Workers' Compensation Questions & Answers by State
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Workers' Compensation Questions & Answers
Q: When on workmans comp how do they calculate the wages paid? Is it current wages or last years wages.
Glenn Neiman's answer
Generally speaking, if you have been employed for at least a year before the injury, your wages from the year prior to the injury are what is used. Again, generally, the wages from the year prior to the injury are divided into four quarters and the top three quarters are averaged. This gives your Average Weekly Wage (AWW). From there, the compensation rate is calculated. Since mistakes are often made by the workers' compensation insurance carrier in this area, it is always a good idea top...
Generally speaking, if you have been employed for at least a year before the injury, your wages from the year prior to the injury are what is used. Again, generally, the wages from the year prior to the injury are divided into four quarters and the top three quarters are averaged. This gives your Average Weekly Wage (AWW). From there, the compensation rate is calculated. Since mistakes are often made by the workers' compensation insurance carrier in this area, it is always a good idea top...
Q: Why is Workers Comp denying me back surgery?
Steven James Foster's answer
First, I would suggest you get an attorney to assist you with your case.
The denial of the psychological evaluation appears to be based on their denial of psyche injury as part of your claim. The surgery was denied based upon Utilization Review (UR). Is sounds like they did not UR the psychological evaluation and it is likely too late for them to do so. Your attorney can file for a hearing to force them to provide the psychological evaluation since it is needed for the surgery and a...
First, I would suggest you get an attorney to assist you with your case.
The denial of the psychological evaluation appears to be based on their denial of psyche injury as part of your claim. The surgery was denied based upon Utilization Review (UR). Is sounds like they did not UR the psychological evaluation and it is likely too late for them to do so. Your attorney can file for a hearing to force them to provide the psychological evaluation since it is needed for the surgery and a...
Q: How can I get paid from my boss who refuses to pay me out of pocket?
1 Answer
| Asked
in
Contracts, Employment Law, Workers' Compensation and Small Claims
for
California
on
Answered on Apr 17, 2018
Answered on Apr 17, 2018
Nancy J. Wallace's answer
He is NOT your 'boss' because you say you are an Independent Contractor. So, he is just a client. When a client fails to pay per the contract, you give them one written warning with a deadline to pay as per the contract, then you file for a Breach of Contract in Small Claims. IF you are not really an independent contractor, if you can show you are really an employee, then you can go to the LABOR COMMISSIONER and file a Wage Claim: https://www.dir.ca.gov/dlse/HowToFileWageClaim.htm BUT...
He is NOT your 'boss' because you say you are an Independent Contractor. So, he is just a client. When a client fails to pay per the contract, you give them one written warning with a deadline to pay as per the contract, then you file for a Breach of Contract in Small Claims. IF you are not really an independent contractor, if you can show you are really an employee, then you can go to the LABOR COMMISSIONER and file a Wage Claim: https://www.dir.ca.gov/dlse/HowToFileWageClaim.htm BUT...
Q: Injured at work and going to PT, can work demand I go on my time after work hours?
Glenn Neiman's answer
The general rule is that if medical treatment for a work injury is available outside of your work hours, then the workers' compensation insurance carrier would not be responsible for the payment of wages you would lose by getting the treatment. On the other hand, if the medical treatment is NOT available outside your work hours, then the workers' compensation insurance carrier would be responsible for the payment of wages you would lose by getting the treatment.
The general rule is that if medical treatment for a work injury is available outside of your work hours, then the workers' compensation insurance carrier would not be responsible for the payment of wages you would lose by getting the treatment. On the other hand, if the medical treatment is NOT available outside your work hours, then the workers' compensation insurance carrier would be responsible for the payment of wages you would lose by getting the treatment.
Q: I have been moved from 8 hours to 6 hours per my WC dr do I loose my accrued hours or do I loose pay?
Nancy J. Wallace's answer
Your Primary Treating Physician MUST put precise work restrictions with specific times in writing first, THEN YOU provide that writing to the insurer and employer with a demand for Temporary Partial Disability payment for the hours that you are to stop work, and include a deadline for that payment to be received (3 weeks is safe). IF you don't have the missing 10 hours of money in hand in 3 weeks you need a WCAB Case Number and a DOR for an expedited hearing...which is impossible for most...
Your Primary Treating Physician MUST put precise work restrictions with specific times in writing first, THEN YOU provide that writing to the insurer and employer with a demand for Temporary Partial Disability payment for the hours that you are to stop work, and include a deadline for that payment to be received (3 weeks is safe). IF you don't have the missing 10 hours of money in hand in 3 weeks you need a WCAB Case Number and a DOR for an expedited hearing...which is impossible for most...
Q: Slip and fall at work back in July 2016 and treated for GAD in 2017 What are my options?
2 Answers
| Asked
in
Employment Law, Personal Injury and Workers' Compensation
for
California
on
Answered on Apr 16, 2018
Answered on Apr 16, 2018
Domingo Castillo Jr's answer
It might be related. I suggest you speak to a experienced workers comp attorney right away. There are alot of issues and questions. Is your wc case open? Do you have an attorney? At what stage are you in your workers comp claim? Have you seen a QME?...and so on.
It might be related. I suggest you speak to a experienced workers comp attorney right away. There are alot of issues and questions. Is your wc case open? Do you have an attorney? At what stage are you in your workers comp claim? Have you seen a QME?...and so on.
Q: I hurt my back and received a settlement,my back issues came back, will my Medicaid insurance pay for my treatment?
1 Answer
| Asked
in
Employment Law and Workers' Compensation
for
Illinois
on
Answered on Apr 16, 2018
Answered on Apr 16, 2018
Charles Candiano's answer
Medicaid will Absolutely pay for any needed care through a Medicaid provider. If you had been represented by a competent attorney, initially, You would have recovered much more money or kept the medical open for the rest of your life.
Medicaid will Absolutely pay for any needed care through a Medicaid provider. If you had been represented by a competent attorney, initially, You would have recovered much more money or kept the medical open for the rest of your life.
Q: How do I verify the C&R payout? I received 32% disability rating and the report states I require surgery. $37,500 low?
Joel Friedman's answer
We do not accept non-Arizona workers' compensation cases. You will need to contact an attorney in California
We do not accept non-Arizona workers' compensation cases. You will need to contact an attorney in California
Q: my workers comp claim was denied.I'm wondering who will be responsible to pay medical bills from on the job injury
Joel Friedman's answer
You are responsible for paying medical bills not covered by your Worker's Comp. claim, regardless of the reason. If you disagree with the denial, you have (or had) 90 days from the date of the notice, not 90 days from the date you received it, to file a request for hearing with the Industrial Commission of Arizona at 800 W. Washington St., Phoenix. The request for hearing must actually be delivered to the Commission, and not just put in the mail on or before the 90th day. If you are still...
You are responsible for paying medical bills not covered by your Worker's Comp. claim, regardless of the reason. If you disagree with the denial, you have (or had) 90 days from the date of the notice, not 90 days from the date you received it, to file a request for hearing with the Industrial Commission of Arizona at 800 W. Washington St., Phoenix. The request for hearing must actually be delivered to the Commission, and not just put in the mail on or before the 90th day. If you are still...
Q: got hurt at work and had 3 disc in neck replaces and employer let there worker comp lasp my Insurance has payed
Nancy J. Wallace's answer
Are you trying to say the Employer has no workers comp insurance? You would have to show actual 'Fault' on the part of the employer that lead to your injury and treatment...a personal injury attorney would be able to give you an estimate of what a jury might award at trial. TROUBLE IS IF the employer declares bankruptcy and then you 'won' a piece of paper, and if the employer is so unsophisticated that he didn't buy workers comp insurance, he probably has very few assets and could be on the...
Are you trying to say the Employer has no workers comp insurance? You would have to show actual 'Fault' on the part of the employer that lead to your injury and treatment...a personal injury attorney would be able to give you an estimate of what a jury might award at trial. TROUBLE IS IF the employer declares bankruptcy and then you 'won' a piece of paper, and if the employer is so unsophisticated that he didn't buy workers comp insurance, he probably has very few assets and could be on the...
Q: I am collecting child support from my xhusband’s workers comp claim in Wyoming I live in Ca. And raised my children here
1 Answer
| Asked
in
Workers' Compensation and Child Support
for
California
on
Answered on Apr 15, 2018
Answered on Apr 15, 2018
Nancy J. Wallace's answer
I do NOT know about WYOMING regulations (might try avvo.com for a wyoming child support expert), but in California if the county Child Support rep has filed a LIEN in the Workers Compensation state file requesting that the overdue amount be ordered paid FIRST before the worker is paid on the award at the close of the claim, the California judge requires the lien be 'resolved' before she orders the insurer to pay the injured worker. So I would be certain there is the exact and precise set of...
I do NOT know about WYOMING regulations (might try avvo.com for a wyoming child support expert), but in California if the county Child Support rep has filed a LIEN in the Workers Compensation state file requesting that the overdue amount be ordered paid FIRST before the worker is paid on the award at the close of the claim, the California judge requires the lien be 'resolved' before she orders the insurer to pay the injured worker. So I would be certain there is the exact and precise set of...
Q: how is the workers compensation commission legally defined;a branch of government or a private enterprise?
2 Answers
| Asked
in
Workers' Compensation, Constitutional Law and Federal Crimes
for
Iowa
on
Answered on Apr 14, 2018
Answered on Apr 14, 2018
Stephen Douglas Lombardi's answer
A governmental agency. Administered by State laws (the Iowa Code), State agency rules (The Iowa Administrative Code) and legal precedent (meaning case law).
A governmental agency. Administered by State laws (the Iowa Code), State agency rules (The Iowa Administrative Code) and legal precedent (meaning case law).
Q: Doctor released my husband to go back to work in October, stopped payments, He couldn't work, in April another doctor
Jan F Hoen's answer
If he is back on "no work" status again, he is eligible for reinstatement of his temporary total disability payments.
If they are not voluntarily reinstated, he will need to file a Claim for Benefits form with the Virginia Workers Compensation Commission based on the change in condition. Supporting medical records (including the work status report from the new doctor) should accompany the claim form.
He should already be under an award for lifetime medical benefits, so if an...
If he is back on "no work" status again, he is eligible for reinstatement of his temporary total disability payments.
If they are not voluntarily reinstated, he will need to file a Claim for Benefits form with the Virginia Workers Compensation Commission based on the change in condition. Supporting medical records (including the work status report from the new doctor) should accompany the claim form.
He should already be under an award for lifetime medical benefits, so if an...
Q: If it's my first time getting hurt on the job can they ask for medical records?
S. Michael Graham's answer
You do not have to provide your medical records. However, the Carrier can deny your claim also. If you put your medical at issue, the Carrier will have a right to look at your medical before they become legally obligated to accept your claim.
You do not have to provide your medical records. However, the Carrier can deny your claim also. If you put your medical at issue, the Carrier will have a right to look at your medical before they become legally obligated to accept your claim.
Q: I was only with the company 4 months when I got hurt, how do they compute my workers comp disability payment ?
Steven James Foster's answer
I assume you were working for a different employer prior to the the employer in which you sustained the injury. If that is the case, your earnings from the prior employer and current employer can be used to calculate your benefits. Labor Code section 4453(c)(4) provides " the average weekly earnings shall be taken at 100 percent of the sum which reasonably represents the average weekly earning capacity of the injured employee at the time of his or her injury, due consideration being given to...
I assume you were working for a different employer prior to the the employer in which you sustained the injury. If that is the case, your earnings from the prior employer and current employer can be used to calculate your benefits. Labor Code section 4453(c)(4) provides " the average weekly earnings shall be taken at 100 percent of the sum which reasonably represents the average weekly earning capacity of the injured employee at the time of his or her injury, due consideration being given to...
Q: I'm in ca. I feel at work and have tbi my cases has settled but they payed me two checks one was medicare msa can they
Steven James Foster's answer
You should look at this link:
https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/Downloads/Self-Administration-Toolkit-for-WCMSAs.pdf
It should answer your questions about your MSA.
You should look at this link:
https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/Downloads/Self-Administration-Toolkit-for-WCMSAs.pdf
It should answer your questions about your MSA.
Q: IN NJ does a corp with the 2 owners (husband & wife) being the only employees need workers comp insurance by law?
H. Scott Aalsberg Esq.'s answer
In general all corps need workers compensation insurance but you should speak with a lawyer as a way around it may exist. Of course expect to pay for the consultation.
In general all corps need workers compensation insurance but you should speak with a lawyer as a way around it may exist. Of course expect to pay for the consultation.
Q: Worker comp Dr. Wants declaring me as permanent disabled with restriction. If I apply for a new job will they know?
Nancy J. Wallace's answer
Maybe not. New employers can look on a database of Injured Workers at the Division of Industrial AccidentsB Workers Comp page and check for your name, then they will know you filed a Workers Compensation claim. BUT THAT does not list what the doctors wrote (just the body parts claimed and the date of injury and the employer and insurer). IF YOU GET a new work injury with this new employer and only then the new employer discovers you had a permanent restriction against working past one full...
Maybe not. New employers can look on a database of Injured Workers at the Division of Industrial AccidentsB Workers Comp page and check for your name, then they will know you filed a Workers Compensation claim. BUT THAT does not list what the doctors wrote (just the body parts claimed and the date of injury and the employer and insurer). IF YOU GET a new work injury with this new employer and only then the new employer discovers you had a permanent restriction against working past one full...
Q: After filing for & receiving a QME, how do I cancel it if I don't want to do it?
Nancy J. Wallace's answer
IF YOU and not the adjuster filed for the QME Panel, just write to the adjuster that you will not be selecting nor scheduling any QME appointment because you now agree with the findings of the Primary Treating PHysician.
If the ADJUSTER requested the QME Panel, then you must pick and you must go.
If the Adjuster didn't object to the PTP opinion but now decides they want a QME opinion, and you fail to pick within the 10 days, the adjuster will pick the most horrific doctor on...
IF YOU and not the adjuster filed for the QME Panel, just write to the adjuster that you will not be selecting nor scheduling any QME appointment because you now agree with the findings of the Primary Treating PHysician.
If the ADJUSTER requested the QME Panel, then you must pick and you must go.
If the Adjuster didn't object to the PTP opinion but now decides they want a QME opinion, and you fail to pick within the 10 days, the adjuster will pick the most horrific doctor on...
Q: Been injured on the job and working with accommodations. If I quit, is workmans comp on the hook for the rest of rehab?
Roy Lee Warren's answer
Yes, changing jobs does not affect your entitlement to life-time medical for your on the job injury.
Yes, changing jobs does not affect your entitlement to life-time medical for your on the job injury.
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