In today’s world, when even a small increase in medical costs can be enough to financially break a family, the last thing anyone wants is to be injured. However, if you are injured at work, the financial burden is lifted from you and your private health insurance. Instead, your employer’s workers compensation insurance, also called workers comp, takes full responsibility for paying for your injuries, as well as some lost wages. To take advantage of this benefit, injured employees must know the steps to file a workers comp claim. An experienced workers compensation attorney with Shillen Mackall Seldon & Spicer may be able to assist you with filing your claim or fighting to get the benefits you are entitled to if your claim is denied. Call (802) 457-4848 to schedule a consultation in one of our Vermont, New Hampshire, or Florida offices to learn more about your claim rights.
What is Workers Compensation?
Workers comp is employer-provided insurance that provides benefits to injured or ill employees when the injury or illness occurs on the job. The employer pays for this insurance with no employee contributions. The specific benefits offered can vary from state to state, but often include cash benefits for lost wages, medical care, temporary disability, and death benefits. When filing a claim, neither the employee nor employer is required to acknowledge being at fault for the injury or illness.
How to File a Workers Comp Claim
Workers comp is required in one form or another in all 50 states, except Texas. Each state is different in where and how employers can purchase coverage, covering out-of-state employees, and how to file a workers comp claim. Understanding these differences can be critical to getting a claim approved.
One important note regarding any injury or illness that occurs at work is that if it is an emergency, medical treatment should be sought before any other steps are taken. While most states indicate that informing the employer should be the first step, this applies only when the injury is not an emergency, as does any requirement to see a doctor chosen by the employer. In emergency situations, the employee or someone else should dial 911 and the injured individual should be transported to the nearest emergency room for treatment.
How to File a Workers Comp Claim in Vermont
The State of Vermont Department of Labor (DOL) outlines a relatively simple process to file a workers comp claim. The first step is to notify the employer of the injury immediately. Some injuries develop more slowly over time, such as repetitive motion injuries, and should then be reported as soon as the injured employee becomes aware of the injury. The employer will send the injured employee to a company doctor (for the first visit only, the employee may choose their own provider for any future visits) for medical treatment. The employee must inform the doctor they are there due to a work injury and if the doctor determines they cannot work, the employee must get a note from the doctor that indicates that fact.
The employer must file a workers comp claim with their insurer within 72 hours of the employee reporting the injury. They must also provide a copy of that report to the employee. If the employer fails to report the injury, the employee may contact the DOL to request a Form 5 and report the injury themselves. They must continue medical treatment as needed, scheduling appointments around their work schedule if they are able to work part-time or being paid for the time spent at these appointments if they must be scheduled during work hours. The insurance company has 21 days from the date the employer is notified to investigate the accident. They may contact the employee with questions and will likely send a Form 7 Medical Authorization for access to the medical records related to the injury. Employees must inform the insurance company of any upcoming medical appointments and any contact information changes that occur while the claim is open.
How to File a Claim in New Hampshire
According to NH RSA 281-A:19 allows injured employees up to two years to report work-related injuries. However, the clock begins ticking on this limitation as soon as the employee knows or should have known the nature of the injury and that it was work-related or, if the employee is deceased, the date any dependent knows or should have known the same. Despite the two year limit, employees should notify their employer as soon as possible so the claim process can begin and their related expenses can be covered. If they have not already, the employee should seek medical treatment.
When the employee needs medical treatment beyond first aid or there are any medical bills incurred, they must fill out a Notice of Accidental Injury or Occupational Disease. The employer notifies the insurance company within five days after the employee notifies them, and the insurance company then has 21 days from the date the claim was received to investigate. One important note regarding New Hampshire’s workers comp is that although workers comp generally does not acknowledge fault, NH RSA 281-A:14 does state that employers are not liable if the employee was engaging in serious and willful misconduct or if the employee is intoxicated, unless the employer was aware that the employee was intoxicated.
How to File a Claim in Florida
FL §440.185 states that injured employees must report their injury to their employer as soon as possible, but no later than 30 days after the injury occurs or their claim may be barred. There are limited exceptions to this, such as if the employer was already aware of the injury (for example, they were present when it occurred). The employee should then seek medical treatment. The employer reports the injury to the insurance company within seven days of the employee’s report, and the insurance company must send an informational brochure to the employee within three days of receiving the employer’s notice.
What Benefits Does Workers Comp Offer?
Generally, the benefits offered by workers compensation are the same for all states, but there are some differences. If an employee is employed by an employer in one state but works in another, they may need to consult with an attorney to determine how their workers comp claim should be filed and what benefits may apply. Employees should also note that while all these benefits may be offered, this does not mean they will be eligible for all benefits. For example, an employee will not be eligible for impairment income or permanent disability payments unless they have a permanent disability or loss of function after being declared at maximum medical improvement (MMI), which means they are as fully recovered as they can be and further treatment will not result in a notable improvement.
Vermont Benefits
Vermont pays for all work injury-related medical care, including doctor visits, prescriptions, physical therapy, and vocational rehabilitation. They also pay temporary total disability (TTD), which is approximately two-thirds of the employee’s usual wage. This pay does not start until the employee is out of work for at least four days. If the employee has dependent children, their TTD is supplemented with additional $10 per week per dependent. Additionally, if the employee has a second (or third) job, they will also receive TTD to replace a portion of those lost wages as well.
If the employee is left with a permanent impairment after recovery, they can receive additional compensation after TTD ends for this loss of function. This amount is calculated based on a schedule provided by state law and is typically provided as periodic payments.
New Hampshire Benefits
New Hampshire also provides medical benefits, including complete payment of doctor visits, prescriptions, hospital stays, physical therapy, and other services and supplies related to the work injury. The insurer must also pay disability income if the individual cannot work, which is 60% of the employee’s average weekly wage. The first three days are unpaid, with disability income beginning on the fourth day (making the employee eligible for one day of pay) and retroactively paying back to the first day after the employee has been out of work for 14 days. If the employee has more than one employer, this pay may also be based on their total income from all employers.
The state also requires workers comp to provide payment for permanent impairment, which is considered the permanent loss of use of certain body parts, including hands, fingers, arms, legs, toes, feet, ears, and eyes. If the individual receives total disability benefits, they also receive a cost of living adjustment. Vocational rehabilitation and the potential right to be reinstated to their former position are also benefits a workers comp claim offers in New Hampshire.
Florida Benefits
Florida also pays medical benefits, covering doctor visits, hospital stays, prescriptions, and other services and supplies related to the work injury. They also provide temporary disability benefits, replacing lost wages at 66 ⅔% of the employee’s average wage. Temporary disability benefits do not start until the individual is out of work for at least seven days, but will be retroactively paid back to the first day if the employee is out of work for 14 days or more, per FL §440.12. Additionally, the employee’s wage may be calculated by adding income from second or third jobs, but the employee must provide the information regarding their wages at their other employers. Impairment income benefits, permanent disability, and death benefits are also benefits that workers comp provides in Florida.
Can You Settle a Workers Comp Claim?
Vermont, New Hampshire, and Florida all allow settlements for workers comp claims, but they do have different rules and ways in which those settlements can be handled. Employees may want to exercise caution when settling their workers comp claim, as they may lose necessary benefits and may get less than they may otherwise be entitled to get. If you are considering settling a claim, an experienced workers compensation attorney with Shillen Mackall Seldon & Spicer may be able to offer guidance and advise you about how to negotiate your claim.
Vermont Settlements
Vermont allows two types of settlements: full and final settlements and permanency settlements. A full and final settlement gives the employee a lump sum payment and closes the claim. This means the individual gives up the right to have future medical bills paid for by workers compensation. Even if the individual believes they are fully recovered, or will not incur any future medical bills related to their work injury, this can be risky, as it means they will be responsible for all future medical bills.
A permanency settlement, or permanent partial disability (PPD), is offered when the individual has reached MMI and still has a partial disability, such as a limited range of motion, limp, or lasting pain. With this settlement, the individual’s claim remains open, and future medical treatments related to the work injury will continue to be paid by the workers compensation insurer. The Vermont DOL reviews all settlements to be sure they are in the injured employee’s best interests and must approve them before they can become final.
New Hampshire Settlements
New Hampshire is very similar to Vermont. They allow a lump sum settlement, which must be approved by the state’s Department of Labor. They also do not allow the injured employee to settle their entitlement to medical bills, which means that future medical care related to the work injury will still be paid for under their workers comp claim.
Florida Settlements
FL §440.20 allows for making a settlement under certain circumstances. This is voluntary, not mandatory, nor is it an automatic process. A workers comp claim settlement in Florida means that the individual loses future medical benefits and will be responsible for paying for all future medical needs related to the work injury. Florida’s Department of Labor does not review these settlements, but a judge of compensation claims (JCC) approves them.
Can You File a Lawsuit in Addition to a Workers Comp Claim?
Employees cannot file a lawsuit against their employer unless there are specific circumstances, such as the employer not having workers compensation insurance. Workers comp is the employee’s exclusive remedy for an injury at work through their employer.
However, all three states allow employees to file a third-party claim, if applicable. This means that if the job-related injury was caused by a third party, or if someone other than the employer was negligent, the employee may file a lawsuit against that person or company. Examples of third-party lawsuits that an employee may file in such instances are a lawsuit against a manufacturer for a defective tool, appliance or piece of equipment, a property owner for unsafe property, a contractor who creates unsafe conditions, or even the manufacturer of defective brakes if those faulty brakes cause the employee to be in an accident while driving an employer’s vehicle or otherwise driving for work purposes (other than commuting to and from work).
How Can a Workers Compensation Attorney Assist You?
Workers compensation insurance provides both employers and employees with a clear and effective method of ensuring that work-related injuries are safely and quickly treated without either party needing to acknowledge fault or pay out money toward medical bills or other expenses. If not filed promptly, settled too soon, or otherwise not handled properly, a claim can be denied or not cover the employee’s expenses fully. If you are concerned that your workers comp claim may be denied, would like guidance on filing your claim, or have other questions regarding a work-related injury, an experienced workers compensation attorney with Shillen Mackall Seldon & Spicer may be able to assist you. Call (802) 457-4848 to schedule a consultation in our Vermont, New York, or Florida offices and learn more about filing workers comp claims.