Traps for the Unwary

 

1. 21 Days to Accept

The Defendant/Employer has 21 days to accept or deny a Workers' Compensation Claim. If a Notice of Compensation Payable is not issued at the conclusion of 21 days, the case is assumed to be denied and no benefits will be paid. Unscrupulous employers have been known to avoid paying Workers' Compensation benefits by saying they are unsure as to whether the claim will be accepted or not. The employer must make a decision by the 21st day, after that day, the injured employee should understand that his or her claim is in the denial status.

 

2. 120 Days Notice

Employees are generally unaware that within 120 days of a work injury the employer must be notified of the injury. This notice does not involve filing a Workers' Compensation claim but is simply notifying a supervisor at the place of employment that an injury has occurred. If notice is not given to a supervisor within 120 days of the date of injury a claim may not be filed. (Note: This is different than the three (3) year statute of limitation which is only applicable if notice was given within the 120 days.)

 

3. Special Termination Petitions

Where an employee is receiving Workers' Compensation benefits the defendant/employer may file a Special Termination Petition which is accompanied by a statement by a medical doctor that the injured worker has recovered from the work injury. With this statement of recovery, the Workers' Compensation Judge will schedule a hearing within 21 days. If the injured employee does not come to the hearing with a medical report indicating that he or she continues to be disabled, benefits will be suspended from the date of the hearing until the case is completely litigated.

 

4. Self-Employment or Status Change

The Act requires that a person receiving Workers' Compensation benefits must report employment or self-employment no later than 30 days after such employment occurs. The employer has a right to send to the injured employee a form requesting information on employment, self-employment or a change in physical condition. If this form is not returned within 30 days the employer may unilaterally suspend the payment of benefits until the form is returned by the employee. An employee who does not return the form in a timely fashion will lose benefits for the entire period that the form has not been returned. The employee will not be reimbursed for the benefit payments missed due to failure to return the form.

 

5. Company Doctor

For a period of 90 days after a work injury an injured employee must treat with one of the physicians posted at the place of employment. If the injured employee treats with a doctor other than a posted physician during this 90 day period the employer and its insurance carrier are not required to pay for any medical treatment received from non-posted physicians. After the 90 day period the injured employee is strongly encouraged to seek a medical doctor other than the posted physician.

 

6. Vocational Expert

Vocational experts are commonly used in open Workers' Compensation cases to establish that there exists work which the Claimant can perform at places other than the defendant/employer's location. The employer can then reduce benefits by the amount of the alternative job. The vocational expert will simply state that jobs exist which the employee is capable of performing. The vocational expert commonly relies on help wanted ads in the newspaper. There is no requirement that the injured employee actually obtain one (1) of the jobs in question, simply that the jobs exist.