I’ve Suffered a Work Injury. What Should I Do?

Report the work injury to your employer right away, the sooner the better. Depending on where you work, you might be informing a manager, supervisor, on-site physician, or a staff member in an HR department. Make sure they document the reporting of your work injury.

What is the Deadline for Reporting the Work Injury?

You must report the work injury within 180 days. But again, it is best to do so immediately, or as soon as you realize your injury or illness is directly linked to your job.

I Reported My Work Injury. Now What Happens?

The employer will then have 7 days to report the claim to the insurance carrier for the business. Following that, the insurance carrier has 14 days to file a Form 122 (First Report of Injury) to the Industrial Accidents Division. A copy of this report must be provided to the injured worker, along with a copy of Form 100 (Injured Workers’ Rights and Responsibilities).

What Doctor Do I Visit?

Your employer should direct you to a designated medical provider. If there is no preferred provider, then you may choose the doctor (one who accepts workers’ compensation insurance). Make sure your employer provides you with contact information for the workers’ compensation insurance carrier and their policy number, which the medical provider will likely request. Explain your injury to the doctor, and note when and where the accident happened at work. (Or in the case of an illness, note how it is a result of the job tasks you perform.)

Does the Doctor Need a Form?

The doctor will need to complete a Form 123 (Physician’s Initial Report of the Injury or Illness) and submit it to the Industrial Accidents Division within 7 days of your first doctor visit. You, the employer, and the insurance carrier should each receive a copy of this form.

I Haven’t Heard Anything from the Adjuster Yet…

After reporting your work injury, it may take some time for the insurance carrier adjuster to contact you. It does not necessarily mean they are ignoring your case.

How Long Do I Have to Wait for the Insurance Carrier to Respond?

Once they receive a report from either the employer or doctor (or reports from both), the insurance carrier will open a workers’ compensation claim. They will then have 21 days to determine if your case is eligible for workers’ compensation benefits. In instances when they require further investigation, the insurance carrier may take an additional 24 days to accept or deny the claim. (That would make 45 days total.) They would file this extension by submitting a Form 441 (Insurance Carrier Notice of Further Notification of Claim) to the Industrial Accidents Division. They must mail a copy of this form to you as well.

What Happens if My Claim is Approved?

The insurance carrier will send a Form 141 (Initial Statement of Insurance Carrier with Respect to Payments of Benefits) plus the first indemnity payment if you have lost work due to the injury (when more than three days of work were lost). Depending on the compensation benefits for time lost and/or decreased wages, the insurance carrier will need to contact the employer for your weekly pay at the time of the work accident. The adjuster should work directly with you to determine what medical benefits the insurance carrier needs to pay directly.

What If My Claim is Denied?

You will receive a Form 89 (Employee Notification of Denial or Partial Denial of a Claim). You can speak with the claims adjuster to ask why it was denied. In certain cases, you may be able to resolve an issue by providing more information that the insurance carrier requires. But if the claim is still denied, you can contact the Industrial Accidents Division via the Intake Claims Department. If the claims staff can not resolve the dispute, you can file an Application for Hearing with the Labor Commission’s Adjudication Division. You can contact them for more information at (801) 530-6800. You can also request to participate in a Claims Resolution Conference, which assists in resolving workers’ compensation disputes.

About the Claims Adjuster

The claims adjuster is the insurance carrier worker who will either approve or deny payment for your medical treatments and your wage-loss benefits (from days missed work, decreased working hours, etc). The adjuster will gather information from your employer regarding the accident. They will also ask you for all your pertinent medical records and any other documents that can help them determine if your injury is work-related.

Communicating with the Claims Adjuster

You will likely need to answer questions about your injury, your reporting of the accident, and all your related doctor visits. Though the adjuster is assisting you with the workers’ comp claim, keep in mind that their goal is to close your case as cheaply as possible. They may ultimately deny your benefits outright, or encourage you to settle your case for a lower amount than you deserve. There is also a chance they will take a lengthy amount of time to respond to any of your inquiries, delaying the process of your claim and the treatment of your injury.

I Haven’t Heard from the Adjuster in a While… What Can I Do to Be Proactive?

• Once you and your adjuster make contact, you can check in on your case regularly. If you speak on the phone or leave a message (either by voice or text), follow up with an email to keep track of all your interactions. A “paper trail” may be helpful for future reference.
• When questioned, always stick to the basic facts of your injury. Be honest and consistent, and avoid rambling or going off-topic. You don’t need to answer questions unrelated to your case, or sign documents without looking them over carefully first.
• Make sure your forms are fully complete. Report all issues related to your work accident. If, say, you primarily injured your left leg, but your left foot has also been hurting—make sure you mention the pain in your foot in the reports too.
• Submit forms and other required materials promptly to keep your case moving along without further delay.
• Consult an experienced lawyer for assistance. A Rose Legal workers’ comp attorney can guide you through the appeals process and help ensure you receive all the benefits you’re entitled to. If you have questions at any point along the way, you can reach us at 801-810-7673.

Example Timeline

In this example, the worker suffers a work injury on April 1st and reports it to the employer on the same day. The employer has 7 days to report to the insurance carrier, so that deadline is April 8th. The insurance carrier then has 14 days to report to the Industrial Accidents Division of the Utah Labor Commission (ULC), so if the employer notified them on April 8th, then the insurance carrier’s deadline is April 22nd.

Meanwhile the deadline for the insurance carrier to accept or deny the claim would be April 29th, since that is 21 days after April 8th (the day the employer reported the injury to the insurance carrier). But if the insurance carrier files for an extension of 24 additional days, then the deadline moves to May 23rd. In summary, it can take up to about eight weeks to get a final answer from the insurance carrier regarding your workers’ compensation claim.

Many workers similarly suffer repetitive stress injuries caused by the repeated motions of their jobs. Though there may not be a singular big accident they can point to for a date of injury, they can nonetheless make a workers’ compensation claim. They will still need to determine a starting date for their injury, however. This will typically be the date when the injury becomes too much for the worker to handle the pain, or the point when the injury finally keeps the worker from being able to reasonably perform the duties of the job.

Types of Chronic Injuries

In workers’ compensation, injuries can also be defined as either acute or chronic based on how long you have continually experienced the pain or discomfort of the injury. Here is a chart that shows how different types of injuries can be classified as one or the other:

What to Do if You Experience Chronic Pain

Chronic pain can take a variety of forms. For some people it involves persistent symptoms that get in the way of their daily routine, such as numbness or a dull ache. For others it can involve more severe reactions from the nervous system, potentially well after the associated injury or illness has otherwise healed. Chronic effects can also be mental or emotional in nature. You should see a doctor who can diagnose your condition to determine what type of chronic pain you are suffering.

If the chronic pain you are experiencing is the result of the work tasks you perform on the job, you may be entitled to workers’ compensation benefits. This can alleviate the costs of medical bills and physical therapy, and help reimburse you for the days you miss work. After you file your workers’ comp claim, your adjuster will have to decide whether to accept or reject it. But in the event your claim is denied, you can still apply for a court hearing—and a Rose Legal workers’ compensation attorney can help. To learn more about navigating workers’ compensation for your chronic injury, click here to schedule a free consultation with an experienced lawyer.

One of the common issues people face in workers’ compensation cases is the matter of pre-existing conditions. How much will officials consider them to be the primary cause of an injury or illness? If an employee claims that pain in his arm is due to the work he performs on the job, the employer’s insurance company will likely examine the worker’s medical history. If the employee broke his arm in a biking accident a year prior, for example, his workers’ comp case may be tougher to prove. That does not mean he has no right to make a claim, however—nor does it mean he has no chance of winning his case.

The Higher Standard of the Allen Rule

The normal standard for workers’ comp cases is that usual or ordinary exertion, so long as it is part of the employee’s duties, is enough to show legal cause. But under the “Allen Rule,” the higher standard applied for workers’ comp cases is that if the employee suffers from a relevant pre-existing condition, then he must show that his duties at work involved some unusual or extraordinary exertion above the usual wear and tear of life outside work. The higher standard of the Allen Rule is not met by simply having a pre-existing condition. It must contribute to the work injury itself.

Allen v. Industrial Commission

This case Robert A. Allen v. Industrial Commission refers to an incident in which Mr. Allen suffered a herniated disc while lifting milk crates at the grocery store he worked at as a night manager. What complicated his case was his pre-existing medical condition: a history of multiple back injuries. The Industrial Commission argued that the back injury of the claim did not meet the statutory definition of an “accident.” But after the administrative law judge denied Mr. Allen’s claim, the Supreme Court of Utah reversed the decision. In the proceedings that followed, the court determined that injured workers with relevant pre-existing conditions must prove two things:

• Legal Cause — the workplace duty in question must involve unusual or extraordinary exertion (the exertion must be greater than that undertaken in normal, everyday life)
• Medical Cause — there needs to be a clear link medically between the exertion of the workplace duty and the injury of the claim

To give an example, lifting a single ordinary box would potentially not be considered unusual or extraordinary exertion. Lifting a particularly heavy or unwieldy one would make for a stronger claim. (Or, alternatively, lifting many of the ordinary boxes repeatedly throughout the shift.)

The Presence of a Pre-Existing Condition

A purpose of the Allen Rule is to eliminate workers’ comp claims for impairments that are the result of injury or illness caused outside of the workplace. The first question to ask then in all this: Is there a pre-existing condition? The higher standard of the Allen Rule does not have to be met if there isn’t a pre-existing condition related to the workplace injury or illness.

The Pre-Existing Condition’s Effect on the Work Injury

If there is a pre-existing condition, then continue to the second question: Did the pre-existing condition contribute to the workplace injury? For example, in the event of a heart attack while on the job, a worker with no past history of heart disease would have a stronger case than a worker with pre-existing heart conditions, proven by medical records stating those pre-existing conditions contributed greatly to the heart attack.

The Amount or Type of Exertion Involved in the Work Injury

If the claimant suffers from a pre-existing condition that contributes to the workplace injury, there is a final condition to meet. The third question: Did the employment activity involve some unusual or extraordinary exertion above the typical exertions of daily life? Workers’ comp officials must determine first what precisely were the work-related activities of the injured employee. Second, they must decide whether those activities amounted to unusual or extraordinary exertion. The court may consider climbing a single-story stairway to be the sort of everyday exertion people do outside of work. But climbing such a stairway repeatedly many times a day, on the other hand, would have a greater chance of being deemed unusual or extraordinary exertion. If you answer the third question with a “yes,” then we can say there is legal causation—it satisfies the Allen Rule.

If you suffer a workplace injury or illness and have a related pre-existing condition, contact Rose Legal to speak with an experienced attorney regarding the matter. Even with a pre-existing condition, you may have a stronger case than you expect.

Can You Receive Social Security Disability AND Workers’ Comp Benefits?

The short answer is yes, you can receive both. The longer answer is yes, but there is a limit to how much total money you can receive each month. The combined amount of your monthly benefits from Social Security Disability Insurance and your monthly workers’ compensation can not exceed 80% of what you were earning each month (on average) before you had a disability. Worth noting: don’t confuse Social Security Disability Insurance with the “regular” Social Security (Retirement Insurance), which workers’ compensation does not affect.

The Difference Between Social Security and Workers’ Comp

• Social Security — The United States’ social welfare and social insurance programs include benefits for retired individuals, the disabled, and survivors (aged and/or disabled widows, widowers, and orphans). If you’ve worked and paid Social Security taxes for at least ten years, you can start receiving monthly retirement benefits starting at age 62.
• SSDI — Social Security Disability Insurance. Sometimes referred to simply as “Disability.” Provides monthly payments to those who have a disability that prevents them from working, or limits their ability to work.
• Workers’ Compensation — If injured at work, employees are entitled to financial assistance from the employer’s insurance company. This may include payment for time off work, coverage of medical fees (surgeries, physical therapy, MRI scans, prescriptions, etc), and additional compensation based on disability impairment ratings.

More Useful Terms to Know

• SSA — Social Security Administration. The independent agency of the U.S. federal government that administers Social Security.
• SSI — Supplemental Security Income. Provides monthly payments to the aged and/or disabled who have little to no income or resources.
• SSRI — Social Security Retirement Insurance. What people typically refer to when saying “Social Security.” It is a separate program from SSDI and SSI.
• ACE — average current earnings. Used to determine whether disability insurance benefits will be paid, and how much will be reduced. Typically based on the one calendar year in which earnings were highest, but may be based on the average of five consecutive years. The individual’s AMW (average monthly wage) based on total earnings and years could also be used for the calculations.
• PIA — primary insurance amount. The benefit you would receive if you choose to begin receiving retirement benefits at a normal retirement age. (For people born in 1960 or later: age 67.)
• Pareto Principle — AKA the 80/20 Rule. Refers to the amount deducted from your SSDI payments if the combination of those plus your workers’ compensation benefits exceeds 80% of the ACE (average current earnings) you received prior to becoming disabled.

An Example of the Workers’ Compensation Offset

If the total amount of your Social Security Disability and workers’ comp benefits exceeds 80% of your ACE prior to disability, the SSA will deduct the excess amount from your SSDI. For example, let’s say your average earnings were $5,000 a month, and you’re eligible to receive $3,000 a month in SSDI benefits. You also receive $1,500 each month from workers’ compensation. That makes a total of $4,500 in monthly earnings for your disability. But 80% of $5,000 is $4,000—which means the SSA will have to offset (or deduct) $500 from your SSDI. If there is ever a change to the amount of your disability payments, you should report to the SSA right away to avoid any future issues with your SSDI. Worth noting, the combined payments of SSDI and workers’ comp will never be less than the SSDI amount on its own.

If you receive your workers’ compensation as a lump-sum payment, you may want to include an amortization provision in your settlement agreement. This can maximize the amount of your benefits, since the insurance company would dole out a portion of the lump-sum payment on a monthly basis, keeping the total with your SSDI at or below 80% of your ACE. Be sure to discuss this with your attorney when settling a workers’ comp case, in order to minimize the potential offset to your SSDI. At Rose Legal, we will take the measures necessary to help ensure you receive all possible benefits for your financial security following a work-related injury or illness.

What is a Hearing?

You’re injured on the job or suffering an illness due to work conditions, but you are denied workers’ compensation. This can mean a complete denial of benefits, or a partial one—such as denying payment of certain medical bills, or not paying what you’re owed for time you missed work while recovering. When a workers’ comp claim is under dispute, either the injured employee or the employer’s insurance company can file a request with the Utah Labor Commission (ULC) for a hearing. A hearing is a legal proceeding in which testimony and arguments are presented before a judge. The ULC will schedule a hearing usually nine to ten months later.

Who Attends the Hearing?

The people who attend a hearing typically include the following:

• the injured worker for the case, and—if if the worker has one—a lawyer representing the injured worker (such as a Rose Legal workers’ comp attorney)
• the insurance company’s lawyer, and potentially a representative for the insurance company and/or the employer
• the administrative law judge (ALJ) who presides over the proceeding
• potentially a court reporter who will type a transcript
• potentially one or more witnesses, such as managers, coworkers, and insurance adjusters
  (note: typically doctors will provide written testimony ahead of time, rather than testify in person)
• potentially some expert witnesses for either side

During the months leading up to the hearing, the two parties of a workers’ comp case may try to resolve their dispute through mediation and settlement. If they are unable to do so, they will need to attend the scheduled hearing. This entails testifying and presenting their arguments before the judge, who will then make a final decision. Most cases are resolved beforehand outside of court… because if a case goes to hearing, it is possible to lose. For injured employees, that often means not receiving any of the workers’ comp benefits they were hoping for.

Preparing for Your Workers’ Comp Hearing

The proceedings of a workers’ compensation case that occur before the hearing provide opportunities for the two parties to reach an agreement outside of court. But if the case does ultimately require a hearing, it is important to be well-prepared. Organize all the documents that will support your case. Discuss the claim with your lawyer so you are both on the same page for what to focus on when testifying. Review all the facts so your statements are consistent. Be ready to answer questions regarding your injury, your incident at work, your job role, your hospital and doctor visits, your medical history, your payment history, and your general background information. Then be sure to arrive to the hearing early enough to discuss any last-minute concerns with your attorney. Some tips for when you’re at the hearing:

• Be on time
• Dress appropriately (neat, clean)
• Be respectful to everyone, including the other party
• Don’t speak unless you are instructed to (don’t interrupt anyone)
• Address the judge as “your honor”

Hearings used to be conducted in person in front of a judge, but following the Covid pandemic, most are now held virtually via Zoom calls on computer. A typical hearing will last a few hours, but may go longer if the case requires it. The judge will issue breaks if needed.

Overview of a Typical Workers’ Comp Hearing

1. Opening Statements — The lawyers of each party in the case will briefly summarize their arguments.
2. Presenting Evidence — The lawyers will make legal arguments to the judge. Evidence can include medical records, medical bills, employment records, pay stubs, accident reports, witness statements, and transcripts from previous case proceedings (such as depositions).
3. Testimony — The judge will put the injured employee under oath to tell the truth. The workers’ comp attorney will then have the injured worker testify, by asking some questions regarding the accident behind the injury (or the working conditions behind the illness), as well as the worker’s symptoms, usual job duties, and any limitations as a result of the injury.
4. Cross-Examination — The insurance company’s attorney will ask the injured worker some questions. The judge may ask some questions as well.
5. Redress — The workers’ comp attorney will also have the option to ask the injured worker some follow-up questions for clarification if needed.
6. Witness Testimonies — The question-and-answer process will be repeated for any other witnesses who testify. (examples: the employer, an HR representative, the workers compensation adjuster, or eye-witnesses to the accident)
7. Closing Arguments — Each party will have a final chance to speak, emphasizing the most significant points of their side of the case, and why the judge should rule in their favor.

After the Hearing

Typically the judge will not make a final decision at the hearing itself. Sometime in the 60 days after the workers’ comp hearing, the judge will issue a written order and send it to the injured worker, the lawyers, and the insurance company. Possible outcomes:

• The judge approves your claim.
• The judge denies your claim.
• The judge issues a partial approval (accepting some aspects of your claim, but rejecting others).
• The judge needs more information before making a judgement, deciding to postpone the final decision or hold an additional hearing.
• The judge recommends submitting the issue of medical causation to a medical panel. This is a likely outcome if your treating doctor’s opinion is different from the opinion of the insurance company’s doctor.

If the judge rules in your favor, the ULC will implement the approved benefits within 30 days. Your employer has the right to dispute the decision, however, if they request a review from the board within 30 days. Likewise, if the judge rules against you, you have 30 days to make an appeal. Your attorney can help you determine if disputing the ULC’s verdict is a worthwhile effort for you. At Rose Legal, our goal will always be to fight for the benefits you are entitled to under workers’ compensation. With credible evidence, effective communication, and relevant experience, we can increase your chances of resolving your workers’ comp case favorably and avoiding unnecessary delays.

What is a Mediation?

A workers’ comp mediation is a conference involving the two parties of the case and a neutral mediator. The purpose of a mediation is to settle a case before it goes to a court hearing. It usually lasts about an hour, but times may vary depending on the case and on how willing everyone is to come to an agreement. The people involved in a mediation typically include:

• the injured employee for the case, and the lawyer for the injured employee (such as a Rose Legal workers’ comp attorney)
• the mediator — an unbiased representative from the Utah Labor Commission or a private mediation company who will act as a go-between for both parties in the case
• the workers’ compensation insurance company representative (often the adjuster), their attorney, and potentially a representative for the employer — (typically, mediation only has the workers’ comp attorney present)

A judge will not be present for the mediation, which is a less formal meeting than a court hearing. A mediation can take place at any time during the workers’ compensation process, arranged by agreement of both parties in the case.

Overview of a Typical Mediation

1. The mediator reviews the basics of the case
2. The injured employee’s attorney summarizes the case (and sometimes the worker will make a statement regarding the injury or illness, medical treatment, current health, etc)
3. The employer’s insurance agent or lawyer shares their view of the case
4. The mediator may ask questions to both parties
5. The mediator separates the two parties (either in different rooms if it’s an in-person conference, or through separate channels if it’s a video conference such as a Zoom call)
6. The mediator alternates discussing the case with each party, going over the strengths and weaknesses of each side
7. The injured employee’s attorney presents a starting demand for the settlement agreement to the mediator — the mediator then conveys this to the other side (the demand will likely be a dollar amount to settle the claim in full, but may include additional items of dispute)
8. The representative for the insurance company (and/or employer) makes their initial offer in response — the mediator then relays this back to the injured worker and attorney
9. This back-and-forth continues either until the settlement amount and terms reach a place that both sides agree on… or until both sides concede to continue the case with a court hearing

Preparing for Your Workers’ Comp Mediation

It is important to cooperate with your workers’ comp attorney in order to make sure evidence. Your attorney will need to know all the facts regarding your job, the workplace incident, your medical treatment, the value of your medical bills and lost wages, and any supporting medical records prior to the mediation.

It is best to arrive fifteen minutes before the mediation starts, in order to have time for any final preparations. Your attorney may give advice of what to say—and what not to say—in front of the mediator. It is best to stick to the facts of your case, rather than vent frustrations with the employer or insurance company. Put your best foot forward by dressing neatly—a suit is not expected, but it is worthwhile to at least look clean and professional.

After the Mediation

If you settle and agree on a dollar amount and terms with the workers’ compensation insurance carrier, the documents needed will be prepared for signatures within a few weeks. The settlement agreement will then be sent to the judge (ALJ) for approval. It usually takes about 30 to 45 days to receive compensation, depending on the agreement and if there are medical liens from Medicaid, Medicare, the VA, or a private health insurance company. The funds in turn may take the form of a lump-sum agreement or a series of installments.

If the case is not settled, the next step will likely be a court hearing. This involves testifying under oath and presenting your case before a judge. It is a lengthier process that is generally more costly for both parties. As such it is worth noting: even if a mediation ends without reaching a settlement agreement, it is still possible for the two parties to settle at a later time before the hearing. The best step to take next in your case can depend on a wide variety of factors. Keep in contact with your Rose Legal attorney for advice during each stage of the process, in order to know when the timing is right for negotiation and compromise.

Are You Covered If Your Work Injury or Illness Returns?

Workers’ compensation can cover illnesses that resurface and injuries that worsen so long as they’re tied to your work. The specifics will often matter in these cases, however, such as the timing of the recurrence. Is your condition directly related to the original impairment? And has it worsened as a matter of course, or is it due to some unrelated incident or habit? Workers’ compensation will typically recognize that certain injuries will flare up again in the future. These can include chronic conditions such as repetitive stress injuries or back injuries. Medical documents will play a key role in showing a connection between your condition and the original work-related incident.

What Do You Do If Your Ailment Worsens After Returning to Work?

You will want to file a claim with workers’ compensation if your work injury or illness returns. Here are the steps you will need to take:

1. Notify your employer right away. Reporting your situation promptly is critical for avoiding future disputes. You will want it to be clear when precisely you started experiencing symptoms of your original injury or illness again.
2. Seek medical attention right away too. Return to the physician who treated you before, or to a medical provider approved by workers’ compensation. A doctor will be able to determine if your symptoms stem from the original work-related impairment.
3. File a recurrence claim. This claim should be linked to your original workers’ comp case, so you won’t need to open a completely new claim.
4. Determine if you qualify for further benefits. If you need to take time off work again, you may qualify for temporary disability benefits. If your injury or illness becomes a more lasting impairment, you may qualify for permanent disability benefits.

What Factors Affect Workers’ Comp Coverage?

There is typically a time limit for reporting and filing a claim for work-related injuries and illnesses that resurface. It may be difficult to secure benefits if too much time has passed since your initial claim or original recovery. The insurance carrier may also argue the recurrence of your ailment is unrelated to your original claim, should your work have changed significantly. This could include either a transfer to light-duty work, or a change of jobs entirely. And as mentioned before, consistent and relevant medical documents will help show just how connected your condition is to the original impairment.

Do You Need to Seek Legal Help?

Though an attorney is not required for making a claim, consulting one who specializes in workers’ compensation can make all the difference. An experienced attorney is especially helpful for situations where your employer or insurer feels your impairment has not truly resurfaced, or has resurfaced for some specific reason unrelated to work. An attorney like one from Rose Legal can navigate the intricacies of your recurrence claim, and help you avoid delays or denials in receiving the benefits you need to recover. Let us advocate on your behalf.

If you’re eager to put the ordeal of the workers’ comp claim process behind you, a settlement offer will likely be tempting. But it’s important to approach the settlement with a full understanding of everything it entails. Whether or not it’s wise to accept your adjuster’s offer to settle will depend not only on the amount of money, but several other significant factors.

Factors to Consider

• Your Injury — Depending on the severity of your injury or illness, you may require extensive treatment. In turn, the longevity of your impairment will determine the length of time for your rehabilitation. You will want your settlement to account for not just the immediate costs, but for future costs as well. Consult a doctor to receive a prognosis for your expected recovery time and any long-term effects of your ailment.
• Your Finances — A quicker settlement could be preferable to a potentially better one later, depending on your financial situation. How likely waiting will lead to a higher payout can depend on a variety of things. It is best to consult with a workers’ compensation attorney to figure out just how fair your settlement offer is.
• The Insurance Company — How well has your insurance company handled your workers’ comp claim so far? If they’ve been cooperative, chances are better that the settlement is generally fair. But if they’ve been difficult to work with or ambiguous in their response to concerns, their offer may be shortchanging you in hidden ways. An attorney can help ensure the offer is properly valued, and that you’re not waiving any critical rights.

Pros of Accepting a Workers’ Comp Settlement

• Closure — Accepting a settlement can allow you to move on and avoid the lengthy struggles of dealing with a legal case. You won’t have to worry about ongoing claims or their chance of denial anymore.
• Financial Relief — A lump-sum payment could provide immediate cash. If medical bills and other financial burdens resulting from your impairment have piled up, a quick settlement may be just what you need.
• Financial Control — Depending on the settlement, you may have the flexibility to determine how to spend the money for your recovery and any other needs. A lump-sum payment can settle matters more quickly and efficiently than smaller regular payments spread across a long period of time.

Cons of Accepting a Workers’ Comp Settlement

• Losing Future Benefits — Typically agreeing to a settlement offer means forfeiting the ability to seek additional compensation for any future expenses. You may end up on your own financially if your impairment requires further treatment in the months or years to come.
• Complicated Terms — Settlements often have stipulations that limit your ability to pursue any further legal action related to your workplace injury or illness. If your ailment returns, worsens, or leads to new complications, the settlement might not be able to cover the extra costs.
• Underpayment — The insurance company’s initial offer may be a “lowball” one that won’t reflect the full scope of your financial needs. This is sometimes especially so for cases involving disabilities or impairments requiring long-term care.

Seek a Professional Opinion

Sometimes accepting a settlement is the best decision, particularly when it aligns with your medical and financial needs. But even if the settlement appears reasonable, it is worth seeking a professional opinion before making your decision. If you accept a settlement, you likely won’t be able to receive further compensation for potential related expenses down the road. Along with a doctor’s medical advice regarding what future care you might need, a lawyer’s legal advice will go a long way for ensuring your best-possible recovery. A Rose Legal workers’ comp attorney can evaluate the offer’s terms carefully, assess your needs, and negotiate for a fair settlement on your behalf.

• Do I have to go to the doctor my employer or workers’ comp carrier chooses?
• Is there any way to select my own medical provider for a workers’ comp claim?
• If I find my chosen physician to be unsatisfactory, is it possible to change doctors?

The answers to these questions can vary, depending on your employer’s healthcare provider network. If the option is available, you may be able to designate a personal physician prior to your workers’ comp case.

Employer-Designated Doctors

Utah laws allow employers to choose the doctor you must visit in a workers’ comp case—at least for the first visit. Your employer or insurance carrier may give you a preferred provider organization (PPO) or medical provider network (MPN). If that’s the case, you will need to choose one of their listed doctors for your initial treatment. This is done in part to ensure the healthcare provider understands state guidelines for treating work-related injuries and illnesses. You could risk a denial of workers’ comp coverage if you avoid this first visit without permission. Or at the very least, you will likely have to pay for that initial treatment out of pocket, either partially or fully.

The Initial Doctor Visit

Employers and insurers should choose trusted medical professionals who have experience with workers’ comp claims. These doctors will be able to assess your ailment and determine what further care you’ll need. They will also provide the medical documentation you’ll need for your workers’ compensation claim. However, after that first visit to your employer-designated doctor, you have the option to change your medical provider. This is one-time transfer allowing employees to make the remainder of their recovery with a physician of their choice.

A Doctor of Your Choosing

It is always possible to visit your own doctor in addition to the one you’re required to see following a work injury or illness. But for the sake of workers’ compensation, if you wish to see your preferred physician from the start, you would need to officially predesignate one in writing. Prior to your injury or illness, fill out the proper paperwork and have it approved by your employer or workers’ comp carrier. You may also be able to choose your own doctor in a workers’ comp case right away if your employer does not have a PPO or MPN in place.

Changing Doctors

After your first visit to the employer-designated doctor, you have the right to change physicians. The exact process can vary, but normally you will need to notify the workers’ comp insurance carrier beforehand. There are multiple reasons why employees may choose to see a different doctor for their work-related ailments. It is perhaps most worth considering if you feel your needs aren’t being met, or if you disagree with the doctor’s assessment. Be sure to discuss and document your concerns with the manager of your workers’ comp case.

Note that it is possible your employer-designated doctor will refer you to another physician better-suited to assist you. This prescribed transfer would not count for your personal one-time change of medical providers.

A Second Doctor’s Opinion

In certain cases, you might simply want a second opinion for your diagnosis or your plan for recovery. Utah law allows this, but again, you will need to notify the workers’ comp insurance carrier beforehand. Similarly, in the event there’s dispute regarding the extent or nature of your ailment or your ability to return to work, you may need an Independent Medical Examination (IME). In those circumstances, you would need to see a second doctor chosen by the employer or insurance carrier.

Getting the Health Care You Need

An attorney can assist you in getting the proper medical attention following a work injury or illness. For example, if you don’t agree with the assessment your employer-designated doctor makes, an experienced workers’ comp lawyer can guide you through the process of switching medical providers. Email legal@workcomputah.com for details on how to proceed and to ensure your rights are protected.

• the nature of the injury or illness
• the cost of medical expenses
• the amount of wages lost while unable to work
• additional benefits in the event of a permanent disability
• many other key components that must be considered during settlement negotiations

Nature of the Injury or Illness

There are many different types of injuries and illnesses one can sustain while on the job. If your illness is particularly debilitating, it may keep you from returning to work for a prolonged period of time. And if your injury is severe, treatment would be significantly more costly than that of a minor cut or sprain. Injuries to the head or central nervous system are often among the most costly, followed by neck or leg injuries, then arm or shoulder injuries. In cases where workers cannot return to their previous jobs, workers’ compensation may also cover the costs of vocational rehabilitation. The costs of job training, education, and assistance in finding new employment can potentially be factored into the settlement amount.

Cost of Medical Expenses

One of the biggest components of workers’ compensation settlement to keep in mind is the cost of medical expenses. A relatively small injury may only need basic first aid and common medication. On the flip side, a severe injury may require costly surgeries and long-term rehabilitation. Along those same lines: the worse an illness, the higher its medical expenses tend to be. In some cases the compensation will be structured payments, and in other cases a lump-sum settlement that covers all medical bills at once.

Amount of Wages Lost

Workers’ compensation can cover wages lost due to your inability to work while recovering. In Utah, workers receive two-thirds of their average weekly wage (AAW) from before the injury or illness. The duration of this financial support depends on the nature of the injury or illness and the worker’s recovery time. Those unable to work for only a limited time period will receive temporary total disability benefits, while those who are permanently unable to return to their jobs will receive permanent total disability benefits.

Permanent Disabilities

In addition to temporary benefits, you may also be entitled to permanent disability benefits. This will increase the amount of your claim. When employees with permanent impairments can return to their jobs and perform some kind of work, they receive permanent partial disability (PPD) benefits. Your degree of impairment and your ability to earn wages are factors that determine the amount you would be compensated. Meanwhile, workers unable to return to any form of gainful employment receive permanent total disability (PTD) benefits. Such benefits are typically paid for life.

How an Attorney Can Help

Every workers’ compensation case is unique, so in turn is the worth of every case settlement. This amount ultimately results from negotiations between the impaired employee and the insurance company. Having an attorney experienced specifically in the field of workers’ compensation can make all the difference in maximizing your settlement amount. A lawyer from Rose Legal can effectively negotiate with insurance companies by ensuring all relevant factors in your case are considered. For professional legal advice regarding your workers’ comp situation, call or text Rose Legal at 801-810-7673.

Having an attorney who specializes specifically in workers’ comp is highly beneficial for incidents such as these:

1. Complex Cases. An attorney can help you navigate complex circumstances involving disputed liabilities, multiple injuries, disagreements over how bad a disability is, or injuries that overlap with pre-existing conditions. For example, if you’ve broken your back sometime in the past, back pain experienced from a later repeated stress injury at work may be blamed on that earlier injury. An attorney can help prove to the insurance company that your current injury stems from the workplace.
2. Denied or Delayed Claims. Employers and insurance companies often reject workers’ compensation claims when they believe workers will immediately drop the matter. When this happens, a workers’ comp lawyer can appeal the decision and gather the evidence needed to support your case.
3. Insufficient Settlements. Judges are often able to approve a settlement agreement so long as it appears even remotely within reason. Having an attorney to negotiate a settlement with the insurance company can ensure you get a fair deal.
4. Permanent Disabilities. Claims involving long-term or permanent impairment usually require legal expertise to ensure sufficient compensation for ongoing medical expenses and loss of earning capability. Since these payments (either delivered weekly or in one lump sum) can really add up, insurance companies often try to avoid paying as much of the full benefits as possible.
5. Social Security Disability Benefits. Without the help of a workers’ comp attorney, the benefits of your settlement may affect your Social Security disability payments.
6. Third-Party Liabilities. If a third party such as a contractor, equipment manufacturer, or negligent driver is partially responsible for your injury, an experienced attorney can assist in taking the appropriate legal action. Some situations call for a personal injury case on top of a workers’ comp claim.
7. Retaliation from Employers. It is illegal for your employer to fire you, demote you, reduce your pay, or cut your hours simply because you filed a workers’ comp claim. If any discrimination of this sort happens to you, contact an experienced attorney to help protect your legal work rights.

There are some situations where you may be able to get by without an attorney. If your injury is very minor, such as a twisted ankle that heals quickly, you might not have to miss much work or require significant medical treatment. You also may happen to have an entirely clear-cut case of a work-related injury that has zero overlap with any pre-existing conditions you might have, and an employer who is willing to provide excellent support throughout the workers’ comp process.

Still, you can always give a Rose Legal attorney a call at 801-810-7673 for a free consultation. That way you will be able to make an informed decision on the matter. You can also email legal@workcomputah.com to see if your claim can be converted to a paid claim. Remember, your claim may be worth more than you think.

• slipping and falling at the workplace
• receiving a strain injury from the repeated movements of frequent work tasks
• exposure to toxic substances on site

What Qualifies for Workers’ Compensation

Workers’ compensation cases are not only for physical injuries, such as broken bones, cuts, burns, sprains, or strains. They can also encompass occupational diseases such as respiratory conditions, carpal tunnel syndrome, hearing loss, and stress-related disorders. So long as you can tie the injury or illness back to the work you perform on the job, you have the potential to qualify for a workers’ comp case.

Not all injuries received at the workplace will automatically qualify for the benefits of workers’ compensation. Typically, you need to report the injury to your employer within a specified timeframe, and support the claim with medical documentation. A case could also be disqualified or reduced if the injury was the result of the employee’s own willful misconduct, or if under the influence while on the job.

Who Qualifies for Workers’ Compensation

It is worth noting that what constitutes a valid workers’ comp case may vary from state to state, as the specifics of workers’ compensation laws can differ. The definition of employee under workers’ compensation will also depend on state laws, and certain types of employees may be covered under programs tied to their industries. For example, the Federal Employers’ Liability Act (FELA) covers federal workers injured on railroad jobs.

The fundamental principles remain consistent across the country, however. By providing financial support for medical expenses and lost wages, workers’ compensation promotes safer work environments by 1) taking care of sick or injured employees, and 2) mitigating the risk of costly lawsuits for employers. Laws will generally describe the employee as someone who works within an organization for a set salary, and the employer as the one who dictates the work performed—as detailed in a contract between the two. In Utah, partnerships, limited liability companies, and independent contractors may be exempt from workers’ compensation coverage.

The Importance of Workers’ Comp Attorneys

All sorts of complications can arise throughout the workers’ compensation process. There may be disputes between employees, employers, and insurance carriers about the validity of claims and the extent of benefits owed. An attorney with experience specifically in the field of workers’ comp law can give you the legal guidance you need. By understanding what constitutes a workers’ comp case, Rose Legal ensures workers who suffer from harm while on the job will receive the medical and wage-loss benefits they are entitled to within the workers’ compensation system.

Workers’ compensation is there to cover you for injuries you may get while on the job, be it at your typical workplace or any other location you may be for work-related reasons. However, the “going and coming” rule dictates that workers’ compensation may not cover injuries sustained during your everyday commute. That said, there are exceptions to this rule:

Traveling Employees

Not all workers have a set job site, and may be “on the clock” as soon as they hit the road. Service technicians, landscaping employees, sales representatives, delivery drivers, and so on travel from place to place for their work, and thus may be exempt from the going and coming rule. Note that travel-intensive jobs may still follow the going and coming rule. For example, workers’ compensation could cover a bus driver when injured while driving a bus, but not when injured while driving their car to the bus garage.

Special Assignments and Dual-Purpose Trips

If an employer assigns some errand to run while the employee is going to work (or while coming home from work), workers’ compensation may cover an injury sustained during that commute—even if the task isn’t specifically related to the employee’s job. Similarly, an employee who takes a detour to fulfill some work-related task may have a case if injured during what would have otherwise been a regular commute.

Transportation a Part of an Employment Contract

Some employers prescribe a set method of transport for workers, or provide a work vehicle such as a company car. Workers’ compensation might cover injuries sustained while traveling in a company car during any use of the vehicle. Or it might cover injuries solely for trips to and from a set job site (if that is the vehicle’s only intended use). The going and coming rule also might not apply if the employer covers the cost of workers’ daily commutes. Their employment contracts should detail this.

Business Trips

Typically all the time spent on a business trip is considered work-related—not only the time spent at an arranged meeting or conference. In these instances, the employer has requested the worker journey to and from some specified location. This overrides the usual limitations imposed by the going and coming rule.

On the Employer’s Premises

In a case decided by the Utah Supreme Court, an employee of Intercontinental Hotels Group tripped and fell in a parking lot while heading to work. IHG denied the worker’s benefits claim, citing the going and coming rule. Upon review of her claim, however, the court concluded that she should receive benefits under the “premises” rule that covers injuries sustained on the employer’s property. In this instance, the court considered the adjacent parking lot was part of the employer’s premises.

While the going and coming rule serves as a general guideline for determining workers’ compensation eligibility regarding commuting injuries, there are plenty of exceptions and interpretations of the rule. If you are injured while going to work or coming home from work, a lawyer who specializes in workers’ compensation can help ensure you receive your entitled benefits and support. Reach out to our team at 801-810-7673 to learn more.

When pursuing a claim for work-related injuries or illnesses, it’s important to understand the various types of injuries and how they might impact your life. At our law firm in Pleasant Grove, Utah, we handle a wide range of cases:

• Head Injuries. These can range from mild concussions to severe traumatic brain injuries. They often result from falls, collisions with objects, or vehicle accidents in the work place.
• Back Injuries. Heavy lifting, falls, or awkward movements at work can lead to sprains, strains, herniated disks, or other severe back issues that can limit mobility and cause chronic pain.
• Broken Bones. From simple fractures to compound breaks, such injuries can result from falls, machinery accidents, or other work-related mishaps.
• Repetitive Stress Injuries. These injuries occur over time due to repetitive motions or positions, often affecting the hands, wrists, elbows, or shoulders.
• Burn Injuries. These can occur in various work environments due to exposure to heat, chemicals, electricity, or radiation.
• Sprains and Strains. Often a result of manual labor or upon slipping and falling, these types of work injuries can affect joints like the ankles, wrists, or knees. Rapid overextension can cause significant pain and limit normal movement.
• Electrical Injuries. These can involve burns, nerve damage, or cardiac issues as a result of exposure to electrical equipment or live wires.
• Crushing Injuries. Often from machinery accidents, these can cause severe trauma and chronic pain.
• Lacerations. Accidents involving sharp objects or machinery can result in deep and severe cuts.
• Work-Related Illnesses. These encompass a broad range of conditions from hearing loss to respiratory issues, often due to exposure to harmful substances in the workplace.

Let Us Help You Pursue Compensation

If you’ve suffered any type of work injury, it’s important to understand the legal process for pursuing a claim and for securing the benefits you’re entitled to receive. At Rose Legal, our devoted team has extensive knowledge and experience in dealing with workers’ compensation claims. Based in Pleasant Grove, Utah, we’re passionate about standing up for the rights of injured workers and strive to deliver the support and guidance you need during this challenging time.

With our single focus on workers’ compensation claims, we aim for positive outcomes in our clients’ cases, ranging from securing adequate medical treatment to obtaining rightful compensation. If you’re facing uncertainty following an accident at work, rest assured you won’t have to navigate this daunting process alone. Consider reaching out to us at 801-810-7673 to learn more about how we can help you through your workers’ compensation claim.

Workers’ comp injury benefits can vary greatly. It is true that in workers’ compensation cases there can be great disparity between two workers, even if they suffered similar injuries. Of course, with medical issues, no two injuries are exactly alike. People have different levels of recovery, different pain tolerances, different genetic characteristics, different nutrition regimens, etc., that all contribute to differences in how each person heals and responds to treatment. But that is only part of the equation for workers’ compensation. The other part is the ‘compensation’ part. Unfortunately, this portion is calculated based on one’s wages at the time of injury. So, the more money you make—the more money you get—for your workers’ comp injury benefits. Let’s look at this comparison:

Bill and Ted are both construction workers. One day, Bill was climbing the ladder and lost his footing and fell 15 feet, landing on Ted. Both Bill and Ted suffered a labrum tear on the right shoulder. They both had the same surgery to repair the damage. They both missed 6 months of work while waiting for and recovering from the surgery. Both of them had all their medical bills paid by workers’ comp. They both got a 5% impairment rating from the doctor for the permanent partial disability they suffered.

However, when they compared the checks that they received for the 6 months of missed wages that they had lost, Ted was shocked. Bill’s lost wages checks added up to $23,686, while Ted’s were only $5,200. And then when they compared the checks they received for the permanent disability. Ted was double shocked. Totally. Bill received $9,531.60 for his 5% impairment rating, while Ted only received $3,120 for the same 5% rating to his shoulder. This is because the wages and impairment payment are based on earnings at the time of injury instead of the severity of the injury alone. Bill works 40 hours a week at $32 per hour, while Ted works only 20 hours a week at $15 per hour. Bill also has a wife and two kids, while Ted is single with no kids.

Even with the exact same injury, Bill received a total of $32,217.60 while Ted only received $8,320. This is why it is important to talk with your attorney about a realistic expectation of what dollar amounts you can expect to receive for your workers’ comp injury benefits and not rely on other people’s stories of what their cousin got for their injury. Working toward a realistic goal will help in your recovery.

Bill and Ted