Is My Work Injury Covered?

In Utah, workers’ compensation is a no-fault insurance system created over 100 years ago by the Utah State Legislature in 1917. There are thousands of workplace injuries across our state each year and approximately 120 fatal occupational injuries in construction, manufacturing, professional, business services, trade, transportation, and utilities.

What is workers’ compensation?

Workers’ compensation is a no-fault insurance system that provides medical and disability benefits for employees who suffer injury or illness because of their work. Additionally, workers’ compensation benefits are the exclusive remedy for work related injuries and illness. This means that injured workers will receive the defined medical and disability benefits provided by the workers’ compensation system, but they cannot sue their employers or co-workers in court for damages.

Additionally, most areas of personal injury require that the injured person not be at-fault, such as motor vehicle accidents, medical malpractice, dog-bite attacks, or other areas of personal injury. However, workers’ compensation is unique as workers are protected without regard for fault, even if the worker accidently injured themselves. In one sense, it broadens the amount of people able to recover for personal injury, however, there are downsides to workers compensation as well.

Limits to Damages

Remember, workers’ compensation is a no-fault system, so as long as the worker didn’t intentionally inflict their injuries, they will be covered. Disability compensation (but not medical benefits) may be denied if the work injury was related to drug or alcohol abuse. What is more, disability compensation can be reduced by 15% for willful failure to use safety devices or follow safety rules. However, disability compensation may also be increased by 15% if an injury resulted from an employer’s willful failure to follow safety rules.

What benefits are provided to injured workers?

Depending on the specific circumstances, workers’ compensation can pay one or more of the following benefits:

a.     Medical care

The most common type of workers’ compensation benefit is that workers’ compensation covers the reasonable expense of medical care necessary to treat a work injury or illness. This includes visits to the hospital, doctor bills, medicine, and prosthetic devices. It also includes reimbursement for the travel to receive medical treatment.

b.     Temporary Total Disability Compensation

Temporary total disability compensation is paid for the time a doctor determines the injured worker is unable to do any work because of a work injury or illness. However, no compensation is paid for the first 3 days after an injury or illness unless the disability prevents the injured worker from working for more than a total of 14 days. in that case, the injured worker will be paid for the first 3 days of disability. This type of compensation ends when they return to work or reach medical stability.

c.     Temporary Partial Disability Compensation

Temporary partial disability compensation is paid if a work injury or illness prevents the injured worker from earning his or her full regular wage while recovering. For example, if the injured worker works fewer hours or works at a light-duty job that pays less than their regular job, they are entitled to temporary partial disability compensation in addition to wages.

d.     Permanent Partial Disability Compensation

Permanent partial disability compensation is paid if the work injury or illness leaves the worker with a permanent impairment. This compensation begins when a doctor determines that the worker has reached medical stability; the duration of this compensation is determined according to an “impairment rating” provided by a physician.

e.     Permanent Total Disability Compensation

Permanent total disability compensation is paid if the work-related injury or illness leaves the worker with a permanent disability that prevents a return to his or her former work or any other work that is reasonably available to the worker.

f.      Death Benefits

Benefits in Case of Death. If an employee dies from a work injury or illness, workers’ compensation will pay up to $9,000 for funeral and burial expenses. Also, the deceased worker’s spouse, dependent children, and other dependents may be entitled to monthly payments.

g.     Independent Medical Evaluation for Partial Disability. 

Once an injured employee has reached maximum medical improvement (MMI), they are referred to an Independent Medical Evaluation (IME) to determine the extent of the employee’s partial disability from their injury or illness. A qualified doctor will conduct the evaluation by reviewing the injured employee’s medical records, treatment plan, as well as current state of stability. An overall report is made to determine the percentage of partial disability and the compensation for the disability is then based on the injured employee’s wages and percentage of disability. Permanent partial disability compensation is specific to an employee’s individual claim.

An Attorney Can Really Help

There are many attorneys out there who assist in workers’ compensation claims, and, at least in Utah, they often are unnecessary. However, there are certain situations where you want to get an attorney involved:

a.     Change of medical provider

A good workplace injury attorney can help you change your medical provider to a better one. This is especially true if your current medical providers appear to be diminishing your injuries. You know the severity of your injuries and the level of pain and discomfort you are experiencing. Additionally, if your medical provider is telling you that you can return to work, even if you do not feel you can safely do so. An experienced workplace accident attorney can make a big difference because we know what doctors to send you to that won’t diminish your injuries or try and rush you back to work.

Remember, workers’ compensation does cannot tell you which doctors you have to go to, as injured workers can change medical providers one time. The injured worker must give notice to the workers’ compensation insurance carrier of the change. Also, a referral from one medical provider to another is not considered a change in medical providers.

b.     Lump sum requests for permanent partial disability

Lump sum disability compensation can be paid after the Permanent Partition Disability Compensation has been determined and with the prior approval of the Utah Labor Commission Adjudication Division. An injured employee will need to submit Form 134, “Application for Lump Sum or Advanced Payment”, and if a lump sum payment is approved, the amount will be reduced to its discounted present value.

Having a workplace injury attorney when seeking a lump sum can really impact the amount of settlement you receive because the attorney can make sure that you have adequately shown the amount of permanent partial disability, as well as make sure you have an experienced voice in front of the Utah Labor Commission Adjudication Division. This can equate to tens of thousands of dollars in difference in many cases.

However, it should be noted that there are times when it is advised to not request a lump sum for permanent partial disability, as your future medical costs are so severe and unknown that it would serve you better to just accept workers’ compensation’s award of providing future medical benefits. Remember, under this situation, you typically must visit a doctor annually to continue to show that ongoing medical treatment is reasonable and necessary.

c.     Dispute Resolution for Denied Claims

You also might need an experienced workers’ compensation injury attorney if your workers’ compensation claim is denied. If this happens, but you were in injured at work, it is highly recommended that you speak with an attorney. Your attorney can gather information as to why the claim was denied and see if there is any additional information that can be submitted to resolve the dispute. Your attorney can also file for a hearing with the Labor Commission’s Adjudication Division.

Before the hearing takes place, you and your attorney can request to participate in the Claims Resolution Conference. A Claims Resolution Conference is offered by the Adjudication Division to assist in resolving workers’ compensation disputes between an injured employee and a self-insured employer or insurance carrier.

d.     Third-Party Claims. 

Although the general rule is that you cannot make a claim for damages against an employer for injuries sustained while at work, this does not take away your ability to make third party claims. For example, while you are working driving a small delivery truck you are t-boned by a semi-truck driver who fell asleep at the wheel. Your medical expenses will be covered by workers’ compensation insurance, but you can certainly file a claim against the semi-truck driver’s insurance. Workers’ compensation will also seek reimbursement from the semi-truck driver’s insurance. In any situation where the at-fault party is not related to your job, you should contact a We Win Injury Law attorney immediately to assist you in your claim.

Takeaway

As you can see, work injuries can be a complex issue that will sometimes necessitate retaining a workplace injury attorney. These uncertainties in medical bills, lost wages, and partial or permanent disability and hardships can leave many questions unanswered. We Win Injury law are strong advocates for injured workers in Utah and can help you understand you rights. Contact us to see if you need to retain an attorney to fight for what you deserve. Remember, the consultations are always free, and no fees unless We Win.