Tag Archives: Benefits

State Laws Determine Worker’s Rights: Work Comp Benefits, Process Vary by State

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Many workers are hired in one state but are required to attend orientation or participate in a hiring process in another state because their potential employer is principally located and doing business there. Once they are hired and accept the job, they are then required to work in another state for various reasons. In these situations, many workers do not realize that a different state’s laws could apply to their workers’ compensation claim if they are injured in a state that is

  1. different from where they were hired,
  2. different than where they accepted the job,
  3. different from where their employer is principally located or performing work, or
  4. even different than where they currently live. 

If you have been injured in another state, you may be eligible to have your workers’ compensation benefits determined by another state’s laws. This is important, as the benefits you could be entitled to are different in every state. In certain respects, the differences are significant in terms of the amount of weekly benefits, permanent benefits, or type and duration of medical care you may be able to receive.

The right to choose your family physician to treat you for your injury or the amount and duration of the disability benefits you may be entitled to are significantly different in every state. Let’s consider a few pairs of cities:

  • Omaha, Nebraska & Council Bluffs, Iowa
  • Sioux City, Nebraska & Sioux City, Iowa
  • Nebraska City, Nebrsaka & Harlan, Iowa

These cities in different in Iowa and Nebraska border each other, and a great number of residents from one are employed and work in the other. If you are injured in one state but live in another, and depending on where you were hired or where you were when you accepted the employment, you may have a Nebraska or Iowa workers’ compensation claim, or even both. 

Nebraska

If your employment or your accident has any ties to the state of Nebraska, your employer is required to file a First Report of Injury with the Nebraska Workers’ Compensation Court. When this occurs, it is common for the Nebraska Workers’ Compensation Court to actually mail you a copy of your own First Report of Injury that was filed with the court by your employer. Just because a First Report of Injury was filed in Nebraska and just because the Nebraska Workers’ Compensation Court sends you a copy does not mean you are limited to Nebraska for the benefits that you may be entitled to. 

Iowa

It is also normal for an insurance carrier of the employer to mail you a letter that says, “Your employment agreement, whether in writing or made in person, required your accident to fall under Iowa law,” or some other state’s law. Generally, no one has the right to decide for you which state your case can be determined in. It is a question of each state’s laws that determine where your claim can be processed.

Nebraska and Iowa

As a matter of general practice, if your accident occurred in that state, your claim and benefits can be determined based on that state’s laws. Other things like where your employer is principally located or where your employer regularly performs work can determine if you have a claim in each state. Further, your contract of hire or where you accepted the employment can also play a part, as well as where you were residing at the time of your accident in relation to where your employer was performing work, can also determine which state you may have a claim in. 

These things, as well as what type of benefits each state allow, could make it possible for you to file in both states.

Time Periods to File in Each State

Each state has a certain time period in which to file a claim or action in the compensation court. 

  • In Nebraska, you have two years from the date of accident OR two years from the date of any payment (weekly disability check, medical bill, mileage, prescription) in which to file an action in the compensation court. 
  • In Iowa, a person has two years from the date of accident OR three years from the date of payment of a weekly disability benefit check in which to file an action in the compensation court.  

Beware, however, that payment under one state’s laws may not save your claim in another state. For example, a payment under Iowa law will count toward a payment in Nebraska. However, a payment under Nebraska law will not count toward a payment under Iowa law.

Award, Order or Settlement Agreement for Benefits

It is important to note as well that an award, order or settlement can affect your right to file a claim in another state. 

For example, if one obtains a Court Award, Order or Settlement in Nebraska, this would prevent you from obtaining any benefits in Iowa, if you had the option of pursuing benefits in both states. 

On the other hand, if the same person obtained a Court Award, Order or Settlement in Iowa, a person could still pursue additional benefits in Nebraska that are different than what was provided in Iowa.

In both states, the insurance carrier would be entitled to a credit for what they paid in the other state, but you would still have the opportunity to pursue different and additional benefits in the other states, potentially.    

Summary

The differences in law issues are often very complex. Whatever your situation is, if you think there might be any question as to which state’s laws apply to your case, you should speak to an experienced attorney who can advise you about the laws in each applicable state.

Study: Work Comp Benefits Up; Employer Costs at Historic Low

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Respected colleague Thomas Domer of the Domer Law Firm in Milwaukee, recently wrote a post about a study released by the National Academy of Social Insurance (NASI).

The study, titled Workers’ Compensation: Benefits, Coverage, and Costs, 2012, is a treasure trove of information, as you can see if you click on the 86-page document. The 2012 report was just released this summer, I am guessing because it takes a bit to compile all this data.

Here’s what Mr. Domer said about the study (reprinted with permission):

“A new study released by the National Academy of Social Insurance (NASI) indicates worker’s compensation benefits rose by 1.3% to $61.9 billion in 2012 while employer costs rose by 6.9% to $83.2 billion. Even though total benefits and costs increased in 2012, worker’s compensation benefits and costs per $100 of covered payroll have been lower from 2007 to 2012 than at any time over the last 30 years. In 2012 benefits were 98 cents per $100 of covered payroll while employer costs were $1.32 per $100 of covered payroll. 

Over the last 30 years medical benefits have accounted for an increasing share of total benefits from 33% in 1984 to nearly 50% in 2012. Medical benefits accounted for almost 50% of the $61 billion in total benefits paid. In Wisconsin medical benefits exceed cash benefits, indicating that medical cost containment is a significant issue.

The Academy’s report Worker’s Compensation: Benefits Coverage and Costs 2012 is the 17th in an annual survey. The report provides the nation’s only comprehensive data on worker’s compensation benefits coverage and employer costs.”

Rehm, Bennett & Moore includes attorneys licensed in both Iowa and Nebraska, so I was most interested in these two states. As Mr. Domer indicated, cash wage replacement benefits and medical benefits are almost even nationwide, although cash benefits used to be a much greater cost to employers than medical benefits were. There is some difference in benefits between states, too, according to the study.

“The share of benefits paid for medical care varies tremendously across states. The variation not only reflects between-state differences in amounts paid for medical care, but also differences in the relative generosity of cash benefits across states,” according to the study.

Both Iowa and Nebraska are the same as what Mr. Domer reported with Wisconsin above: medical benefits very much outpaced cash benefits, and medical cost containment is definitely a concern. In 2012 in Iowa, over $362 million was paid in medical benefits, while almost $280 million was paid in cash benefits. In 2012 in Nebraska, over $192 million was paid in medical benefits, while over $120 million was paid in cash benefits.

There is a lot more information to digest in this document, so perhaps future blog posts will address some of the details. But I will end on an encouraging note from the 2012 study: “Workers’ compensation covered an estimated 127.9 million workers, (90 percent of the employed workforce) an increase of 1.6 percent from the number of workers covered in 2011 (125.8 million). … Between 2010 and 2012, all states experienced an increase in both covered wages and covered workers.”

That is definitely good news for workers, whether injured or not, and their loved ones.

Why Your Vote Matters to Workers

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I frequently write about the intersection of workers’ compensation benefits for workers and politics. The bottom line on my comments is that workers, and citizens who care about workers, need to vote for candidates who will protect workers’ rights. These comments arise from a now quarter-century attack on workers’ compensation benefits by big business and insurance interests. Their power is almost incomprehensible in terms of the money they will spend to take away or limit benefits.

Recently, a Florida court found that the limiting of workers’ benefits in Florida has destroyed the “social bargain” that led to the creation of workers’ compensation. Workers’ compensation laws are slightly more than 100 years old. The notion of a bargain is workers got fast and fair benefits in exchange for giving up their right to full compensation. There have been a lot of discussions since the big business/insurance attack on worker benefits that the bargain is no longer fair.

The Florida court also found the exclusive-remedy rule unconstitutional. The exclusive-remedy rule deprives injured workers and their families of benefits for pain, suffering and non-occupational disability. I have also represented a client in Nebraska where the exclusive-remedy rule was limited by a court.

Big business and big insurance will not back down. They won’t let up. As I write this blog, billions of dollars are being poured into political campaigns by the Koch Industries, TD Ameritrade and scores of others to support candidates who want to reduce and eliminate workers’ benefits.

Workers, their families, and everyone else who cares about ordinary human beings must not let these wealthy interests buy elections. We must stand up and vote. We must inform ordinary human citizens that the corporate citizens are taking away our rights as fast as they can. This is a crucial election, and every election will be crucial until people stand up and convince the mega wealthy that they can’t buy elections any longer.

When Did My Workers’ Compensation ‘Accident’ Occur?

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Nebraska workers’ compensation law states that an accident is “an unexpected or unforeseen injury happening suddenly and violently, with or without human fault, and producing at the time objective symptoms of an injury.” Neb. Rev. Stat. §48-151(2). In our practice, we are often faced with a situation where an injured worker is unable to answer the question: “When did the accident occur?” Often, this is because they don’t even realize they have experienced what Nebraska workers’ compensation law considers to be an “accident.” The plain, ordinary and popular understanding of what “suddenly and violently” means in the English language doesn’t seem to fit with this situation. This is because the injury resulted from repetitive trauma – i.e. an overuse injury – and the worker is unable to point to a particular point in time when an “accident” occurred. They didn’t slip and fall, nothing fell on their foot, they weren’t in a car accident, etc. It just started hurting and affecting how well they could do their job then finally got so bad that they had to seek medical treatment.  The Nebraska Supreme Court recently addressed this issue, and, in the process, reaffirmed and explained Nebraska’s rule for determining when a repetitive trauma injury happened. 

In Nebraska, the phrase “suddenly and violently” means only that the injury manifested at an identifiable point in time. The rule for the last 15 years or so has been that the “identifiable point in time” is essentially when an employee discontinues employment and seeks medical attention. What this means in simpler terms is that the date of accident is whenever an injury got so bad an injured worker had to take off work to go to the doctor. The Supreme Court reaffirmed this rule for a number of reasons, including how simple it is to determine the date of accident, based on this objective criteria. The Court also found that it just makes sense to say that an employee has really experienced a decrease in their employability or earning capacity, and therefore experienced a disability, when they have to take time off work to go to the doctor.   

Why is it important to know the date of accident in a repetitive-trauma case? It is important for a number of reasons, and you should seek the advice of an experienced workers’ compensation attorney for more information and/or assistance with your case. Particularly for injured workers, it is important because it is relevant to when the statute of limitations on the case begins to run. These injuries often start developing years before they get so bad that the worker must take time off to go to the doctor. This fact may discourage injured workers from reporting or pursuing workers’ compensation claims because they think it is too late. It is always important to understand whether your claim is barred by the statute of limitations or not, but knowing when the accident occurred is the first step in that determination. It is also important because the maximum benefit rates available to injured workers for temporary and permanent indemnity benefits are based on what year the accident occurred and change from year to year. Finally, it is important because people change jobs, and companies change ownership. Regardless of how long an injury took to develop, and how many different employers an injured worker performed work for, Nebraska law states that the employer who employed that worker on the date of accident, and their insurance company, is liable to that worker.

Workers’ Compensation May Cover Weight Loss Treatment, Surgery

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Gastric bypass is one type of weight loss surgery

Obesity is a disease that affects Americans in many ways.

Workers’ compensation is affected by obesity as well. A work injury or disease, coupled with chronic obesity, frequently becomes much more difficult to deal with. The usual methods of treatment may not be possible for an injured worker living with chronic obesity. 

Thomas A. Robinson, a noted expert on workers’ compensation, recently posted a great discussion on obesity treatment. The well-written article discusses how various state workers’ compensation systems deal with these problems. The short answer is some states award benefits for treating obesity as part of the work injury, and some don’t. Nebraska and Iowa have cases denying gastric bypass surgery based on factual findings that it was not necessary to treat the work injury, but leaving to door open with more proof of medical necessity. 

Our firm has had at least one case where gastric bypass surgery was paid voluntarily when it was apparent the surgery was necessary to enable proper treatment of a serious work injury. A workers’ compensation trial award was entered in early January awarding gastric bypass surgery as necessary to reduce weight so a back surgery could be performed safely. This award reinforces that with proof of medical necessity to treat a work injury, weight loss treatment and surgery may be covered by workers’ compensation in Nebraska.

Is Worker’s Comp Profitable Because Disabled Workers Don’t Get Benefits?

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My friend Tom Domer of The Domer Law Firm in Milwaukee, who happens to be one of the most knowledgeable workers’ compensation lawyers I know, wrote a great blog post explaining why workers’ compensation insurance companies profit mightily and injured workers struggle. Workers need to avoid the kind of thinking that leaves them with empty pockets and insurance companies with growing bank accounts. Injured workers should speak with qualified experienced lawyers before deciding whether to pursue workers’ compensation benefits or to abandon a claim if they are being denied.

I recently wrote an article in the national magazine for the Worker’s Injury Law Advocacy Group (WILG), the Worker’s First Watch, Fall 2013 reviewing the worker’s compensation resources research report indicating that the worker’s compensation industry is extremely profitable.  I began representing injured workers in 1976.  It seems every year since then worker’s compensation insurance carriers have complained they are not making profits and the culprit responsible is increased benefits paid to workers.  In fact, over the last 20 years the insurance industry has been profitable in 16 of 19 years and broke even in one year.  Several factors account for this profitability, including worker’s compensation insurance carriers successfully pursuing deregulation and “reform” measures to restrict eligibility. 

The net result of increasingly restrictive rules for compensability in many State worker’s compensation systems as a result of “reform” resulted in many workers with disabilities caused by work who did not receive worker’s compensation benefits.

The general trend since the early 1990s has been to restrict coverage through State statutory and administrative “reform”.  Many workers face lengthy litigation and frustration.  More restrictive regulations may preclude claims where the worker lacks “objective” medical evidence for his injury, or is unable to medically document persistent pain, or has a disease resulting from multiple causation that cannot be distinguished from workplace disease, or has job stress related disorders.  One significant problem is that many injured workers fail to file for benefits.  (For those of us in the trenches daily, these pose obstacles to compensability.)  Among the many reasons for failure to file are:

  • Ignorance of worker’s compensation and eligibility.
  • Ignorance of the work-relatedness of the condition.  (Many workers know they suffer an impairment but do not know the health condition is caused by work.)
  • Reimbursement for medical care or Short Term Disability benefits available.  (Many workers use Short Term Disability or group medical insurance rather than worker’s comp.)
  • Belief that the injury is lacking in sufficient severity.
  • Many workers fear job loss or other forms of retaliation, who do not want to report a condition as work-related.
  • Workers do not want to be perceived as complainers or careless.
  • Deciding not to file based on the negative experience of co-workers.
  • Fear of the stigma associated with being a worker’s compensation claimant.  (Much of this stems from the intense focus on fraud perpetrated by the insurance industry, resulting in increased levels of stigmatization, decreasing the likelihood injured workers will file for benefits.)
  • Pressure from co-workers on safety incentive programs.  (These programs, sometimes called “Safety Bingo” create incentives not to report.)

Those of us who have hearings daily that involve the non-reporting of an injury, or significant time delay between the occurrence of an injury and the reporting of an injury, can refer to the above list for some ammunition on the “non-filing” or “late filing” issues.

What is Workers’ Compensation Law in Nebraska?

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Before workers’ compensation was an option in Nebraska, injured workers could only sue their employers under tort law for damages. While providing complete compensation – i.e., damages such as those for pain and suffering were available – it also required proof of negligence, and claims were often barred by affirmative defenses such as assumption of the risk and contributory negligence. For more than 100 years now, injured workers have had the protection of workers’ compensation laws that provide for no-fault benefits that are received quickly, and employers can avoid more expensive court challenges.

The Nebraska workers’ compensation system includes a dedicated court, and Nebraska is one of the only states to have this avenue for injured workers.

There are several different types of benefits that an injured worker is entitled to:

1.      Benefits to manage or cure the injury: includes hospital, doctor, chiropractic and physical therapy costs. This also includes the costs of diagnostic testing, doctor-prescribed medicine (even if it’s over-the-counter) and items like braces.

2.      Compensation while temporarily disabled: These payments of two-thirds of an injured worker’s average weekly wage may start after an injured worker has been off work for seven days, and usually an injured worker continues to collect payments – either for total or partial disability – while he or she is convalescing until a doctor signs off on a full return to work and/or places an injured worker at maximum medical improvement.

3.      Compensation for permanent injuries: These benefits are two-thirds of an injured workers’ average weekly wage (or wages earned in a 40-hour work week for part-time workers) and are available after an injured worker has reached maximum medical improvement. These benefits may be for permanent impairment to a specific body part or may be to compensate for an injured worker’s loss of earning ability. This distinction depends on the type of injury. Benefits may also be partial or total, depending on the type and degree of injury.

4.      Vocational rehabilitation: These are services provided under Nebraska workers’ compensation law to injured workers when, as a result of a compensable injury, the injured worker is unable to perform suitable work for which he or she has previous training or experience. This may include job placement and retraining. 

5.      Death benefits: If a worker dies as a result of his or her injury, that worker is entitled to medical expenses as well as burial expenses up to $10,000.  The deceased worker’s dependents are also entitled to benefits, which vary depending on the circumstances.

If the system worked the way it was supposed to, employers (or their insurance companies) would pay injured workers, pay the medical bills, and focus on getting the worker either back to work or moving on with the best quality of life possible. The reality is that employers (and their insurance companies) don’t always see eye-to-eye with doctors’ opinions or treatment recommendations, or follow work restrictions. Speaking with an experienced attorney when navigating the workers’ compensation system can reassureinjured workers and their loved ones and make a very stressful time a little less difficult.

Different states have workers’ compensation systems that vary, but all, to some extent, are intended to protect injured workers. If there are questions, please contact the firm and provide the details to an attorney who can advise on the best steps to take for each specific situation.

How Do Iowa Workers’ Compensation Permanent Benefits Work?

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Iowa’s workers’ compensation laws classifies permanent injuries to the neck, back, shoulders or hips are as unscheduled, or body as a whole, disabilities. Most other injuries are treated as scheduled member injuries, for which an injured worker can still recover permanent partial disability (PPD) benefits.

A permanent partial disability is a permanent injury that does not totally keep the injured person from eventually returning to work.

How is my percentage of disability determined in Iowa scheduled member cases? 

This is initially determined by a doctor chosen by your employer or your employer’s insurance company. The doctor typically looks at a medical text to determine what percentage is appropriate. If that physician assigns you a rating of permanent disability that you think is too low, you have the right to be examined by another doctor whom you choose. The cost of this second opinion is also paid by your employer or their insurance company. However, you must first submit an application to the Iowa Workers’ Compensation Commission to get this second opinion.

How much will I receive in permanent partial disability payments? 

The amount of money you receive as a PPD benefit payment depends on several things. First, your average weekly income before the accident or injury affects the amount of your weekly benefits. Injured workers receive 80 percent of their previous weekly pay, up to a maximum benefit amount of $1,419 each week. All workers entitled to PPD benefits will receive a minimum weekly payment of $270, even if their weekly earnings were lower than that amount.

Second, the amount of your disability also affects the amount of benefits. Scheduled members are assigned a number of total weeks by statute. You simply apply the percentage of disability assigned by the doctor to the total weeks. The result is how many weeks the worker must be paid the full weekly benefit.

How is my percentage of disability determined in Iowa body as a whole cases? 

Body as a whole injuries have a different compensation package. An injured worker with a permanent body as a whole injury receives a maximum of 500 weeks of PPD benefits. You will receive benefits according to the lost earning capacity. For example, if a back injury left you with a 15 percent earning capacity loss, you will receive benefits for 15 percent of the 500 weeks, or 75 weeks at the full weekly rate discussed above.

When determining the percentage of lost earning capacity, the Commissioner will weigh a number of factors:

  • age of the worker;
  • the employer’s ability to accommodate a return to work;
  • lack of motivation to find a job;
  • whether the earning capacity changed after the healing period;
  • psychological conditions impacting ability to work;
  • employee’s work experience, educational background, and training before the injury;
  • functional impairment or impairment rating caused by injury;
  • whether the worker can speak English or has tried to learn English;
  • inability to engage in other employment because of injury, despite making bona fide efforts to do so;
  • has the worker retired; and
  • workers’ refusal to submit to medical treatment or surgery.

None of the factors are determine the issue alone, and all factors will be considered as a whole when determining the earning capacity rate. Typically, a vocational counselor must be hired to evaluate these factors and how they impact a workers’ earning capacity. Anyone with permanent restrictions from a work injury should contact an attorney to ensure they receive all of the permanent benefits to which they are entitled.

Whole body injuries can affect the rest of your life and be incapacitating. The attorneys at Rehm, Bennett & Moore can make sure you receive all of the benefits you are owed, which includes fair compensation for your injury. Contact our office at (800) 736-5503 to set up your free initial consultation with one of the attorneys licensed to practice in Iowa. Find out more about the practice at www.rehmlaw.com.