I am reading these threads, seeing so much misinformation, sharing of information that is specific to certain claims for certain people in certain states, and hearing fear, confusion and worry . . . I would love to help! However, I can not set myself up as an expert and give legal advice, nor have I worked claims in every state and those I did have probably changed their laws somewhat since then . . .

But there are some very basics that I could offer to help you through the "system."

Is there an interest? What are your most pressing questions or issues? And what is it that you don't understand, find confusing, or find depressing about being on workers compensation?



i will begin by saying Workers Compensation Insurance is a state run program. Your employer, and most of the time you, pay premiums each month (yours comes out in payroll taxes), and those premiums are set according to the degree of hazard and the number and costs of claims your employer experiences on average in your state. They desire to keep these premiums, and their costs, low . . . and this can lead to conflicts over coverage, allowance and sometimes even the handling of your claim. This is why attorneys are sometimes needed. Because workers compensation was instituted over 100 years ago to take the burden off the injured worker, it is supposed to be a no-fault system. If your injury happened on the job -- the language usually includes the words "arising out of" and/or "in the course of" your job duties and activities, it is supposed to be covered. W/C was designed to make sure the worker got proper medical treatment, to replace the lost wages with a benefit that would keep them from economic ruin (about 2/3 of your usual wages) and keep you from losing your job for being injured.

During the industrial revolution and until about 100 years or so ago, if you were injured (cut off your arm, broke your back, etc. . . . ANY injury) you were shown the door, escorted sometimes to your company housing, where you were thrown on the street after being handed a bill for rent and your tab from the company store, and you were responsible for sewing your own arm back on or fixing your broken spine the best you could. Back then there was not even health insurance, so you really were out of luck! (I did my senior thesis on the Pullman Car Company of Calumet City, IL, where I learned these things happened all the time.)

So if your benefits and your hassles with your claims person seem too much, just appreciate what history stands behind you. Then learn about your particular state's claims process the best you can. Many injured workers went before you, blazing a painful and costly trail to this time in history.

W/C is not meant to make you rich. You will go backwards financially a little, even though you get a check each week or two. However, your medical should be paid at 100%. If you are ever billed for something that w/c should cover, turn the bill in to your claims person. If you are ever billed for a balance after w/c adjusted the bill, this is a violation of the law. . . tell your claims person!

For now let me just say a few things that are basic good claimant (that's you) etiquette:

• Be polite, calm, rational and businesslike with your claims person, the doctors and anyone regarding your claim. It will move you farther than being the opposite: threatening, belligerent, angry or pushy.

• Do all your paperwork promptly. There may be a reason something gets delayed, but your claims person can only act on what he or she has in the file. A common slogan among claims handlers is: If it isn't in the file it didn't happen. This is why I recommend following up every important phone call with a letter: you may need the paper trail later. Keep a file and keep copies of every letter you receive and write, every notice, note, and some even keep copies of checks (or the stub to show what it paid) . . . and a log of your phone calls, in the file.

• Learn to use your word-processing program, including spell check, so your correspondence will be businesslike. If you don't have a printer, see if you can e-mail your correspondence.

• Find out if you can protest any unfavorable decisions and follow the timelines. A day late and you lose! A protest is not hard to write. . . the statute will often give you the format and the words to use, or close to that.

• Do not skip doctors appointments or skip treatment. Like all medical treatment, you have the right to participate in your treatment plan, to a great extent. If you are unhappy with your physician, therapist or counselor (if you are in vocational counseling) . . see if you can change. You can refuse a treatment that is against your beliefs or better judgment, and you can not be forced to have surgery or other invasive procedures against your will. However you must have a good reason, and be prepared for your claim to be a little more complicated if you refuse, say, a surgery that could return you to work with low risk, or an test that could move your healing forward.

• Do not lie. Do not cheat. Do not fake. Do not try to get away with being off work if you are truly not injured. Claims people hire investigators all the time, even on "nice" people. Sometimes it is the protocol for handling claims for a particular company, or standard claims handling practice for certain types or levels of claims. (I once won a case forcing the "injured" worker to repay over $84,000 because we caught him doing heavy farming activity when he claimed he could not turn his head to drive or lift a gallon of milk. I saw it on the surveillance tapes myself!)

• While you must adhere to your restrictions, you are allowed to shop, and take care of your kids . . . and, yes, you may leave the house while on total disability! You probably want to stay away from the roller rink, the softball game or even the fishing boat on a holiday weekend, depending on your injury.

• It is believed you get your way by piling up phone calls and messages to your claims person. If you have to go that far to be heard, ask for their supervisor. Follow up your first call with a letter, and copy their supervisor or the manager. When their file is reviewed it will come to someone's attention you have not been answered . . . and someone should get a reprimand for ignoring you. If all 200 claimants called me every day hounding me for checks that are late, for information, or just to talk, I would never have gotten anything accomplished in a day! Remember, they are doing their job to please their boss, just like you have to when you are at work.

• Keep in touch with your employer so they know a) how you are doing, b) if and when you might return to work, c) that you are still an employee (do not abandon your job mid-claim, it makes life messy later) and d) it is the correct way to keep them onboard with your claim. That way they know you are earnestly trying to get well and return, and will see you more as a returning asset than a present liability.

• Stand up for your rights. If something seems amiss, ask. Protest when you feel a decision or action is wrong. Stay on top of your claim. Start a file and keep everything in it in some form of useable order.

• Return to work when you are released. If it does not go well, or you flare up your injury, your doctor is the one to document the medical reason you can not continue, and might need more treatment. In fact, your doctor must provide documentation for almost all of your benefits: time loss, restrictions, treatment, and return to work, as well as when healing is complete (maximum medical improvement, end of healing period, or whatever it is called in your state) and permanent impairment.

• Make sure impairment is addressed before claim closure.

• Find out what the statute of limitations is for reopening, and under what conditions this claim might need to be reopened.

• Understand that in many states if your injury is the same as one you have years ago with another employer, you may be asked over and over for a work history so that they can see if some of the costs should be thrown back on the previous employer's injury. Every state seems to handle pre-existing injuries or conditions differently: find out early how your state handles it. Then don't spin your wheels trying to fight it. Only cases that are hard-fought in court change laws, and unless yours seems that strong, concentrate on getting all your benefits that are due under the law. Unfortunately that can sometimes be harder than just going back and doing your job!

• Of you qualify for FMLA, file for it! You have approximately 12 weeks of protection of the job you were in at the time of injury, or a substantially similar position, under FMLA. Unfortunately, if you use FMLA for your neurological condition, you may have to share that 12 weeks with your condition . . . you only get so much time under FMLA regardless of how many conditions you use it for.

• Do not compare your claim to anyone else's claim. Rarely, if ever, will two injuries, severities, wages, hours, and employers be identical, let alone doctors, details, outcomes, or "settlements." . You are wasting energy wishing you would get the big "settlement" your neighbor, friend, or second cousin on your father's side did! This is a cruel trick you play on yourself if you listen to everyone else's expert advice, because they had a claim or knew someone who did. Run, don't walk, to the nearest earplugs. Tell them how interesting you find their information. Thank them. But do not ruminate on what they claim or believe you should be getting. It is almost like saying every lottery ticket is a big winner. It just ain't so. Some claims, and rightly so, close with no big jack-pot at the end.

• I strongly object to the term settlement when discussing workers compensation. Being a no fault system, if you are permanently impaired or disabled by your injury, you are entitled by law in most if not all states to an award of permanent disability benefits. This money is to compensate you for future medical needs that might be consequential or might arise later (such as prescriptions, they are not generally covered after claim closure), but not be sufficient for reopening. It is also to make up for a possible drop in your future earning capacity due to your loss of function in the work place. It is not a windfall to be spent on a new 4x4 or vacation, unless you have an endless income stream guaranteed in your future. I suggest you buy a few certificate of deposits and sit on it for as long as you can. It might come in handy down the road when you get laid up with a non-work medical condition and have no or little income, or when you can no longer do your job and find you are earning less. That is what it is designed for. Honest. But I bet over 50% of the checks I cut were "blown on stuff" before the ink dried on signature on the back of the check.

Sometimes the final payment, if it is more than a year's worth of benefits would be, are paid out in monthly amounts. If this happens, be glad you have an extra check each month to put into savings after you get back to work. Don't sell out to one of those companies who will give you cash now. You will get less than you are due, because they will pay you at a discounted rate, and they will walk away counting your money as it enters their pocket. They may be legitimate, but they are immoral by preying on people in dire need in my book. If you are hard-pressed for money when it comes time for your final permanent disability payment, and it is set up as monthly payment, ask your employer or claims person if you can have a hardship lump sum of all or part of it.


Well . . I am up wa-a-a-ay past my bedtime. If there are any questions, ask away. I will discuss permanent total disability if anyone is in this situation. Sometimes it is called a W/C Pension. They are rare, hence I am no expert. But maybe I can help if you have questions I can answer or give you a direction to go for answers.

For now . . . good night. If I have any typos or misspellings. . . . it is 2:37am here right now. . . .


"Z-z-z-z-zz-z-z-z-zz-z-z . . . . . ."