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workers' comp claim

What to Expect from Your Workers’ Comp Claim

Episode 23: Louisville workers’ compensation attorney Scott Scheynost offers advice about what to expect from your workers’ comp claim.  For many injured workers, this may be the first time they’ve filed a claim.  Scott will use his 35 years of experience to provide helpful insights to give you a better understanding of the process.

Notify Your Supervisor of Your Injury

This is one of the first steps in the process.  It’s also required by Kentucky law.  You have an obligation to notify them as soon as possible.  A delay may make it more difficult to prove your injury was work-related.  It’s also a defense your employer can use against paying your workers’ comp benefits.

You have to notify a supervisor, team leader, manager or safety coordinator.  Telling your co-worker or even your union steward does not satisfy this legal requirement.  Take the added step of writing down who you told, the date and what you told them.

The Workers’ Comp Claim

As part of the process, your claim will receive a specific claim number assigned by the workers’ compensation carrier.  This is the insurance carrier who is responsible for paying your benefits.  The carrier will assign an adjuster to oversee your claim.  It’s similar to an auto accident.

You want to be sure to know your claim number.  This will be the “magic key” to ensuring the medical bills are sent to the insurance company and adjuster, instead of you. 

If you are having trouble getting the claim number from your employer or the adjuster, you can contact the Kentucky Department of Workers Claims.  The phone number is (502) 564-5550.  Scott also discussed this in Episode 21.

Getting Medical Treatment for Your Workers’ Comp Injury

Your employer (or actually the insurance carrier) is responsible for your medical treatment and related expenses.  It’s important to get to the right provider.  Kentucky law allows you to choose your own doctor.

If the company is recommending a specific doctor, it may be because that doctor will be more loyal to the company.  You want to begin with your family doctor.  He or she will be more focused on ensuring you heal properly.  They may refer you to other providers, but it’s a better option than dealing with “the company doctor.”

Reimbursement for Medical Treatment-Related Expenses

Kentucky workers’ compensation benefits cover related expenses.  If you have to travel to see a doctor or other specialist, the mileage expense can be reimbursed.  You have to submit your expenses within 45 daysClick here for the form you’ll need to use.  Always keep a copy of the form and the date you submitted it.

If you have to get a hotel while traveling to approve medical providers, you can be able expense the cost of the hotel and meals, in addition to the mileage.

The Extent of Your Injuries

Scott always says, “The worst news I can give you is that you have a great workers’ comp claim.  It means you have serious injuries.”  Nobody wants to have to go through this, if they could have avoided it. 

Minor injuries are those with no permanent injuries.  Cuts, strained muscles and similar injuries may involve some limited time off work and then you can get back to the job you were originally doing.  You’ll receive workers’ comp benefits based on the extent of the injury, your treatment and any time off of work.  The good news is, no permanent damage was done.

Significant injuries limiting your range of motion, your grip strength, sensations, etc. can be considered permanent injuries, resulting in some level of permanent disability.  These take much longer to resolve due to surgeries, recovery time and other considerations.  You should definitely consider hiring an attorney because the issues will be much more complicated. 

The insurance adjuster may try to prevent you from getting specific tests, medication or treatments (including some surgeries).  This may result in a medical fee dispute and/or a delay due to Utilization Review.  Your workers’ comp attorney will know how to fight for your treatment. 

What Is an Impairment Rating?

Once the medical providers have done everything possible and you’ve reached a point where no further improvement is expected, you’ve reached maximum medical improvement (MMI).  This could take a few weeks, months or even years.  While you may have ongoing treatment to maintain your level, your condition is not expected to improve.

Your temporary total disability payments (TTD) will now end.

The doctor will perform an independent medical exam to determine your impairment rating.  This rating helps to set the level of benefits you’ll receive, going forward.  It basically determines what work you can or can’t do because of a limited range of motion or some other limitation.  It may even determine you are going to be totally disabled. 

The impairment rating is subjective.  Different doctors may assign different ratings to the same patient.  Once an agreement has been reached on the correct rating, the process moves forward.  The goal is to ensure you get the proper care, any ongoing treatment or medication, vocational rehabilitation and other issues. 

Litigating Your Workers’ Compensation Case

However, if agreement can’t be reached regarding the impairment rating, your attorney may have to litigate your case.  Your claim now becomes a “formal claim.”  A new claim number is assigned and you’ll now have a judge assigned to your case.  The judge will issue a proof-schedule about the details of your case.  You may go to mediation in a last attempt to fairly settle your case.  If that isn’t successful, the litigation proceeds.

Eventually, the judge will make a decision in your case.  At that point, either side may decide to appeal the decision.  There are 3 levels of appeal, after the judge reaches his/her decision.  The first level is the Kentucky Department of Workers Claims Board.  The second level is the Kentucky Court of Appeals.  The third level is the Kentucky Supreme Court.

Re-Opening Your Case

Once your case is finally resolved, you may eventually need to re-open your case.  There are certain criteria required.  If your permanent disability significantly changes, such as after a surgery, the case may be re-opened.  There’s a 4-year window from the date of settlement or the final decision in your case to re-open your case.  

The process now begins again.  Proof will be collected to show how your impairment rating has changed.  Maybe you’re unable to return to your old job or some other qualifying factor. 

There’s a chance that you may be able to increase the amount of benefits you receive, because the impairment rating has increased.  It’s possible you are now having new complications, such as the onset of Complex Regional Pain Syndrome (CRPS). 

You should see if you can get your original attorney to re-open your case.  He/she will be more familiar with you and your injuries. 

Social Security Benefits Related to Your Workplace Injury

Social Security Disability Income (SSDI) is available if you’ve satisfied the requirements, usually based on your work history.  Both workers’ compensation benefits and SSDI can be filed for at the same time.

SSDI is different from what we commonly think of as social security retirement.  If you are totally disabled and can’t work, you may be able to receive SSDI payments. 

However, your social security disability insurance benefits may be reduced (“offset”) by your workers’ comp benefits.  Your attorney will understand how to properly word your settlement in an effort to prevent this from happening.  Your SSDI benefits generally have no direct impact on the amount of workers’ comp benefits you receive.

The Medicare Set Aside

This comes into play with your settlement.  It’s related to your SSDI benefits.  Your employer and the insurance carrier want to get out of paying future medical benefits.  The Medicare Set Aside (MSA) is a separate account established by the employer.  The money in that account will go directly to pay for your medical expenses.  If it gets depleted, then Medicare will begin paying the benefits.

There are important factors that need to be considered in determining if this is a good option for the injured worker.  If money remains in the account at the time of the worker’s death, it can be possible for those funds to go to the estate. 

The Kentucky workers’ compensation laws will continue to change.  It’s important to work with an experienced Louisville workers’ comp attorney to protect your rights and the benefits you deserve.

It Cost You Nothing to Speak with Scott

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.