Basics of the Workers Compensation System

Basics of the Workers Compensation System - A Primer

Introduction

Today, we'll delve into the fundamental principles of the workers' compensation system. This primer aims to provide a basic understanding that will prove useful as you navigate through your workers' compensation claim. We will cover the importance of immediate injury notification, the active and permanent phases of a workers' compensation claim, and the critical recommendations made by doctors during the process.

Overview of Discussion

Let's begin with a brief overview of the topics we'll cover today:

1. Importance of Prompt Injury Notification
2. The Active Phase of a Workers' Compensation Claim
3. The Permanent Phase of a Workers' Compensation Claim
4. Doctor's Recommendations and Their Impact

The Notification Door

Before delving into benefits and obligations within the workers' compensation system, it's crucial to address the initial step – notifying your employer of your injury. This is a legal obligation, and failure to do so promptly may lead to claim denial.

A visual aid: A diagram illustrating the active and permanent phases, with emphasis on the notification door.

Tips for Notification:

• Notify your employer immediately after an injury.
• Ensure you can prove the notification (e.g., written report, witness).
• Inform treating doctors and medical staff about the work-related nature of the injury.

Active Phase vs. Permanent Phase

The workers' compensation system comprises two phases – the active phase and the permanent phase.

Active Phase:

• Doctors actively work to improve your medical condition.
• Entitlement to medical care related to the work injury.
• Compensation at 66% of the average monthly wage prior to the injury.
• Litigation may occur over issues like recommended treatments or compensation disputes.

Permanent Phase:

• Begins after reaching Maximum Medical Improvement (MMI).
• Doctor's three recommendations: Supportive Care, Impairment Rating, and Compensation.

Supportive Care:

• Ongoing medical treatment to monitor rather than cure.
• Agreement to the adequacy of supportive care is essential within 90 days.

Impairment Rating:

• Determined based on the American Medical Association (AMA) guidelines.
• Essential to understand and potentially dispute if deemed inadequate.

Compensation:

• Varied based on the type of injury (scheduled vs. unscheduled).
• Scheduled injuries involve limbs and have a fixed compensation period.
• Unscheduled injuries require a loss of earning capacity analysis for lifelong compensation.