the Kentucky Department of Workers Claims.  It’s assigned to a judge and the attorneys begin a formal process.  At this point discovery takes place.  There will then be a discovery deposition.  This is why it’s important to avoid posting information on Facebook about your injury, status or activities.  The other side’s attorneys will try to take those issues out of context in an attempt to minimize your injuries.

Now, the information will be submitted and the judge will review it to make a decision.  A hearing will be involved.  It’s not a jury trial, but it’s still a legal procedure.  You will be able to finally tell the judge how you’re doing as a result of the injuries and treatment.  It only lasts 30-45 minutes. 

The judge will then give both attorneys 30 days to write a brief.  These briefs are presented in front of the judge who listens to both and adds them to the case file.  He/She will then review the evidence and issue a decision.  It’s possible that either side may decide to appeal the decision.  There are guidelines determining whether the decision can be appealed. 

If there is an appeal, your case will go before the Kentucky Department of Workers Claims Workers’ Compensation Board.  A panel of 3 will review the facts and render a decision.

The case could actually be appealed to the Kentucky Court of Appeals.  The Kentucky Supreme Court and possibly even the US Supreme Court could also be options. 

Contact Scott Scheynost at (502) 937-5287.  This podcast is meant to provide information and is not legal advice.  Scott’s principal office is located at 7619 Dixie Highway, Louisville, KY 40258.  Co-host Jim Ray is a non-attorney spokesperson.  This is an advertisement.