Worker’s Compensation

Worker’s Compensation FAQ:

What is Workers’ Compensation?

Workers’ compensation is the system we use to provide wage replacement, medical, and rehabilitation benefits to men and women who are injured while at work.

Who is covered by the Workers’ Disability Compensation Act?

Nearly all employers in Michigan are covered by workers’ compensation. This includes both public and private employers. In fact, when talking about workers’ compensation, it is easier to discuss the exceptions. There are a few classes of workers who are covered by federal laws and are not covered by the Workers’ Disability Compensation Act of Michigan.

Employees of the federal government (such as postal workers, employees at a veteran’s administration hospital, or members of the armed forces) are covered by federal laws.

People who work on interstate railroads are covered by the Federal Employers Liability Act. Seamen on navigable waters are covered by the Merchant Marine Act of 1920, and people loading and unloading vessels are covered by the Longshoremen’s and Harbor Workers’ Compensation Act. Virtually all other workers and employers are subject to Michigan’s law.

Certain very small employers are exempt. If a private employer has three or more employees at any one time, or employs one or more workers for 35 or more hours per week for 13 or more weeks, the employer is subject to the Workers’ Disability Compensation Act.

Who pays workers’ compensation benefits?

In Michigan, employers are required to purchase insurance for their employees from a workers’ compensation insurance company — also called an insurance carrier. In Michigan, larger employers who are clearly solvent are allowed to self-insure or act as their own insurance companies, while smaller companies (with fewer than three or four employees) are not required to carry workers’ compensation insurance at all. When a worker is injured, his or her claim is filed with the insurance company — or self-insuring employer — who pays medical and disability benefits according to an approved formula.

Are all on-the-job injuries covered by workers’ compensation?

Most are. The workers’ compensation system is designed to provide benefits to injured workers no matter whether an injury is caused by the employer’s or employee’s negligence. But there are some limits. Generally, injuries caused because an employee is intoxicated or using illegal drugs are not covered by workers’ compensation. Coverage may also be denied in situations involving:

  • self-inflicted injuries (including those caused by a person who starts a fight)
  • injuries suffered while a worker was committing a serious crime
  • injuries suffered while an employee was not on the job, and
  • injuries suffered when an employee’s conduct violated company policy.

Does an injury have to have a definite date of onset in order to be covered?

Not necessarily. Your injury does not need to be caused by an accident — such as a fall from a ladder. Many workers, for example, receive compensation for repetitive stress injuries, including carpal tunnel syndrome and back problems, that are caused by overuse or misuse over a long period of time. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions — for example, heart conditions, lung disease and stress-related digestive problems.

Are you covered by workers’ compensation?

Most workers are eligible for workers’ compensation coverage, but every state excludes some workers. Exclusions often include:

  • business owners
  • independent contractors
  • casual workers
  • domestic employees in private homes
  • farm workers
  • maritime workers
  • railroad employees, and
  • unpaid volunteers.

Check the workers’ compensation law of your state to see whether these exclusions affect you.

Federal government employees are also excluded from state workers’ compensation coverage, but they receive workers’ compensation benefits under a separate federal law.

In addition, about one-third of the states do not require workers’ compensation coverage from employers having fewer than a designated number of employees — three to five, depending on the state. So, if you work for one of these employers, you may be excluded from the state program.

Do I have to be injured at my workplace to be covered by workers’ compensation?

No. As long as your injury is job-related, it’s covered. For example, you’ll be covered if you are injured while traveling on business, doing a work-related errand or even attending a required business-related social function.

How do I claim workers’ compensation benefits?

First, promptly report the work-related injury or sickness to your employer. Most states require that this be done within two to 30 days following an injury. If an injury occurs over time (for example, a breathing problem or carpel tunnel syndrome), you must report your condition soon after you discover and realize that it is caused by your work.

Next, get the medical treatment you need and follow the doctor’s instructions exactly. This may include an “off-work order” or a “limited-duties work order.” Finally, file a claim with your workers’ compensation carrier. Necessary forms must be provided by your employer. Ask someone in the personnel or benefits department.

Finally, make sure you save copies of all correspondence with your employer, its insurance carrier and your doctor concerning your workers’ comp claim. If you have any difficulties with any of these steps, call Nichols & Eberth toll free at 888-571-5700.

What kind of benefits will I receive?

The workers’ compensation system provides replacement income, medical expenses and sometimes vocational rehabilitation benefits — that is, on the job training, schooling or job placement assistance. The benefits paid through workers’ compensation, however, are almost always limited to relatively modest amounts.

If you become temporarily unable to work, you’ll usually receive two-thirds of your average wage up to a fixed ceiling. But because these payments are tax-free, if you received decent wages prior to your injury, you’ll fare reasonably well in most states. You will be eligible for these wage-loss replacement benefits as soon as you’ve lost a few days of work because of an injury or illness that is covered by workers’ compensation.

If you become permanently unable to do the work you were doing prior to the injury, or unable to do any work at all, you may be eligible to receive long-term or lump-sum benefits. The amount of the payment you may be entitled to receive varies greatly with the nature and extent of your injuries. If you anticipate a permanent work disability, contact your local Workers’ Compensation office as soon as possible; these benefits are rather complex and may take a while to process.

Social Security Benefits for the Permanently Disabled

If you’re permanently unable to return to work, you may qualify for Social Security Disability benefits. Social Security will, over the long run, provide more benefits than workers’ compensation — but be forewarned that these benefits are hard to get. They are reserved for seriously injured workers. To qualify, your injury or illness:

  • must prevent you from doing any “substantial gainful work,” and
  • must be expected to last at least twelve months, or to result in death.

If you think you may meet the above requirements, contact your local Social Security office.

Can I be treated by my own doctor and, if not, can I trust a doctor provided by my employer?

In some states, you have a right to see your own doctor if you make this request in writing before the injury occurs. More typically, however, injured workers are referred to a doctor recruited and paid for by their employers.

Your doctor’s report will have a big impact upon the benefits you receive. While it’s crucial that you tell the doctor the truth about both your injury and your medical history (your benefits may be denied based on fraud if you don’t), be sure to clearly identify all possible job-related medical problems and sources of pain. In short, this is no time to downplay or gloss over the presence of a pain.

Keep in mind that a doctor paid for by your employer’s insurance company is not your friend. The desire to get future business may motivate a doctor to minimize the seriousness of your injury or to identify it as a pre-existing condition. For example, if you injure your back and the doctor asks you if you have ever had back problems before, it would be unwise to treat the doctor to a 20-year history of every time you suffered a minor pain or ache. Just say “no” unless you really have suffered a significant previous injury or chronic condition.

If I am initially treated by an insurance company doctor, do I have a right to see my own doctor at some point?

State workers’ compensation systems establish technical and often tricky rules in this area. Often, you have the right to ask for another doctor at the insurance company’s expense if you clearly state you don’t like the one the insurance company provides, although there is sometimes a waiting period before you can get a second doctor. Also, if your injury is serious, you usually have the right to a second opinion. And in some states, after you are treated by an insurance company’s doctor for a certain period (90 days is typical), you may have the automatic right to transfer your treatment to your own doctor or health plan with the cost being paid for by the workers’ comp insurance company. Because the insurance company is footing the bill, don’t hesitate to go to a doctor who specializes in your injury or illness — even if the cost is great.

To understand your rights, get a copy of your state’s rules or, if necessary, research your state workers’ compensation laws and regulations in the law library.

How do I find a good workers’ compensation lawyer — and how much will it cost?

Nichols & Eberth, P.C. can refer you to attorneys who we know to be competent in handling worker’s compensation claims. Call us too free at 888-571-5700.

In Michigan, fees for legal representation in workers’ compensation cases are limited to 15% of any eventual award. Because these fees are relatively modest, workers’ compensation lawyers customarily take on many clients and, as a result, do not have time to provide much individual attention. Most of your contacts with your attorney’s office will be with paralegals and other support personnel. This is not a bad thing in itself, if the office is well run by support staff. Nichols & Eberth can refer you to attorneys who are able to stay on top of paperwork and filing deadlines, and knowledgeable people on staff to answer your questions clearly and promptly.

What to do when the insurance company won’t pay?

Some workers’ compensation carriers take an aggressive stance and deny legitimate claims for workers’ compensation. When this happens, it’s often because the insurer claims you haven’t been injured or, if you have, that it’s not serious enough to qualify you for temporary or total disability. Commonly, this is done after a private investigator hired by the insurance company follows you and obtains photographs showing you engaging in fairly strenuous physical activity, such as lifting a box or mowing the lawn, despite claiming a back injury.

If your legitimate benefits are denied, you should immediately file an appeal with your state appeals agency — called the Industrial Accidents Board, the Workers’ Compensation Appeals Board or something similar. You may also want to hire an attorney to help you press your claim.

If I receive workers’ compensation, can I also sue my employer in court?

Generally, no. The workers’ compensation system was established as part of a legal trade-off. In exchange for giving up the right to sue an employer in court, you get workers’ compensation benefits no matter who was at fault. Before the workers’ comp system was passed, if you went to court, you stood to recover a large amount of money, but only if you could prove the injury was caused by your employer.

Today, you may be able to sue in court if your injury was caused by someone other than your employer (a visitor or outside contractor, for example) or if it was caused by a defective product (such as a flaw in the construction of the workplace equipment).

What if my employer tells me not to file a workers’ compensation claim or threatens to fire me if I do?

In most states, it is a violation of the workers’ compensation laws to discriminate against an employee for filing a workers’ compensation claim. If this happens, immediately report it to your local workers’ compensation office.