Anatomy of a Workers

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Anatomy of a Workers Compensation Claim
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Anatomy of a Workers Compensation Claim
Its all so confusing! Where do I go for
information?
Bewildered and confused by the process of
workers compensation, Nicholas hopes to gain an
understanding of how to handle work injuries at
his place of employment. Luckily there is hope,
and Nicholas is not alone. . .
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Nebraska Workers Compensation Court
Phone [phone] Web address www.wcc.ne.gov
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Now that Nicholas knows where to go for
information, hed like to know about the Workers
Compensation Court. He calls Judy, a friend of
his who works as a supervisor with another
company, to see if shes got the scoop on how the
court operates.
Of course I can tell you a little about the
Workers Compensation Court. Theyve helped me
out in the past!
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Court Structure
Seven Judges
Public Information
Court Administrator
Coverage Claims
Clerk of the Court
Vocational Rehabilitation
Legal Counsel
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I just dont know which employers are covered by
the Workers Compensation Act. Are all types of
workers covered? Are there any exceptions? Oh
the humanity!
Nicholas is feeling much more confident about
understanding workers compensation. He has also
become more handsome. Yet, questions still nag
at the corners of his mind. He must have answers
. . .
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Who is covered by the Workers Compensation Act?

• The Following ARE covered by the Workers
  Compensation Act
• Employers with one or more
• employees
• Part-time Employees
• Minors
• Charitable Organizations

• The Following ARE NOT covered by the Workers
  Compensation Act
• Federal Employees
• Railroad Employees
• Some Agricultural Operations
• Self-Employed Persons,
• Sole Proprietors, Partners,
• L.L.C. Members
• Volunteers
• Independent Contractors

I think I understand most of that. I remember a
co-worker, Sally, who had trouble understanding
that Independent Contractor classification . . .
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Independent Contractor or Employee? Sallys tale
of woe followed by insight.
Norma helps Sally with her dilemma.
I have a worker who was injured on the job. How
do I tell if he is an employee or an independent
contractor?
Well Sally, even though the question is
determined on a case-by-case basis, there are
some guidelines. Lets see, where is that list of
factors? Aha! Here it is . . .
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How to Determine Independent Contractor Versus
Employee
So thats how you figure it out! Thank you!
It was no trouble, Sally! Im glad I could help
with your workers compensation question!
Hence, Norma helped Sally solve the dilemma of
independent contractor versus employee status.
Nicholas stirs from his daydream. He must know
more . . .
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As compelling as the lesson is, Nicholas becomes
impatient . . .
Look, this is super fascinating, but Im a busy
man. Why dont you move along to benefits?!
Now, on to BENEFITS
Nicholas would be well advised to table his
complaints and be aware that this area of
workers compensation law is quite complex.
Additionally, it involves math.
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Types of Workers Compensation Benefits
I thought you said this would be complicated.
Its easy . . .
Indemnity/Wage Loss Death Benefits Medical
Expenses Vocational Rehabilitation
Ill tell you how life aint so easy for one girl
named Sue, but first . . .
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Before we get into the nitty gritty of the
benefits, can you explain the waiting period Ive
heard about?
The waiting period . . .
Fred was injured on the job on May 9, 2005.
The first 7 days are not paid unless the employee
is disabled for 6 weeks or more.
Fred was not disabled for 6 or more weeks. He is
entitled to benefits beginning on May 16, 2005.
OUCH!
Now, Sue. . .
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A Girl Named Sue
Sue, Ive examined your wrist. Im going to
recommend that you be off work for six weeks due
to your wrist injury.
I hurt my wrist in an accident arising out of and
in the course of my employment!
Sue goes to Dr. Mend.
Thank goodness for the Workers Compensation Act!!
BENEFITS
But how do I figure my average weekly wage?!?
Because Dr. Mend has taken Sue off work
temporarily, she is entitled to Temporary Total
Disability Benefits. TTD is calculated as 2/3 of
Sues average weekly wage for the six weeks that
Sue is off work.
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Average Weekly Wage

• as many of the preceding 26 weeks as the
  employee worked for that employer
• Vacation weeks (and other off-work weeks) are
  not counted
• Earnings from previous employer are not counted
• Earnings from another employer are not counted
• Bonuses and fringe benefits are not counted
  UNLESS part of the hiring agreement

Back to calculating Sues disability benefits!
Sue makes 1,500.00 per week. She has made this
amount during all of the past 26 weeks . Sue has
an AWW of 1,500.00.
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Sue has an AWW of 1,500. She is entitled to 2/3
of 1,500 for Temporary Total Disability. This
comes to 1,000.
So, Ill be off work for six weeks because of my
work injury. That means TTD benefits are 747.00
per week for the six weeks Im off work. Well
see what Dr. Mend has to say after six weeks. . .
BUT WAIT!!! Nebraska law sets a maximum weekly
benefit for injuries. The maximum for 2014 is
747.00. Sue can only receive up to the
statutory maximum her benefits are capped at
747.00.
Six weeks later . . .
Sues employer finds Sue a position within her
restrictions, but the new position pays less than
Sue made at her old position.
Well Sue, youre doing better, but youre not
quite fully recovered. I am going to let you go
back to work, but only at light duty for another
six weeks.
I can work, but Ill make less money! Am I
entitled to any more indemnity benefits for my
injury?
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BENEFITS
Because Dr. Mend has allowed Sue to return to
work, but with light duty restrictions, she is
entitled to Temporary Partial Disability
Benefits. TPD benefits equal 2/3 of the
difference in wages at the time of injury and the
earning power after the injury.
Six weeks later, Sue returns to Dr. Mend . . .
What does this impairment rating mean for my
workers compensation claim?!
Sue you have reached maximum medical improvement
because your wrist has healed as much as
possible. Im afraid, however, that you have a
permanent impairment rating of 10 loss of use of
your left wrist.
Read on for the answer . . .
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Permanent Partial Disability Benefits
Two types of PPD
Body as a Whole
Member Injuries
Injuries to the trunk, neck, or head.
Loss or loss of use of a member.
The number of weeks of PPD for a member injury
depends on the type of member and the amount
provided by statute.
300 weeks of PPD benefits for body as a whole
(inclusive of any weeks of TTD or TPD).
So, my wrist injury was a member injury, and my
PPD benefits are based on the of weeks
specified by statute!
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Member InjuriesTypes of Injury and Number of
Weeks
Neb. Rev. Stat. Section 48-121(3)
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Being hurt at work wasnt easy for Sue, but if
you think thats bad, let me tell you a story
about a man named Jed . . .
Poor Sue!
Jed Hits His Head
WHACK!
One day, while at work, Jed was hit on the head
with a piece of equipment. When he regained
consciousness, he was in a great deal of pain.
Ouch!!! That hurt!!!
Unlike Sue, Jed has a body as a whole injury
because he sustained an injury to his head. Jed
is entitled to 300 weeks (inclusive of TTD or TPD
received) for his body as a whole injury.
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Another type of disability benefit is Permanent
Total Disability.

• inability of employee to earn wages in the
  same kind of work or similar work, or any other
  kind of work he or she is capable of
• benefits are owed until PTD ceases
• training that helps an employee work again can
  end PTD
• total loss or total loss of use of two members
  in one accident is PTD
• odd lot employment does not end PTD

That kind of disability benefit sounds
complicated. Good thing it doesnt happen very
often!
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In addition to indemnity benefits, the Workers
Compensation Act also provides death benefits.
Its a good thing Jed and Sue both survived their
injuries. What happens if an employee dies as a
result of a work-related accident?
BENEFITS

• Burial expenses up to 10,000.00 (July 19, 2012)
• Spouses are entitled to benefits for life or
  until remarriage
• Children are entitled to benefits until age 19
  or until age 25 if they are full-time students

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Alright, so weve been through indemnity benefits
and death benefits. You mentioned something
about job training or vocational
rehabilitation. Can you tell me more about that?
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In order for Nicholas to understand vocational
rehabilitation, lets look in on Veronica the
vocational rehabilitation expert. . .
My 4 oclock client, Stan, should be here any
minute. Lets review his file. Looks like he
was unable to return to his previous job or to
any other employment with his previous training
and experience. He was injured at work and he
just didnt have the physical ability to return
to work. Because he had only a high school
education, there were no jobs within his physical
abilities that he could do without more training.
Stan arrives for his appointment with Veronica.
Hi Veronica. Im here to talk about my
vocational rehabilitation situation. Ive
requested vocational rehabilitation services
from my employers workers compensation insurer.
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Excellent. Also, in cases where the insurance
carrier does not agree to the need for VR
services, or to the selection of a particular
counselor, the Workers Compensation Court can
appoint a counselor.
I see, so where do we start?
Well, Stan, first there are some established
priorities for vocational rehabilitation
counselors.

• Return to previous job with the SAME employer
• A new job with the SAME employer
• A job with a NEW employer
• A period of formal retraining which is designed
  to lead to employment in another career field.

Ok, so because I cant do my old position, and
there is no job within my abilities at my same
employer, a vocational rehabilitation counselor
will help find me a new employer with a job
position within my abilities.
You got it. Its called job placement.
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If the job placement doesnt work and you still
arent able to find a job you can do within your
restrictions, you could undergo a period of
training to gain skills for a new career.
Cool!
Neat, vocational rehabilitation is easy. So what
about doctors. Who picks the doctor?
RULE 50
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Choice of Physician Rule 50

• EMPLOYEE CHOOSES when
• Employer does not give notice of choice, or
• Employer gives notice of choice and the employee
  chooses a family physician

• EMPLOYER CHOOSES when
• Employer gives notice of choice and employee
  fails to choose a family physician or makes no
  choice at all

But REMEMBER . . . restrictions on change of
physician only apply when the employer has given
the employee notice of the right to choose!
Once a physician is selected, there can be NO
CHANGE unless both the employer and employee
agree.
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There are a few options for resolving a workers
compensation dispute . . .
So weve been through just about all of the
things employees are entitled to when they are
injured on the job. What do you do if there is a
dispute as to an employees entitlement to
benefits?
Litigation Before the Workers Compensation Court
Informal Dispute Resolution
Please tell me more about each option!
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Litigation in the WCC

• Employee may file a petition with the Workers
  Compensation Court
• The petition must be filed within 2 years of the
  date of the accident or the date of the last
  payment of compensation
• Upon receipt of the petition, the WCC will
  notify the employer/insurer
• The defendants have 14 days to answer the
  employees petition
• The case is then set for trial before one of the
  seven judges of the court
• There are procedures to appeal a trial court
  decision

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Informal Dispute Resolution

• IDR is an alternative to trial
• It is provided by the court at little or no cost
  to the parties
• Its speedy
• Its voluntary and confidential
• Its available to anyone involved in a workers
  compensation dispute
• IDR is conducted by staff attorneys employed by
  the Workers Compensation Court

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Issues settled in IDR
Payment of medical bills
Compensability of injury
Necessity of medical treatment
Vocational rehabilitation
Choice or change of physician
IDR sounds like an efficient and effective way to
resolve disputes at little or no cost. And you
dont even need a lawyer to do it!
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Reporting an injury
What else should I know?
The employee must notify the employer of the
injury as soon as practicable. Generally,
employers notify the insurance carrier.
Reportable injuries must be reported to the court
by the insurance carrier via electronic filing.
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Lump Sum Settlements
Workers compensation benefits can be paid out
periodically (weekly) or in a lump sum settlement
The parties reach an agreement and usually will
submit the documents for approval by the court
Generally the employee must have reached MMI and
returned to work at the time of the settlement.
Payment of the settlement total must be made
within 30 days of the date the court approves the
settlement
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So Nicholas gained a greater understanding of how
workers compensation operates.
He also got to meet some interesting characters
along the way.
If Nicholas has any more questions, he can always
contact . . .
The Nebraska Workers Compensation
Court 800-599-5155 www.wcc.ne.gov
Now I know the anatomy of a workers compensation
claim!
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THE END!
Nebraska Workers Compensation Court 800-599-5155
www.wcc.ne.gov