What if my claim is denied?
The insurance company may deny your claim by asserting that you were not injured at work, or that your injury was caused mainly by a pre-existing condition such as arthritis or another injury.
If your claim is denied, you must request a hearing within 60 days or you will probably lose your right to contest the denial. You can expect it to take at least four months from the date you request a hearing until the hearing date.
You will not need to worry about paying for your attorney. The insurance company will pay your attorney fee if you win, but there will be no attorney fee if you don’t win. Sometimes there are out-of-pocket expenses incurred, such as for reports from doctors or the costs to subpoena witnesses for your hearing, which will be your responsibility, win or lose.
When will my claim be closed?
When your attending physician says you have reached your maximum improvement from your injury, you will be declared “medically stationary” and your claim may be “closed.” Note: An injured worker might be medically stationary even if there is not a full recovery.
In order to close your claim, your attending physician is supposed to examine you and determine whether you have any permanent impairment. From your doctor’s impairment evaluation the insurer will determine whether you are entitled to an award of “permanent disability.”
Permanent disability is an arbitrary and small award that does not reflect how your injury might affect your ability to work and earn a living in the future. If worker A and worker B have the same injury and the same impairment, the amount of their permanent disability will be the same, even if worker A was earning only minimum wage and worker B was making $100,000 a year.
If you feel your award for permanent disability was not properly determined, you may request review by the Workers’ Compensation Board. You may request an examination by an independent doctor (“medical arbiter”) if you think your own doctor might have understated your impairment.
Do I have any rights after my claim is closed?
You will be entitled to palliative medical care, which is defined by law as that care necessary to allow you to continue to work or to monitor medications or prosthetic devices you might be prescribed as a result of your injury. Palliative care does not include pain control.
You may be entitled to vocational assistance if you are left with a permanent disability that prevents you from earning 80% of the income you were earning at the time of your injury.
You will have the right to reopen your claim if, within five years of the date your claim was closed, your condition worsens. This would involve a claim for aggravation and could entitle you to further medical treatment and time loss benefits, and a redetermination of permanent disability.
Can workers’ compensation claims be settled?
Workers’ compensation claims can be settled. Sometimes workers can settle their entire claim for an agreed amount of money. Sometimes there is a partial settlement in which workers retain their right to future medical benefits but give up the rest of their claim rights. All settlements must be approved by the Workers’ Compensation Board.