how does workmans comp actually work?

[Susuki_Jah]

ok my gf had a nail go through her foot at work today. she is saying that her company sais not to use her insurence but to pay out of pocket then they will pay her back through workmans comp... I dont think it works that way. someone please help explain this to me. it sounds like the company is trying to get around using workmans comp.

[pandy]

Susuki:

The employer is NOT following Workman's Comp law. Your girlfriend should insist on filing a written report of her injury with her supervisor. She should find out who the Workman's Comp carrier is for her company (it should be posted with the employee postings), and she should not have to pay anything out of pocket for a trip to the E.R.

She should absolutely, positively NOT let her company try to shaft her. She may not need to miss any time from work now, but if her foot becomes infected (or if there are blood infections, etc), she will need her injury verified in writing. I'm not writing any of this to scare you, but just to give you possible scenarios about WHY she should absolutely get her injury documented properly. They should be rushing her to the doc's to get it looked at and get appropriate vaccinations.

Don't let her waffle on this one. Insist that she get proper medical attention immediately, and to get written documentation from her employer and the hospital/doctor.

http://www.comp.state.nc.us/ncic/pages/all50.htm

[Susuki_Jah]

Susuki:

The employer is NOT following Workman's Comp law. Your girlfriend should insist on filing a written report of her injury with her supervisor. She should find out who the Workman's Comp carrier is for her company (it should be posted with the employee postings), and she should not have to pay anything out of pocket for a trip to the E.R.

She should absolutely, positively NOT let her company try to shaft her. She may not need to miss any time from work now, but if her foot becomes infected (or if there are blood infections, etc), she will need her injury verified in writing. I'm not writing any of this to scare you, but just to give you possible scenarios about WHY she should absolutely get her injury documented properly. They should be rushing her to the doc's to get it looked at and get appropriate vaccinations.

Don't let her waffle on this one. Insist that she get proper medical attention immediately, and to get written documentation from her employer and the hospital/doctor.

Ok I just talked to her before you posted this telling her I thought they werent following proper law. She kinda blew me off on it I think. ok so I asked her why she didnt go to the docters or ER right away she said that the van had a flat tire and some how out of the guys and girls in the van it took them 2 hours to change a tire  so anyways she was on her way to the docs. I read the MD law and told her she had to right to choose her physician, but I dont think she really cared to hear it. Shes blowing me off again on the issue. anyways do you know where I can find the part of the law that sais she does not have to pay for anything upfront? I always thought that the hospital or physician bills the company on the workmans comp laws and that she doesnt have to do anything. they made her go back home first to get her wallet so she could pay for it. I think they are trying to get around filing it. She doesnt seem to beleive me or care though.  I guess some people go through the world knowing nothing and letting people run over them.

thanks for the quick response though it helps.

[pandy]

http://www.wcc.state.md.us/Gen_Info/WCC_Benefits.html

Her employer should have provided her with a list of docs, unless they're taking her to the ER. If the company is self-insured, they should pay (they might reimburse, I'm not sure), but if they have a carrier, a claim is made directly through the WC carrier.

Contact the Maryland Insurance Administration Fraud Hotline: 1 (800) 846-4069

Also remember that you can only give her the information. You won't be able to force her to do what you think she should or what's legal for the company to do, so keep the hothead under control and try to convince her calmly that it's in her best interest to make sure she files a WC injury claim (because it IS in her best interest).

I've been dealing with WC and WC insurance carriers long enough to know that you'll get screwed any which way they can, whenever they can, so there's only one person who can watch out for a worker: that worker. 

[pandy]

General info on MD WC:

http://www.wcc.state.md.us/Gen_Info/FAQ_Employees.html

What information is the employer required to provide with respect to worker's compensation?
State law requires every employer to post an official notice in a prominent site at the workplace. It's usually put up on an employee bulletin board, by a time clock, in an employee lunchroom or some similar location where workers will see it. The poster identifies the employer as having obtained workers' compensation insurance and it outlines the responsibilities of both employers and employees. It also provides the employers full legal name, address, the Employer's Federal Identification Number (FEIN) and the name of the insurance company providing this insurance. This information is needed when filling out a claim form.

When should I report the accident?
You should report any accident to your employer immediately. A delay in reporting may affect your claim.

When and how do I file a claim?
If you believe you have suffered a compensable injury, you may file a claim with the Workers' Compensation Commission by filling out an Employee Claim Form and then mailing it to the Commission.  If your employer does not have one of these claim forms the Commission will send you one and all of the necessary information you may need. Forms are provided without charge.

What do I do about a doctor?
Your employer or your employer's insurer will pay for your doctor's visits and treatment if the injury is covered under Workers' Compensation.

What medical treatment will workers' compensation insurance pay for?
All doctor bills, hospital bills, physical therapy, prescriptions and necessary expenses related to the accidental injury are covered by this insurance up to the limits established by the Official Maryland Workers' Compensation Medical Fee Guide.

When am I entitled to benefits?
You are entitled to income replacement benefits if you miss more than three (3) days from work.  If you miss more than 14 days you will also be paid for the first three days, provided your employer did not pay you for any of these days. When your claim is received by the Commission (in the mail) a claim number and a "consideration date" is assigned to it. The consideration date means that we allow your employer or his insurer until that date to raise any objections they may have to your claim.

What if there are objections?
The employer or insurance carrier will probably contact you directly and tell you what the objections are. They must also inform the Commission, stating their objections or issues in writing. If your claim is contested by the employer/insurer, it will be scheduled for a hearing before a Commissioner. You will be notified by mail.

How much are the income replacement benefits?
These benefits are called "Temporary Total Disability Payments" and you should receive two thirds of your average weekly wage, but not more than the State's average weekly wage for the year in which the accident occurred.

[Susuki_Jah]

General info on MD WC:

http://www.wcc.state.md.us/Gen_Info/FAQ_Employees.html

What information is the employer required to provide with respect to worker's compensation?
State law requires every employer to post an official notice in a prominent site at the workplace. It's usually put up on an employee bulletin board, by a time clock, in an employee lunchroom or some similar location where workers will see it. The poster identifies the employer as having obtained workers' compensation insurance and it outlines the responsibilities of both employers and employees. It also provides the employers full legal name, address, the Employer's Federal Identification Number (FEIN) and the name of the insurance company providing this insurance. This information is needed when filling out a claim form.

When should I report the accident?
You should report any accident to your employer immediately. A delay in reporting may affect your claim.

When and how do I file a claim?
If you believe you have suffered a compensable injury, you may file a claim with the Workers' Compensation Commission by filling out an Employee Claim Form and then mailing it to the Commission.  If your employer does not have one of these claim forms the Commission will send you one and all of the necessary information you may need. Forms are provided without charge.

What do I do about a doctor?
Your employer or your employer's insurer will pay for your doctor's visits and treatment if the injury is covered under Workers' Compensation.

What medical treatment will workers' compensation insurance pay for?
All doctor bills, hospital bills, physical therapy, prescriptions and necessary expenses related to the accidental injury are covered by this insurance up to the limits established by the Official Maryland Workers' Compensation Medical Fee Guide.

When am I entitled to benefits?
You are entitled to income replacement benefits if you miss more than three (3) days from work.  If you miss more than 14 days you will also be paid for the first three days, provided your employer did not pay you for any of these days. When your claim is received by the Commission (in the mail) a claim number and a "consideration date" is assigned to it. The consideration date means that we allow your employer or his insurer until that date to raise any objections they may have to your claim.

What if there are objections?
The employer or insurance carrier will probably contact you directly and tell you what the objections are. They must also inform the Commission, stating their objections or issues in writing. If your claim is contested by the employer/insurer, it will be scheduled for a hearing before a Commissioner. You will be notified by mail.

How much are the income replacement benefits?
These benefits are called "Temporary Total Disability Payments" and you should receive two thirds of your average weekly wage, but not more than the State's average weekly wage for the year in which the accident occurred.

hmmm that would make sense, considering workmans comp is a specific insurence company by the employer than that means all they would need is that insurence name or company name and the isurence should cover the visit upfront. I must tell her this.

[Susuki_Jah]

ok im reading that in MD , you can be self insured.. Im wondering how this works. I would think you have to pay just like an isurence company. but I have heard of systems where they pay you back... although what if the person didnt have the money?  a tetnis shot cost some DOE! 

[pandy]

I haven't had to deal with self-insured companies, but whether a company is self-insured or has a WC insurance carrier, they have to follow the rules...one of the rules is allowing a worker to make an injury report (and too many companies do their best to discourage someone from making a report....ALWAYS ALWAYS ALWAYS ALWAYS ALWAYS make a report...do not EVER trust a company to do what's in your best interests, even if you've worked for them for 20 years...does it sound as though I've seen what can happen?).... And...if ya' get nothing else from this....ALWAYS FILE AN INJURY REPORT!!!! 

[Susuki_Jah]

I haven't had to deal with self-insured companies, but whether a company is self-insured or has a WC insurance carrier, they have to follow the rules...one of the rules is allowing a worker to make an injury report (and too many companies do their best to discourage someone from making a report....ALWAYS ALWAYS ALWAYS ALWAYS ALWAYS make a report...do not EVER trust a company to do what's in your best interests, even if you've worked for them for 20 years...does it sound as though I've seen what can happen?).... And...if ya' get nothing else from this....ALWAYS FILE AN INJURY REPORT!!!! 

thanks Pandy. she listened to me FinallY! she went to the ER and she gave them the company info. she never paid a dime. so the company will now be forced to file a report.

[pandy]

thanks Pandy. she listened to me FinallY! she went to the ER and she gave them the company info. she never paid a dime. so the company will now be forced to file a report. 

This is fantastic news. Believe me, one should ALWAYS FILE A REPORT.

The ONLY time I would suggest not filing a report is.... NEVER!!! ALWAYS file a report! 

Seriously...I've seen workers trust the company. The company says, "don't worry, we'll take care of you." Then the injury turns out to be worse than the worker thought. You know what happens then? Years of battling to get treatment. Been there, done that. Please....always file a report. I would never, EVER let one of our employees NOT file a report.

Love,
She who keeps her boss on the straight and narrow and keeps the workers safe

[Jake D]

I didn't read any of the other posts, but here is how work comp works in my state:

She is entitled to three things: TTD - temporary total disablity (she gets paid for the time she is off of work.  Meds - treatment for her work related injury (she can choose her doctor or get a second opinion, but she has to pay for that because because the employer chooses the treaters it pays for).  PPD - permanent partial disability (she gets paid a lump sum payment for any permanent disability she suffers at the end of treatment). 

PPD works by getting a rating from the work comp doctor (and sometimes a second opinion) who would be rating the disability suffered to that partiular limb.  For example, if the middle finger is disabled from the middle joint down, it is 50% disabled.  The middle finger is "worth" 35 weeks of her wage rate.  All of the body part get similar ratings by the state.  210 weeks for the elbow down, 232 weeks for the shoulder down, and up to 400 weeks of the body as a whole.  So if she had a 50% disability to her right arm, you'd take her wage rate "z" and multiply it times the number of weeks she gets for the arm, 232, times the disability percentage.  This is how you figure PPD.  So for example $300 x .50 x 232 = PPD.  She is not entitled to this until she has been released by the doctors and has reached MMI (maximum medical improvement).

I am not her attorney, and the laws of your state are likely different.  She should consult with local counsel. 

Late.

Jake D