Worker’s disability compensation is an employee benefit established in 1912 by the Michigan legislature which entitles employees who suffer injuries “arising out of and in the course ofemployment”, wage loss, medical benefits and rehabilitation. Compensation is provided for disability as a result of work related injury or disease, without regard to whomever may be at fault. Generally, if an employee is injured while traveling to or from work, there is no coverage; however, if the injury occurs on the employer’s premises or during work related travel, then the employee would be entitled to benefits. Benefits are paid by employers either directly or through their insurance companies. The following is a summary of your rights and responsibilities under the Worker’s Disability Compensation Act.
Make Claim Within 2 Years
Michigan law requires that an employee must make a claim for workers compensation benefits within 2 years after the injury. As with notice, the claim does not have to be in writing, but it is best that any claim be submitted in writing.
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The law says that an employee is “disabled” when there is a limitation in the employee’s wage earning capacity because of a work related injury. Therefore, in order to receive benefits, there must be a work related injury and there must be a wage loss. As long as an employee is considered disabled, they would be entitled to receive benefits, however, if the employer or anyone else offers an injured employee a job that is within the abilities, the employee must accept the job or risk losing benefits. An employee does not have to accept any job which would pose a clear threat to their health or is not within a reasonable distance from their residence. Whether an employee can perform the job usually requires the expert opinion of a doctor. If a worker tries the job and is unable to do it, benefits are resumed.
What Medical Benefits Can Be Received
An employee who is hurt on the job is entitled to reasonable medical care to cure or relieve the effects of the work related injuries or disease. This includes chiropractic treatment: medical, surgical and hospital services; orthopedic devices and appliances as prescribed by the treating physician. The responsibility to provide chiropractic or medical treatment continues indefinitely so long as the need for the care is related to the work related injury
Who Elects The Treating Doctor
During the first 10 day of treatment, the employer has the right to choose the doctor. An employee may not go to a doctor of their own choice during the first 10 days unless they first obtain their employer’s permission. After 10 days, the employee may then have the right to choose to see a doctor of their own choice; however, this requires giving notice to the employer of their intent and providing the employer with the name of the physician.
How Are Medical Bills Handled
Generally, the chiropractic physician or other health treater will send their bills directly to the employer or its insurance company. If the employee pays the doctor directly, they would be entitled to be reimbursed by the employer of its insurance company.
What Wage Loss Benefits Can be Received
An employee is entitled to wage loss benefits which are usually 80% of the after tax value of their wage loss. Not only can an employee include their total earnings as wage loss, but fringe benefits are also considered in determining the employee’s total wage loss. Fringe benefits include the cost of health insurance, an employer’s contributions to a pension plan and vacation and holiday pay.
How is Wage Loss Determined
The Bureau of Worker’s Disability Compensation publishes tables which are used to determine what 80% of the after tax value of a given wage would equal. Many factors are included in this calculation, including the tax filing status, the number of dependents and the state and federal tax rates. The Bureau of Worker’s Disability Compensation also places a cap or a maximum rate as to the amount of weekly benefits an employee may receive, if an employee is employed by more than one employer at the time of injury, the earnings from both employer are added together to calculate the average weekly wage.
When And How Long Are Wage Loss Benefits Paid
The law requires that prompt payment of benefits be made on the 14 th day after the employer has notice of the disability. Benefits continue so long as the employee is disabled; however, there is a 5% yearly reduction beginning with the employee’s 65 th birthday which would continue until the age of 75. There also may be a reduction in benefits if an employee receives old age Social Security benefits, pension or retirement benefits or benefits from a disability insurance program paid by the employer. There is no affect on worker’s compensation benefits on monies received from Social Security Disability.
VOCATIONAL REHABILITATION BENEFITS
Vocational rehabilitation generally involves an outside rehabilitation counselor who will work with the employer and employee to assist in the employee’s return to appropriate employment as soon as reasonably possible. This may mean that a vocational rehabilitation agency, either a state agency or a private agency, will aid the employee to work at the same job or similar job with the same employer. If the employer offers vocational rehabilitation services and the employee refuses, in certain circumstances, wage loss benefits can be terminated.
DENIAL OR TERMINATION
Filing a Petition
If an employee’s claim for benefits has been denied or if benefits were paid and later terminated by the employer, the employee’s best recourse is to file a petition with the Bureau of Worker’s Disability Compensation in Lansing. At the time the petition is filed, the employee must also provide the employer with any medical records relevant to the claim. After being served with the petition for benefits, the employer must then file a Carrier’s Response Form and send medical records to the employee or employee’s attorney.
Obtaining An Attorney
In most workers’ compensation cases, both the employee and employer are represented by attorneys. The law permits individuals to represent themselvesat worker’s compensation trials, but as will be discussed below, most trials involve complex legal issues and court procedures which may be overwhelming for nonattorneys.
Mediation hearings are informal hearings with a bureau mediator to seek a resolution of the case without the necessity of a formal trial. Mediation hearings are scheduled for those cases that involve a claim for a closed period of time, a claim for only medical benefits or where the employee is not represented by an attorney. If the matter is not resolved at mediation, the case is assigned a trial date before a worker’s compensation magistrate.
Trials in worker’s compensation cases are held before worker’s compensation magistrates. There are no jury trials. Most cases involve medical questions and therefore, testimony by doctors is crucial. The doctor’s testimony is almost always recorded by a court reporter at a deposition. The deposition transcript is used at a formal trial as expert testimony along with the testimony of sworn witnesses. These procedures are best handled by a competent attorney as worker’s compensation trials, like any court, are governed by strict court rules.
Although an employee may represent themselves, the complex issues involved often times are best handled by an experienced worker’s compensation attorney. Should you have any questions, please feel free to make an appointment to discuss your particular situation. There is no charge for the consultation, and all cases are handled on a contingent fee basis.
The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation.
Copyright © 2007 Bryan M. Black. All rights reserved. You may reproduce materials available at this site for your own personal use and for non-commercial distribution. All copies must include this copyright statement.