Timeline of a Case
This simplified chart represents the basic steps for the typical uncontested worker’s compensation case. An uncontested case is one where your employer does not contest responsibility for your work-related injury or occupational illness. The chart provides basic step-by-step information for the injured worker (“You”), the employer, and the treating doctor.
1. Work-Related Illnesses
You (the employee) should immediately report your injury to your employer. You should get prompt medical care and treatment, including emergency room hospital care if needed, for your workplace injuries. You should file a 30C Form with the Workers’ Compensation Commission to provide official notice of your claim. Your employer should provide you with any necessary medical care and treatment, and should file a “First Report of Injury” Form with the Workers’ Compensation Commission. Your employer must pay you for a full day of your regular wages for your date of injury. Your treating doctor should provide initial medical care and treatment for your injury. Your treating doctor should also submit initial medical reports about the nature and extent of your injury to you and to your employer (and to your employer’s insurance company, if known). You should also obtain experienced legal representation to safeguard your interests in pursuing your workers’ compensation case.
2. Continued Medical Treatment and Total Incapacity From Work
After receiving your initial medical care and treatment, you must choose your attending physician. This can be your personal primary care doctor, if appropriate, or another qualified physician of your choice. You must engage with your attending physician, attend your medical appointments, and accept appropriate care and treatment from your attending physician. You should start to provide your employer, or its workers’ compensation insurance carrier, with a record of your visits to your doctor(s) for mileage reimbursement.
At the same time, your employer should provide a statement of your wages to its insurer, who will start payment of Temporary Total Disability (known as “TT”) benefits once your doctor confirms that you are unable to work. Your employer, through its workers’ compensation insurance, also must pay your medical bills. Your employer may want to issue a Voluntary Agreement with respect to paying these benefits, particularly if your leave from work is going to be an extended period. This will ensure that your benefits will be paid in a timely manner for the duration of your temporary total disability from work.
Your doctor should continue to provide appropriate medical care and treatment, confirm your work capacity (likely Temporary Total Disability) in writing to your employer, and should provide medical reports and bills to your employer and/or its insurance provider.
3. Improvement and Light Duty
Your goal is to fully heal, be compensated for your time out of work, and return to work as soon as possible. Unless you have been seriously disabled from your injuries or your occupational illness, your condition should improve with continued medical treatment. There should come a time when you can return to work, at least in a partial capacity. You might not have the ability to perform your full job duties, but you are able to perform some work for your employer. For example, a factory worker might not be able to return to the production line, which requires constant standing, bending, and lifting, but can perform quality control inspections while seated. This is an example of “light duty” capacity work. Some employers will have this type of work available for employees who can return to work but cannot fully perform their old job duties.
The time frame for this depends on the nature and extent of your injury. For instance, muscle strains may keep you out of work for several weeks. Severe spine injuries may effectively disable you from working for many months, if not longer. When your condition improves to the point that you can return to work in some capacity, you must request “light duty” work from your employer. If your employer makes a position that involves light duty work available to you, you must accept it and return to work. If the pay is different, you will receive a wage differential benefit through workers’ compensation. If light duty is not available, then you can seek Temporary Partial Disability (known as “TP”) benefits. To receive these benefits, you are required to search for other jobs that might be able to accommodate your restrictions. Assuming that you do not accept any other job offers, you will be paid TP benefits.
When your employer learns that you can return to work, at least in a partial capacity for light duty, they will file a Form 36, labeled “Notice of Intention to Reduce or Discontinue Payments.” It is important to pay attention to this notice. It signals a change in your receipt of benefits from Temporary Total Disability benefits to Temporary Partial Disability benefits, and it indicates that your employer believes that you can return to work.
4. Maximum Medical Improvement
You will reach a point where the effects of your injury will be resolved, or they will no longer continue to improve. This is your point of maximum medical improvement. Based upon your attending doctor’s evaluation (written Form 42), you may be formally diagnosed with a permanent partial disability to your injured body part. Your employer could contest this diagnosis and request a Respondent’s Medical Evaluation or reach an agreement and issue a Voluntary Agreement for payment of Permanent Partial Disability benefits (your “specific award”). Receipt of your full Permanent Partial Disability benefits could conclude your workers’ compensation case if you are then able to return to work. If you are not able to return to work, you may be eligible for further discretionary benefits (known as “308a benefits) and/or a final stipulation and settlement.
Again, this is a simplified chart reflecting the flow of the typical uncontested workers’ compensation case. Your case could involve all or only a few of these steps. Your experienced workers’ compensation lawyers at our firm can guide you through this process. Contact us to discuss your individual case.