Michigan Workers’ Compensation Questions | FAQs & Answers

In Michigan, wage loss benefits are calculated by taking the average of the highest 39 weeks of the last 52 weeks of your gross wages prior to injury.

This is your Average Weekly Wage (AWW). Generally you should receive 80% of the after-tax value of your AWW. Your first check is due and payable on the 14th day of the disability. After receiving your first check, you should be paid your benefit on a weekly basis.

A wage loss check is not considered late until 30 days after the due date.

Workers’ compensation benefits are not subject to either state or federal income tax.

Sometimes, however, when benefits have been delayed for a long period of time and an employer or insurance company pays a worker interest in addition to the workers’ compensation benefits, those payments of interest may be subject to both state and federal income tax.

Yes, you should always remember that your main goal is to return to work.

If you are able to do some type of work after your injury, even if it is different than your regular job, you are required look for available work. The law demands that you make a “good faith effort” at obtaining a job.

As you know, finding a job in this economy is very difficult. Under the workers’ compensation statute, the insurance company may have to assist you with your search.

You may be entitled to vocational rehabilitation services. A vocational rehabilitation program and counselor will determine the type of jobs that you are able to perform, prepare you for the job, and help you line up employment.

The term IME stands for Independent Medical Examination, but we all know that these doctors are not independent at all.

They are hired by the insurance company and your employer to provide a report that will give the insurer a basis for denying or terminating your benefits.

The doctor will usually report that either you have recovered from your injury and can return to work or that your condition is not related to your job.

The IME doctor may make recommendations about your restrictions or your ability to return to work.

You are not required to follow those recommendations and can follow your own doctor’s restrictions. However, this may result in the suspension of your benefits.

You are entitled to a copy of your IME report. It is a good idea to show it to your own doctor.

Many times, your doctor will write a letter to the insurance company disputing the IME doctor’s opinions.

If the insurance company agrees with your doctor, then your benefits and restrictions should continue. If the insurance company does not agree, you can either follow the IME recommendations or file a workers compensation claim if your benefits are terminated.

It is best to report your injury as soon as it happens. This will be strong evidence that you were injured at work.

If possible, make a report to document how the injury occurred.

Once an injury occurs, however, you should report the incident to the company within 90 days, but the sooner the better.

Most companies require that injuries be reported to usually to a supervisor or the human resources department. Again, follow your company’s reporting procedure.

If you have a repetitive-type injury, like carpal tunnel syndrome, the date of your injury would be the date of diagnosis of the condition because it occurred over many years.

The work does not have to be the only cause to receive workers’ compensation benefits. However, your work must cause, contribute to, or aggravate a medical condition which results in disability.

If you do something at work that causes you to become disabled, you are entitled to benefits. This is true even if you have a pre-existing injury, like a bad back, that makes you more vulnerable to getting hurt on the job. The employer cannot avoid paying benefits just because you had a condition that made you more susceptible to an injury.

For specific injuries, Section 301 of the Workers’ Disability Compensation Act states:

(1) An employee, who receives a personal injury arising out of and in the course of employment by an employer who is subject to this act at the time of the injury, shall be paid compensation as provided in this act. A personal injury under this act is compensable if work causes, contributes to, or aggravates pathology in a manner so as to create a pathology that is medically distinguishable from any pathology that existed prior to the injury. In the case of death resulting from the personal injury to the employee, compensation shall be paid to the employee’s dependents as provided in this act. Time of injury or date of injury as used in this act in the case of a disease or in the case of an injury not attributable to a single event is the last day of work in the employment in which the employee was last subjected to the conditions that resulted in the employee’s disability or death.

(2) Mental disabilities and conditions of the aging process, including but not limited to heart and cardiovascular conditions and degenerative arthritis, are compensable if contributed to or aggravated or accelerated by the employment in a significant manner. Mental disabilities are compensable if arising out of actual events of employment, not unfounded perceptions thereof, and if the employee’s perception of the actual events is reasonably grounded in fact or reality.

(3) An employee going to or from his or her work, while on the premises where the employee’s work is to be performed, and within a reasonable time before and after his or her working hours, is presumed to be in the course of his or her employment. Notwithstanding this presumption, an injury incurred in the pursuit of an activity the major purpose of which is social or recreational is not covered under this act. Any cause of action brought for such an injury is not subject to section 131.

For occupational diseases, Section 401 of the Workers’ Disability Compensation Act states:

(3.1) As used in this chapter, “disability” means a limitation of an employee’s wage earning capacity in work suitable to his or her qualifications and training resulting from a personal injury or work related disease. A limitation of wage earning capacity occurs only if a personal injury covered under this act results in the employee’s being unable to perform all jobs paying the maximum wages in work suitable to that employee’s qualifications and training, which includes work that may be performed using the employee’s transferable work skills. A disability is total if the employee is unable to earn in any job paying maximum wages in work suitable to the employee’s qualifications and training. A disability is partial if the employee retains a wage earning capacity at a pay level less than his or her maximum wages in work suitable to his or her qualifications and training. The establishment of disability does not create a presumption of wage loss.

(3.2) As used in this chapter:

(a) “Disablement” means the event of becoming so disabled.

(b) “Personal injury” includes a disease or disability that is due to causes and conditions that are characteristic of and peculiar to the business of the employer and that arises out of and in the course of the employment. An ordinary disease of life to which the public is generally exposed outside of the employment is not compensable. A personal injury under this act is compensable if work causes, contributes to, or aggravates pathology in a manner so as to create a pathology that is medically distinguishable from any pathology that existed prior to the injury. Mental disabilities and conditions of the aging process, including but not limited to heart and cardiovascular conditions, and degenerative arthritis shall be compensable if contributed to or aggravated or accelerated by the employment in a significant manner. Mental disabilities shall be compensable when arising out of actual events of employment, not unfounded perceptions thereof, and if the employee’s perception of the actual events is reasonably grounded in fact or reality. A hernia to be compensable must be clearly recent in origin and result from a strain arising out of and in the course of the employment and be promptly reported to the employer.

Section 373 of the Act contains a special definition of disability for retirees. A person is considered a retiree if he or she is receiving a pension or retirement benefit (but not a disability pension) that was paid for by the employer. To be disabled, a retiree must prove that he or she is unable “to perform work suitable to the employee’s qualifications, including training or experience.”

The Workers’ Disability Compensation Act is very specific on how this is done:

§301(4)(c) “Wage loss” means the amount of wages lost due to a disability. The employee shall establish a connection between the disability and reduced wages in establishing the wage loss. Wage loss may be established, among other methods, by demonstrating the employee’s good-faith effort to procure work within his or her wage earning capacity. A partially disabled employee who establishes a good-faith effort to procure work but cannot obtain work within his or her wage earning capacity is entitled to weekly benefits under subsection (7) as if totally disabled.

§401(2)(d) “Wage loss” means the amount of wages lost due to a disability. The employee shall establish a connection between the disability and reduced wages in establishing the wage loss. Wage loss may be established, among other methods, by demonstrating the employee’s good-faith effort to procure work within his or her wage earning capacity. A partially disabled employee who establishes a good-faith effort to procure work but cannot obtain work within his or her wage earning capacity is entitled to weekly benefits under subsection (5) as if totally disabled.

Under certain circumstances the value of fringe benefits may be included in determining your average weekly wage.

Fringe benefits include things such as the cost of health insurance, employer contributions to a pension plan, and vacation and holiday pay. Sometimes when a worker is injured, the company continues to provide fringe benefits. There is nothing in the law that requires the company to do this.

However, if benefits are not continued, then you have suffered a greater loss of income.

The value of fringe benefits that are not continued is added to the value of the cash wages to determine your average weekly wage; however, there is a limit. Fringe benefits cannot be used to raise the benefit to more than two-thirds of the state average weekly wage.

Yes. The law provides that the maximum rate of benefits is 90 percent of the state average weekly wage for the year prior to the injury.

You cannot receive benefits higher than this amount regardless of how high your earnings might have been.

For the ordinary injury there is no minimum benefit. However, if you suffer a specific loss you are entitled to a minimum benefit equal to 25 percent of the state average weekly wage.

The same applies if you are totally and permanently disabled. In the case of death, the dependents of a deceased worker are entitled to a minimum benefit equal to 50 percent of the state average weekly wage.

Yes. The workers’ compensation statute provides for the coordination or reduction of workers’ compensation benefits to the extent the worker receives other benefits paid for by the employer. Therefore, if you receive, or are entitled to receive, sick and accident benefits, pension benefits, or other similar benefits, your workers’ compensation rate will be reduced by the after-tax value of other benefits.

Social security benefits are paid 50 percent by the employer and 50 percent by the worker.

Accordingly there is a 50 percent reduction for old age retirement social security benefits.

Social security disability benefits can be reduced if an individual receives workers’ compensation, so there is no reduction in Michigan workers’ compensation for social security disability benefits.

Under the Michigan Workers’ Compensation Statute, you to all reasonable and necessary medical care. This includes medical, surgical, and hospital services, dental services, crutches, hearing apparatus, chiropractic treatment and nursing care.

The responsibility to provide medical care continues indefinitely so long as the need for the care is related to the industrial injury.

During the first 28 days starting when the care begins, your employer has the right to select the medical care providers. After that, you are free to change doctors if you wish.

In order to change, however, you must notify your employer of your desire to change and provide the name of the physician you select.

Your medical providers should send their bills directly to your employer or its insurance carrier. The provider will be paid in accord with the Workers’ Compensation Health Care Services cost containment rules.

If for some reason you pay the doctor (or other provider including pharmacy) directly out of your pocket, you are entitled to full reimbursement by your employer or insurance company.

In most cases, a claim under the Workers’ Disability Compensation Act is considered to be the injured workers’ “exclusive remedy” against their employer. This means that the individual injured at work can only receive workers’ compensation benefits and cannot sue for other damages.

There are some exceptions to this rule, including civil rights claims, violation of labor laws, and other type claims.

If the employer knew that an injury was certain to occur it may give basis to a personal injury type claim.

There may also be claims against other parties liable for the injury, like product manufacturers, and it may be possible to file a personal injury lawsuit in addition to a workers’ compensation claim.

Each Michigan construction accident case depends on the facts of the particular accident, whether you were injured by a co-worker, whether the general contractor was negligent, and several other factors. It is important to contact our office to determine whether your injury qualifies for a lawsuit.