First, you should contact Kemmitt, Sanford, & Kramer right away. When the insurer has denied a recommendation from your doctor, QRC, or payment of wage loss that means they will not pay a single cent towards the denied benefit unless or until a Work Comp Judge or department of Labor Arbitrator orders them to. The law creates several hoops that you have to jump through in order to get your case in front of a judge or arbitrator. Kemmitt, Sanford, & Kramer will help to get your claim through this complex web of discovery, notices, and appearances.
Next, it is important to make sure your health insurance coverage is in place so that we make sure you get the treatment you need while Kemmitt, Sanford, & Kramer fight with the insurance company to get you the benefits you deserve.
There are different ways in which wage loss benefits are calculated for a work injury. Typically, benefits are calculated based upon your “Average Weekly Wage” which is figured by averaging all of your pay for the 26 weeks immediately before your injury. When you are unable to work at all or if your employer is unable to accommodate your work restrictions from a work injury then you are entitled to receive two thirds of your Average Weekly Wage as a wage loss benefit.
If you are able to work with work restrictions due to your work injury but are working at a wage loss, then you may be entitled to receive two thirds of the difference between your Average Weekly Wage and your actual reduced earnings with restrictions.
Both of these kinds of wage loss benefits have caps under the relevant law and these caps are based upon the date of your injury. Kemmitt Sanford and Kramer will assist you in determining your wage loss benefits and ensuring they are received.
While this is a great question, the answer simply put, is that it depends and it typically gets complex fast. First, every case is different, every person’s situation is different, and every claim progresses differently.
For example, assume you and your neighbor worked in the exact same job, earning the same amount of money, and suffer the exact same injury. Now, you are in a lot of pain but are still making it to work part-time and doing things around the house. You go to one doctor who recommends conservative treatment like physical therapy and injections, which seem to help. Your neighbor has a lower pain tolerance than you and can’t get out of bed. So his doctor recommends he have a major surgery, a month after the injury. He’s off work completely for 6 months but then ends up coming back to work full-time.
Even with the same injury, the same employer, the same wage, and the same insurance company these two cases would be valued dramatically different in court and/or in settlement. This is before we get into when or what benefits were denied.
Second, it matters when or what benefits you want to put on the table in potential settlement or litigation; and what the insurance company is denying/approving/disputing.
If your claim has been accepted by the insurance company then the insurer should pay for treatment and bills that are medically reasonable, medically necessary, and causally related to your work injury.
If your injury is not from a specific or single event, but instead stems from repetitive stress, motion, or activities that develop pain over time, then you can still be covered by workers’ compensation. This is a common issue for injuries like carpal tunnel, degenerative joint disease, or degenerative disc disease. Minnesota workers’ compensation calls these claims Gillette injuries. If you suffer from this kind of injury you should report the injury to the Employer as soon as you develop symptoms and have reason to believe that these symptoms were caused by your work activities. In most cases workers realize this after they have gone in to see a doctor and received their diagnosis.
For more information, contact our Minneapolis workers’ compensation attorneys today.