What is Workers’ Compensation?
If you are injured while at work, workers’ compensation will give you a set amount of compensation for your injury. The idea behind workers’ compensation is that it replaces the traditional tort process, and instead guarantees workers with compensation while also allowing employers to avoid large settlements and court costs. When workers’ compensation is available, the worker’s right to sue his employer for a personal injury is waived, although in some cases, the injured worker may be able to file suit against a responsible third party.
What Should I do if I’m Injured at Work?
If your injury requires emergency medical care, you should first go to a hospital for emergency treatment. Tell the emergency medical technicians, nurses, and doctors who are providing you with emergency medical care that you were injured while at work if possible.
Once your injury is no longer an emergency (or if it wasn’t an emergency to begin with), you need to notify your employer of your injury as soon as possible. You will only have 30 days to inform your employer of your injury before you run the risk of losing some of your rights. You notice should be given in a written format, and include the date you sustained your injury, a brief description of how you were injured and your name. It will then be your employer’s responsibility to fill out an “Employer’s First Report of Injury” (C-20) Form.
Once your employer has filled out this form, you will be able to seek initial treatment from a physician. Your employer will have a list of physicians (usually consisting of about three doctors) to chose from. The doctor that you choose will give you initial treatment, determine the extent of your injury, and confirm that your injury is work related. Afterwards, you should expect to receive benefits in about two weeks, if your claim is accepted.
It is important to note that almost all workers are covered by workers’ compensation law the day they start working. The few exceptions are in sole proprietorships, companies with less than five employees, and independent contractors. If your employer claims that you should not receive workers’ compensation benefits because you are an “independant contractor,” you should consult with a workers’ compensation ombudsman from the Tennessee Division of Workers’ Compensation Office, or a Tennessee workers’ compensation attorney.
What Benefits are Available Under Tennessee Workers’ Compensation Law?
Workers’ compensation provides many benefits. These benefits can include medical benefits that will compensate you for any relevant medical costs, and compensation for vocational rehabilitation. However, workers’ compensation is primarily used for income replacement, in which a worker is compensated for a portion of his wage while he heals from his injury. Income benefits include:
Temporary Total Disability
If you are unable to return to work because of your injury, but you are still in the process of healing, you may qualify for Temporary Total Disability (TTD) benefits. TTD benefits are equal to two-thirds of your average weekly wage, which is calculated by taking the average of the 52 weeks prior to your injury. TTD benefits will last until your injury has reached Maximum Medical Improvement (MMI), or until you can return to work.
Temporary Partial Disability
If you can return to work, but can only work limited hours or do certain kinds of work and suffer a lower wage as a result, and are still in the process of healing, you may qualify for Temporary Partial Disability (TPD) benefits. TPD benefits are equal to two-thirds of the difference of your post and pre-injury wages. For example, if you were paid $900/week before your injury, and are paid $600/week after your injury, you would receive $200/week in TPD benefits. Like TTD benefits, TPD benefits can last until your injury has reached MMI, or until you have recovered a wage of equal or greater value to your pre-injury wage.
Permanent Partial Disability
Some injuries never heal completely. In such cases when your doctor determines that your injury will never improve or worsen (MMI), you may receive permanent disability benefits. If your injury is only partially impairing, you may qualify for Permanent Partial Disability (PPD) benefits. Calculation for PPD benefits is one of the more difficult benefits to calculate. Your doctor will determine a “rate of impairment” for your injury, which represents how much your injury affects your ability to work and overall impact on your quality of life. The impairment rating is then factored in with the scheduled amount of compensable weeks that are allocated to the part of your body that is injured. This will determine how long you will receive compensation. Each week that you are given for your partial impairment will pay you with two-thirds of your average weekly wage prior to your injury. You may also choose to accept your PPD payment in a lump-sum payment.
Permanent Total Disability
In the rare event that your injury stops you from working indefinitely, you may qualify to receive Permanent Total Disability (PTD) benefits. PTD benefits compensate you for the same amount provided by TTD benefits. The difference, is that PTD benefits will compensate you until you are old enough to retire under Social Security Law. However, to qualify for PTD benefits your injury would have to be considered “catastrophic.” An example of a catastrophic injury would be a spine or head injury that results in complete paralysis, or the amputation of multiple limbs.
The amount of compensation that you can receive for income benefits is limited to Tennessee’s state average weekly wage.
What Should I do if My Claim is Denied?
Workers’ compensation claims are not denied often. Usually, a claim is denied because it was misfiled or because their was not enough evidence provided to show that your injury was work-related. You will receive notice if your claim is denied that should inform you as to why it was denied. Should this happen, it might be as simple as calling the insurance company to resolve the problem. However, if your claim is still challenged by the insurance company after calling them you should contact an ombudsman from the Tennessee Division of Workers’ Compensation, who can mediate your case and offer advice.
If your claim is still not settled to your satisfaction, you should retain a workers’ compensation attorney right away. Your case may have to be presented in a claims appeal hearing, in which case having a strong legal representation is key to protecting your rights. It is your legal right to retain a workers’ compensation attorney at any point in the claims process. The claims process for workers’ compensation is complicated and requires an in-depth legal understanding. Your employer’s insurer will have an attorney if your case goes to a hearing, so it would be wise for you to do the same.