Workers compensation claims increase contests over benefits

 

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Carol Forsloff - While neighbors may gossip about the guy who stays home from the job after
injury, the weekly benefits are not life-long and can be terminated for a
number of reasons.  What are these and how is this issue a concern in the recession.
In
Colorado, as in other states, there is workman's compensation, which is
offered to individuals when they are injured on the job.  After an
injury, the employee is required to notify the employer, and the
employer subsequently notifies their insurance carrier.  Ordinarily this
has to be done within a certain time limit or there will be a contest
regarding payment.

In the picture here a collapsed building killed and injured workers, in a most extreme example of the issue. (source: wikimedia commons)

A notice of contest is a denial of benefits and may require the employee to submit additional information.

Even
if a determination is made about these benefits, either the employer or
employee may seek redress, frequently through some sort of hearing.

Now
to clarify those benefits when they are approved and the fact that a
worker can lose the benefits at some time and under certain conditions.

Temporary disability benefits can be terminated by the insurance company for several reasons.

The
employer chooses the doctor for the injured worker. Often the employee
does have some rights in this process and may choose a different doctor,
but there are time limits for doing so, as in the case of Colorado
where the choice has to be made within 90 days.

 If th deoctor
maintains the worker has reached what is called maximum medical
improvement, benefits may be terminated.  This can happen even if the
injured person still cannot return to work.  At that point, often some
permanent offer or award is determined.

Eligibility to return to
work can also be the reason used to terminate benefits, and that can
occur even if the job is no longer available.

 An offer
of modified work, then return to work, can also bring a termination of
benefits.

Employers can require the injured worker keep medical
appointments.  A failure to appear at these appointments can also be
grounds for terminating benefits.

Sometimes employers will seek
to terminate an employee's benefits for "fault," something that may have
occurred some time before the accident.  Attorneys say this is often a
refuse to get rid of the injured worker so that the problems of
maintaining, finding a job and providing alternative work no longer
remain the employer's issue.

Benefits can also be terminated if
an employee violates safety rules.  These benefits may be reduced by 50
percent, and the insurance company does not need a hearing to do this
but must prove that violation if the reduction is contested.


Permanent total disability benefits are paid at a rate of 66 2/3 percent
of the pre-injury wage, up to a set maximum, for the life of the
injured worker.  That is the settlement.

Workers compensation
claims can be impacted by a recession where there are often more claims
and also more efforts to reduce or contest them.  Connecticut found its claims doubled during the recession.

Where there are questions of money, there are often more contests.  That is often when attorneys are required to battle it out.

In
this recession those battles are occurring across the country, in
record numbers, according to the claims of insurance companies.

To
know one's rights in either direction can sometimes prevent expensive
problems for individuals and for the states in which injuries and

payments occur.