Suffering an on-the-job injury may leave a person with a handful of questions without answers. Unable to work, they may be facing a stack of medical bills and uncertainty over how to proceed.
Both workers and employers are governed by the Workers’ Disability Compensation Act, which was first adopted in 1912 and is meant to provide compensation to workers who suffer an injury on the job, as well as to protect employers’ liability. Essentially, the mission of the Workers’ Compensation Agency is to efficiently administer the Act and provide prompt, courteous and impartial service to all customers.
If you were injured while at work or have sustained an occupational illness, consider contacting a Michigan workers’ compensation lawyer to discuss the possibility of seeking recovery for your injuries. A successful claim for benefits may help to alleviate your financial stress, so that you can focus on your recovery. By enlisting the help of a tenacious and experienced attorney, you could rest assured that a legal professional is by your side through each step.
How Accidents Happen at Work
People may expect injuries at work to only happen on construction sites, railways, and other occupations with a higher risk for dangerous accidents. However, an on-the-job injury can happen virtually anywhere in Michigan and range from mild to severe.
- Trip and falls
- Overexertion from lifting, lowering, and carrying items
- Repetitive motion stress
- Chemical exposure
- Accidents involving dangerous tools
- Falling objects, such as merchandise, tools, or debris
- Crashes with trucks, forklifts, or other vehicles and machinery
- Workplace fires and electrocution
Common Workplace Injuries
No matter the occupation, a workplace incident could result in severe trauma. While some accidents, such as a minor fall may only result in cuts and bruises, others could lead to any number of damages and occupational illnesses. These include, but are not limited to:
- Arm and wrist injuries
- Carpal Tunnel Syndrome
- Knee damage
- Herniated discs
- Broken bones and fractures
- Post-traumatic stress disorder
- Toxic diseases—such as mesothelioma and silicosis
- Burn injuries
- Spinal cord damage
- Brain trauma
What to do After Being Injured On-The-Job
While seeking medical attention is paramount for any person injured on-the-job, it is also essential that they report their injuries to their employer as soon as possible after the incident. This is important because it might essentially initiate the start of a workers’ compensation claim, as well as diminish the opportunity for an employer to claim the injury was sustained somewhere else outside of work.
Even when an injury or occupational illness is discovered outside of work, an employer should still report their condition to their employer. Furthermore, a condition should still be reported upon its discovery, even if the full extent of its damages is unknown. During any step of this process, the aid of a well-versed Michigan workers’ compensation lawyer may also help an injured worker, especially as they seek recovery.
What is Available Through Workers’ Compensation?
Essentially, workers’ compensation is an insurance program established to provide wage replacement, medical expenses, and rehabilitation benefits to an employee who was injured at work. While these claims are technically made against an employer, it is their insurance company that typically pays the required benefits.
Full and part-time employees may be covered under this system. In general, all employees are covered for on-the-job injuries. However, Some of the major exceptions to this coverage include:
- Employees of the federal government, such as postal workers (but such workers may be covered by the Federal Employment Compensation Act)
- Some agricultural workers
- Employees of companies who employ a very small number of people
- Independent contractors
Disputes very frequently arise over whether medical treatment is reasonable and necessary, or over whether the injured person is an employee or an independent contractor. The outcomes of these disputes can have significant consequences for someone who is injured at work. For example, if it is decided that a medical expense is not reasonable, the cost of its treatment will no longer be covered, which means the injured person will have to pay for the treatment out of their own pocket. If the injury is a serious one, this can cost many thousands of dollars over a person’s lifetime.
To take another example, quite often, employers attempt to argue that the injured person is an employee in order to bring them within the scope of the workers’ compensation law. The reason an employer might do this is so it will be cheaper for them to pay the wage loss benefits and medical expenses, than it would be to face a lawsuit for these and other damages—such as pain and suffering, or punitive damages that workers’ comp would not pay. Furthermore, there have even been instances in which an injured person’s job title was “independent contractor,” but the employer nonetheless argued that the person was an “employee.” Because of these nuances, having a seasoned Michigan lawyer who is familiar with each component of the workers’ compensation system could be critical for an injured worker.
A worker who suffers a work-related injury is entitled to reasonable and necessary medical care for work-related injuries or diseases. This includes payment of expense for all medical treatment, including surgery, physical therapy, rehabilitation, and hospital services. Employers or their insurance carriers are required by law to provide these services and benefits must be paid as long as the treatment is related to a worksite injury.
State law does not require prior authorization from the employer or insurance company for medical services. However, it does allow the employer to direct the care for the first twenty-eight days of medical care. Many large employers have company clinics and doctors that will see and treat the injured worker and refer to an outside specialist if necessary. After the four-week period, the employee may choose their own treating physician.
Typically, the doctors and other medical providers send their bills directly to the employer or its insurance carrier. There is a specified fee schedule for services and doctors and hospitals are not permitted to charge more than the set fees. If they do charge higher fees, the insurance company will only pay according to the fee schedule. A worker who incurs out of pocket expenses is entitled to reimbursement. Many times, the employer will unlawfully refuse to pay for necessary medical care and treatment, while other times, the company doctor or an insurance medical examiner (IME doctor) will give an opinion that an injury is not work-related or that medical treatment is no longer necessary and medical benefits will be terminated.
Wage loss benefits are calculated through an Average Weekly Wage system. After an injury is sustained, a worker must wait seven days before they can become eligible for wage loss. However, if they are unable to work for 14 days or longer, they should receive retrospective wages for the first seven days they missed. A worker who suffers on the job injury is normally entitled to eighty (80%) percent of the after-tax value of his other wage loss. This is the case whether the worker is “totally” or “partially” disabled.
The amount of wages is calculated based upon the average weekly wage, which is essentially the highest amount of wages in the 39 of the last 52 weeks before the injury. If the employee worked less than 39 weeks during the year before an accident, the wage loss amount is determined by dividing up total earnings by the number of weeks worked. If a person returns to work at a lower rate of pay, however, the company must pay the wage difference from the higher rate to the current rate. A knowledgeable workers’ compensation lawyer in Michigan could help a claimant to understand what benefits are available to them, as well as guide them through the process of filing a claim. State law provides that the maximum rate of wage benefits is 90 percent of the state average weekly wage for the year prior to the injury. Therefore, a worker cannot receive benefits higher than this amount regardless of how high his or her earnings might have been. Furthermore, these benefits are only taxable certain unique circumstances.
There is no requirement to pay compensation for an injury which does not last for at least one week. Beyond one week, the worker is entitled to benefits as of the eighth day after the injury. For a disability that continues for two weeks or more, the worker is entitled to be paid compensation for the first week of disability. Wage loss benefits continue as long as the worker is disabled and this can be for a lifetime. The amounts get reduced after the worker’s 65th birthday, and again at age seventy-five. Despite these requirements, employers and insurance companies often look for reasons to terminate, or cut off, an employee’s wage loss benefits. It can either be just the refusal to pay the benefits or termination of benefits based upon a company doctor or highly paid insurance medical examiner (IME) doctor.
Total Disability Benefits
Michigan has a specific statute governing the basis for determining if a worker is permanently disabled from work. Section 361(3) provides that a worker is totally and permanently disabled if he or she has suffered:
- Total and permanent loss of sight of both eyes
- Loss of both legs or both feet at or above the ankle
- Loss of both arms or both hands at or above the wrist
- Loss of any 2 of the members or faculties in subdivisions (a), (b), or (c)
- Permanent and complete paralysis of both legs or both arms or of 1 leg and 1 arm
- Incurable insanity or imbecility
- Permanent and total loss of industrial use of both legs or both hands or both arms or 1 leg and 1 arm—for the purpose of this subdivision, such permanency shall be determined not less than 30 days before the expiration of 500 weeks from the date of injury
Unfortunately, employers, companies, and insurance companies often deny that a worker has a permanent disability. They might also dispute that any total disability was work-related or arose out of the employment. Because of this, retaining a hardworking attorney to argue against these exact issues might be crucial.
When a worker is permanently disabled, the employer must pay the same benefits it would in an ordinary case. In addition, however, the worker is allowed to take advantage of changes in the minimum and maximum rates of benefit. The additional benefits paid to the worker are the responsibility of the Second Injury Fund and are called differential benefits. Additionally, a totally and permanently disabled worker is entitled to the minimum benefit available, which is equal to 25 percent of the state average weekly wage. Finally, a permanently disabled worker is not subject to the coordination of other benefits.
What Happens if a Claim is Denied?
Sometimes, an employer or their insurance company may try to have benefits denied. Often, a company will dispute a claim and make the argument that a worker was injured outside of the scope of their work—by, for example, conducting in horseplay after hours while on company property, or by injuring themselves while on a lunch break.
When an employee is facing medical bills and is unable to continue earning pay, denial of workers’ comp benefits may be a frightening possibility. However, a determined Michigan workers’ compensation attorney could help to assess the circumstances of a claim and its denial and work toward filing an appeal.
These appeals are applied for through an application for mediation or a hearing with the Michigan Workers’ Compensation Agency. If an appeal application is accepted, an injured claimant often must enter a legal dispute over the denial of their benefits. Here, the skill of a legal professional may prove useful.
Call a Michigan Workers’ Compensation Attorney for Assistance
After sustaining a workplace injury, an employee may worry about their financial security as they recover from a potentially severe injury and miss time at work. However, a claim for workers’ compensation benefits might help to mitigate financial strain and allow a person to focus on their recovery.
If you were injured on the job, call a Michigan workers’ compensation lawyer to discuss how to best proceed with a claim. An attorney familiar with the claims process could help to guide you through each step and work to build a thorough claim to fit your circumstances. To discuss your workplace injury, call a legal professional today.