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.

Ways Social Media Posts Can Be Used Against Your Workers’ Comp Case

From your mobile phone or from any computer, it is now easier than ever to share what you’re currently up to at any given time. People can construe your posts and photos for all sorts of details: where you are, what you’re doing, who you’re with, and how much money you’re spending. In turn, people can infer things like your physical capabilities, your mental state, your emotional well-being, and your financial circumstances—and what they imagine might not be accurate. Some examples of things people can speculate on from your social media presence:

• A post that simply states, “Clean, crisp air… Feeling good on this lovely spring morning!” Your employer may argue that you’re feeling good enough to return to work. Even if in reality you only intended to comment on the weather—not your health.
• A photo of you making pancakes, holding a spatula. An attorney may say this means your hand injury isn’t bad enough that you can’t use the tools for your job. Even if in reality you were only at the griddle for a moment, for the sake of a picture to share with family.
• A short video of you with friends, who are playing a game of baseball. The insurance company could try to use this as evidence that your back injury can’t be giving you as much grief as you’ve claimed. Even if in reality you didn’t participate in the game itself, and were only there to watch.
• An automatic update from a campground app tied to your social media account, upon arrival at the campsite (tagging your location and the date). Perhaps you did not do anything strenuous on the weekend trip, but it may arouse suspicion for the judge, regardless.

Tips for Using Social Media During Your Workers’ Comp Case

1. Consider taking a break from social media until your case has concluded. Anything you say about your case, your job, your injury, your doctor visits, your process of recovery, or your ability to perform certain tasks could be used in arguments against you.
2. If you do continue to use social media, give some thought to how your words or any images you share could be misconstrued, before clicking the Submit button. Does the family reunion photo make it look like you can stand up by yourself just fine, when the truth is you’re holding on to a handrail that’s not visible in the picture?
3. Keep in mind that even if you stop using social media, your friends and family might continue to do so. And they could tag you in their photos, or talk about what you’ve been up to lately. Let them know what you would like for them to not share with the world at this time.
4. Take a look at the privacy settings on your social media apps and websites. You may wish to choose all the options that offer the highest level of privacy, and to avoid accepting follower requests from anyone you don’t know. Just keep in mind, even then it may still be possible for someone to leak or access information from your profile, one way or another.
5. Use your own email, phone, and computer when communicating with your lawyer. A shared email account, a work computer, or the chat function of a social media app is likely less secure or confidential.
6. Don’t go back and edit or delete old posts on social media. During a workers’ comp case, a judge may consider this to be tampering with evidence. Chances are someone could still dredge up your original posts, anyways.

Insurance Companies Can Hire a Private Investigator

Along with all the data they can glean from your online presence, your employer’s insurance company may choose at some point during the case to hire a private investigator. It is illegal for such a person to enter your home without your consent, to trespass on your property (or place surveillance equipment therein), to wiretap your phone, or to place a tracking device on your vehicle. But things an investigator may do include the following:

• Observe your daily activities in public, noting what you appear to be capable of doing (e.g. “able to drive to the grocery store, walk in the store for a half hour, carry a 24-pack of water bottles,” etc)
• Take photos or video footage of you outside your home
• Interview coworkers, neighbors, and anyone else who could give information about your health or everyday life (including you yourself)

You don’t need to live in paranoia from day to day while your workers’ comp case is ongoing. But it is worth taking a few cautious steps to avoid adding unneeded stress to your case. Stick to your doctor’s orders, and don’t take any unnecessary risks—both for the sake of your health, and your workers’ comp case. If you are not sure about what to share online while your case is ongoing, consult your workers’ compensation attorney for advice.

What Does a Workers’ Comp Nurse Case Manager Do?

The typical duties of a nurse case manager can vary, depending on the patient’s needs and the instructions of the insurance company. A good nurse case manager will assist in coordinating a path to full recovery from your work injury. A bad nurse case manager will try to dictate what treatment you receive—or don’t receive—on behalf of the insurance company’s interests. Typical duties may include the following:

• Create a return-to-work plan for the injured employee
• Schedule medical appointments and follow up on them
• Communicate status of the employee’s recovery to the insurance company
• Provide required paperwork to approve insurance for treatments and medication
• Arrange transportation for appointments
• Coordinate with healthcare professionals to ensure patient’s specific needs are met

Your Rights When Working with a Workers’ Comp Nurse Case Manager

Section G of Utah Admin. Code R612-300-2 – Obtaining Medical Care for Injured Workers goes over the injured worker’s right to privacy (note the “agent of the payor” includes nurse case managers):

No agent of the payor may be present during an injured worker’s medical care without the consent of the injured worker. However, if the payor’s agent is excluded from a medical visit, the physician and the injured worker shall meet with the agent at the conclusion of the visit or at some other reasonable time so as to communicate regarding medical care and return-to-work issues.

When you meet with a healthcare professional for an exam, checkup, treatment, or surgery, you have the right to decline a nurse case manager’s presence. This way you and the doctor can decide on treatment, medication, and work restrictions without outside influence. The nurse case manager may speak to your doctor after the conclusion of your appointment, and you may wish to stick around to ensure the message they receive is accurate. They will be reporting back any useful information to the insurance company they work for.

Careful Communication

Here are a few tips to keep in mind when speaking with your nurse case manager:

• Don’t agree to any changes to your recovery plan before consulting with your doctor.
• Don’t downplay your injury or illness, or try to guess how soon you will get better.
• Don’t talk about issues unrelated to your current injury or illness (such as pre-existing conditions).
• Don’t let yourself get pressured into saying you’re ready to return to work before you’ve made a full recovery.
• Don’t agree to change your doctor at the nurse case manager’s insistence.

Your Doctor, Your Nurse Case Manager, and Your Workers’ Compensation Attorney

Remember, it is your doctor who should be recommending a course of treatment for your recovery—not the nurse case manager. If you feel your nurse case manager is making decisions that are not in your best interest, go over your concerns with them. If they are unwilling to cooperate, try speaking with the claims manager of your employer’s insurance company. Or get in contact with a workers’ compensation lawyer (such as a Rose Legal attorney), who can help protect your rights and keep the nurse case manager from damaging your 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.

The Workplace Injury

Despite being retirement age, Lucy Harper worked part-time at a fast food restaurant in order to supplement her social security income. But one day, she tripped over a chair and fell to the floor, breaking her arm near the shoulder. She suffered a painful recovery, and could not return to work due to difficulties in using her arm, including range of motion restrictions.

Note that Lucy’s workplace injury is not unusual. OSHA states “the second-most common cause of workplace injury is a trip or slip hazard that leads to a fall. And 20-30% of workplace falls result in a moderate or severe injury like deep bruising, broken bones, or concussions.”

A Hurdle to Overcome

There are many factors that impact the negotiation of a workers’ comp settlement and its final amount. And each side in a case will strive to support their claim with evidence. In this instance, the Rose Legal attorney argued that Lucy Harper was entitled to permanent total disability compensation: the earnings she would have received at work if she were capable of returning, paid for the remainder of her life. However, the insurance company argued that her arm’s restrictions were simply the result of her arthritis from old age. With the medical records to back this preexisting medical condition up, there was a chance the employer would be able to avoid providing Lucy any further assistance.

A Settlement in Lucy’s Favor

An effective workers’ compensation attorney has to be a skilled communicator, capable of remaining calm yet assertive throughout the back-and-forth of settlement negotiations. For this case, the Rose Legal attorney was able to focus on the goals of the claim and the right evidence in order to guide the discussions to a positive outcome for Lucy. In the end, she received a lump-sum settlement based on her lifetime expectancy, which enabled her to realize the benefits of her workers’ compensation more quickly and conveniently.

The Settlement Negotiation Process

What does the typical process look like for an attorney to negotiate a workers’ compensation settlement? Steps along the way may include:

• Determining settlement goals — It’s important for the injured employee and attorney to discern precisely what financial benefits need to be compensated for in the worker’s case. Then they’ll want to ensure they have all the evidence needed to back up their argument.
• Sending a demand letter — A demand letter to the insurance company’s attorney will describe the worker’s injury and the desired monetary amount to settle the claim.
• Receiving a counter-offer — If the insurance company does not accept the settlement amount, their attorney may make a counter-offer with a lower monetary amount or other terms.
• Continuing communication — The workers’ comp attorney will review the counter-offer with the injured worker, then advise to accept, decline, or negotiate further.
• Reaching an agreement — If both sides manage to agree upon a fair settlement amount, the insurance company’s attorney will write up a settlement agreement. This will be reviewed by your attorney to ensure that all of the necessary provisions and safeguards are included, and make sure you are fully informed before signing.
• Submitting settlement to judge — Once both parties have signed the agreement, it goes to the court judge assigned to the case. Upon approval, the judge will issue an order for the settlement’s payment.
• Receiving payment — The injured employee will receive payment based on the terms of the settlement agreement. The time from reaching an agreement to receiving payment is usually 30-45 days, but can vary based on many factors from the particular case being settled.

The First Step for Your Case

Experienced workers’ compensation lawyers have knowledge of the tactics various insurance companies employ, and are able to plan accordingly for negotiations. An attorney at Rose Legal will focus on your particular interests in the claim and take a proactive approach in ensuring you receive adequate compensation. For a free consultation, call 801-810-7673, or email legal@workcomputah.com for more information regarding the first step to take for your case.

The Workplace Injury

Barry Edmund, a truck driver, was hooking a second trailer to the first, when part of the trailer dolly (the equipment connecting the two trailers) flipped up and pinned his chest to the back of the first trailer, twisting and crushing his back into it. He was able to free himself and finish his run, but the sustained injury to his lower back would eventually require two fusion surgeries.

Getting the Facts Straight

The insurance company tried to fight against Barry’s claim by hiring a mechanical engineering expert to prepare a report about the accident scene. Unfortunately for Barry, this report got certain details of the incident incorrect. It thus became one of Rose Legal’s primary tasks to point out these flaws and have the false records thrown out of court. This required careful investigation to figure out which of the injury details were factual errors. Eventually Rose Legal discerned that the insurance company based their measurements and calculations on the wrong location for the site of the injury. Indeed, the elevation of the road played a critical part in determining the nature of Barry’s injury.

A Settlement in Barry’s Favor

Once the attorney gathered evidence, the case moved forward. By pointing out the mistakes and resolving issues regarding proper notification from the insurance company, Rose Legal was able to get a large settlement for Barry Edmund. At the time, Barry was at risk of losing his house to foreclosure. But thanks to Rose Legal’s efforts to pursue maximum benefits on his behalf, he was able to save his home. The settlement ensured Barry received financial compensation for his time off work, as well as the medical care he needed for a full recovery. Thorough research of the injury, the location of the accident, and any equipment involved were key to winning the case.

Evidence to Help Your Case

What are some other typical pieces of evidence worth looking into for a workers’ comp case? Documentation and other bits of proof for your attorney to investigate may include:

• Medical Records — a doctor’s initial diagnosis, hospital forms, reports from a health specialist, treatment plans, pharmacy receipts, physical therapy records
• Incident Reports — accident reports and any other related documents
• Witness Statements — from coworkers, management, or neutral third parties
• Photographs — of the injury, the scene of the incident, vehicles or items involved in the accident
• Security Footage — if the accident was recorded by surveillance cameras
• Doctor’s Statements — linking the workplace incident to your impairment
• Time Cards — proof you were on-duty at the time of the incident
• Payroll Records — what your expected pay is in relation to your claim
• Maintenance Reports — could provide details that support claim of faulty equipment or previous issues
• Financial Records — medical bills, payroll, receipts of pertinent expenses

Note that the particular facts of your case may determine how important each piece of evidence is to your claim.

If you or a loved one has suffered an injury at work or an illness that is work-related, you can contact Rose Legal to schedule a free consultation. All it took was a quick call/email for Barry Edmund to begin the process of getting the financial compensation he deserved. Likewise, once we have the basics of your case, an experienced workers’ comp attorney will be able to analyze the evidence to present the best case on your behalf.

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.

Opioids as Treatment for Workers’ Comp Injuries

Medical care for workers’ comp cases can include drugs such as opioids to help manage the pain of injuries and surgeries. Over the years, doctors have prescribed opioid analgesics to millions of injured workers for pain relief. These drugs act as painkillers when used medically, and may include codeine, morphine, fentanyle, or oxycodone. They can provide short-term or long-term relief, effectively easing the pain of chronic ailments or surgeries. Opioids should only be taken under the supervision of a physician though, as there are potential side effects to watch for.

Concerns Over Opioid Addiction Following Work Injuries

Unfortunately the misuse of prescription opioids can lead to physical and psychological dependence—and even death from overdose. Those who take higher doses of opioids are also likely to miss more days of work, resulting in higher claim costs for employers. Then when back on the job, such workers may be less alert and slower to react, potentially threatening work safety.

The workers’ comp industry has made efforts in recent years to lower the use of opioids. Thanks to prescribing guidelines, dispensing limits, and raising awareness, claims prescribing opioids have declined. The more physicians go over the matter with injured workers, the less risk they have of dependency. Continuous monitoring throughout the entire recovery period is key to avoiding the misuse of and addiction to opioids. It is also worth looking into alternatives such as physical therapy, acupuncture, and other methods to combat the pain of an illness or injury.

Journavx, an Alternative Non-Opioid Drug for Injured Workers?

The FDA has recently approved Journavx, a non-opioid drug, for the treatment of moderate and severe acute pain. This new pain-management medicine may soon become a viable alternative to opioids, avoiding the risk of addiction and overdosing. As described on the Journavx website, it works to “reduce pain signals before they reach the brain,” and “doesn’t affect other tissues in your body outside of your peripheral nervous system.” The site recommends asking your doctor about how Journavx works, how long you should take it, and what safety precautions you should keep in mind while taking it.

Journavx may be available as soon as March in major national and select regional retail pharmacies. In the meantime, a workers’ comp attorney can assist you with other concerns you might have related to your work injury or illness. Rose Legal will be able to ensure your claim is handled smoothly and fairly while you make your full recovery. Email us at legal@workcomputah.com or call 801-810-ROSE(7673) today.

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.

Toxic Substances

The toxicity of a substance depends on its chemical composition, how much it is absorbed by the body, and how well the body can detoxify or eliminate the substance. The greater the amount of a toxic substance that enters your body, the worse its negative effects. Likewise, the longer you are exposed to such chemicals, the more likely you are to be at risk. Depending on the chemical, the effects may appear immediately after exposure, or hours later, or even days later. In turn, those who work with chemicals regularly (with minimal exposure, but repetitive doses) may also be at risk of chronic diseases that develop gradually over months or years. Chemicals can also affect different people in different ways. Some may have allergic reactions to certain substances, for example.

Detecting Symptoms

Symptoms of chemical exposure can include the following:

• dizziness
• headaches
• skin irritation
• eye irritation
• burning pain in throat or nose
• nausea
• coughing, wheezing, shortness of breath

However, such symptoms may take time to manifest, or be subtle enough to be written off as “not that serious.” That is why it is important to see a doctor after any chemical-related incident. A healthcare professional can conduct an assessment of the exposure and perform tests to identify any hidden ill effects. Conditions may include chemical burns, respiratory problems, neurological disorders, and cancer. The sooner such a condition is detected, the more likely you can minimize its progression and damage.

Avoiding Hazards

There are many steps employers and employees can take to minimize the risk of chemical exposure in the workplace. When working with chemicals, workers should wear the appropriate protective clothing, gloves, goggles, and respirators. The most common way toxic chemicals enter the body is from breathing in contaminated air, so respiratory protection is crucial. Employers should provide the safest chemicals possible, and prescribe a process that minimizes contact with them (such as rotating job assignments). Areas clearly designated for work with hazardous materials should be isolated and enclosed, and have the proper ventilation.

Workers’ Compensation

If exposed to toxic chemicals at work, getting medical care is not only important for your health. It’s also a primary method to support a workers’ comp claim. Healthcare providers can provide documentation of the chemical exposure and the specific ways it has negatively affected you. Such details would back up a claim to receive financial assistance for your medical expenses and lost wages. This in turn will provide you peace of mind while you make a full recovery. If you have experienced a chemical-related incident or any other type of injury at work, call or text Rose Legal at 801-810-7673 to get a free workers’ comp consultation.

• carry workers’ comp insurance
• post protocol to follow (in the event of a work injury or illness) somewhere in the workplace
• provide paperwork for employees to make a workers’ comp claim
• report your injury to their insurance carrier and the Utah Labor Commission
• offer a list of medical facilities under their workers’ comp plan

However, sometimes an employer may encourage you to not make a workers’ comp claim. In other instances, an employer will fail to file your claim out of negligence. And in some cases, an employer could simply refuse to file the claim you’ve made. Employers may not wish to cooperate in order to limit the cost of their company’s workers’ comp insurance. Or they may feel your injury or illness is not that serious, or not truly the result of job-related duties. Whatever your situation may be, there are steps you can take to file your claim and receive legal guidance.

Report Right Away

If you suffer a workplace injury or work-related illness, it is important to report it to your employer as soon as you are able. In Utah the requirement is within 180 days—but the timelier you are, the stronger your case will be to insurance companies. Even if your ailment seems relatively minor at first, it’s well worth taking the time to document it. A workplace accident that “kind of” hurts your back the day of, could hurt your back more severely a month later.

When reporting an injury or illness, complete the required paperwork in writing, properly sign it, and keep a copy for your own records. If your employer denies you reported your ailment, this can serve as evidence that you did your part.

Seek Medical Attention

Even if your employer fails to file your claim, you should still go see a doctor. This is not only important for your physical and mental well-being, but it also provides documentation of your ailment. Having a detailed medical history may be key to getting your workers’ compensation claim approved in the event it’s contested. Inform your physician that your ailment is directly tied to your work—that way it’s stated in your medical records.

File the Claim Yourself

After they’ve been informed, employers are supposed to report workplace injuries and illnesses to their workers’ comp insurance carriers within seven days. If they fail to do so, they may receive a fine, face criminal charges, or risk a lawsuit. Regardless, it is possible to file the workers’ compensation claim yourself, if needed.

If you contact the Utah Labor Commission, you can receive the forms and instructions you need to report your injury or illness. Then you can gather as much of the following to support your claim:

• medical history documents
• witness statements
• any useful correspondence that backs your claim
• records of any interactions you had with your employer regarding the injury or illness
• any other documentation that includes pertinent dates, times, and details

Consult a Workers’ Comp Attorney

If your employer fails to file your claim, an attorney who specializes in workers’ compensation law can guide you through the process. Legal representation can be especially critical if your ailment is serious, if your employer is hostile, or if there is a complex dispute surrounding certain aspects of your incident. An experienced lawyer at Rose Legal will be able to help you put together your workers’ comp claim, appeal a denial, and file an Application for Hearing with the Utah Labor Commission. Doing these things can ensure your rights are protected and that you receive the care and resources you deserve.

If You Can Still Work, but Not at the Same Job

When a work-related injury or illness is severe enough, it can prevent you from returning to your job, or to any other job available from your employer. Vocational rehabilitation services can help you retrain for a new job or career. For example, a rehabilitation counselor could help you put together a pertinent resume, give you a vocational evaluation, and come up with a game plan for returning to work as soon as possible. The goal would then be to find a job that pays close to the wages you earned before your work injury or illness. This new job would be one that complies with all the work restrictions provided by your physician.

If You Can’t Return to Work at All

If your work-related injury or illness prevents you from working in any job, it constitutes a permanent disability. Long-term workers’ comp benefits fall under two categories: permanent partial disability (PPD) and permanent total disability (PTD). These benefits provide compensation based on the severity of your disability and its impact on your ability to work. A workers’ comp lawyer can help you explore available resources to provide you with financial support and other services that assist in adjusting to life with a disability.

Social Security Disability Benefits

Social Security Disability Insurance (SSDI) is an option available for many who are permanently unable to work. It financially assists those who have paid Social Security taxes, but can no longer work due to a disability. However, the Social Security Administration (SSA) has requirements you must meet regarding your ability to perform necessary tasks for employment. The SSA also typically expects your condition to last at least twelve months, or to result in death if less than that. Applying for SSDI often involves extensive documentation and medical evidence. A lawyer who specializes in this field can assist in the demanding process of getting your claim accepted.

Consult a Workers’ Compensation Attorney

Beyond the financial and legal concerns, there are many issues to deal with following a work injury or illness. You will likely need to spend time focusing on your physical and emotional well-being. A workers’ comp attorney can deal with the process of your workers’ compensation claim in the meantime. Claims involving permanent injuries can be especially complicated, so it’s all the more valuable to consult with an experienced attorney. You will want to ensure you receive the full benefits you deserve, so you can concentrate on your life’s new challenges and opportunities. Text or call 801-810-7673 to consult a Rose Legal attorney and explore your legal options.

Does Workers’ Comp Cover You If You Work from Home?

When employees are injured or fall ill for job-related reasons, they are entitled to workers’ compensation. This typically covers medical expenses, rehabilitation costs, and a portion of wages lost during the recovery period. This is a requirement for both those who work in a traditional office and those who work in a home office. However, remote workers need to consider some unique challenges when it comes to workers’ compensation.

When Workers’ Comp Applies to Remote Employees

Remote employees are only covered by workers’ comp if their injuries or illnesses are related to their jobs. Depending on the circumstances, a court may debate whether or not an incident is within the scope of your employment. For example, tripping over your pet in the hallway while taking a break may be deemed unrelated to work, as opposed to tripping over a wire of your work computer while addressing a technical issue. In the case of injuries, it can also be challenging for remote employees to prove that an incident occurred specifically while performing a work task.

Common Injuries for Employees Who Work from Home

A controlled workplace environment must follow a set of safety standards. Your home, meanwhile, may present a variety of hazards and distractions that you would not encounter at a regular office. Though your home is likely familiar to you, it is still worth maintaining a clear awareness of your surrounding environment. Slips, trips, and other collisions can result in head injuries, back injuries, lacerations, sprains, strains, and broken bones.

Another concern for remote workers to watch out for are repetitive stress injuries. These are cumulative injuries that build up over time, such as carpal tunnel syndrome. Some who work from home are likely to have a less ergonomic workstation than that of a traditional office. Poor posture and repeated straining movements can lead to chronic pain, stiffness, swelling, numbness, limited range of motion, and decreased mobility.

Steps to Take for Preventing Work-from-Home Injuries

Remote workers can make their home office safer by removing clutter, keeping the room well-lit, and wearing non-slip shoes. As for the workstation, set it up in a way that you can use your keyboard, mouse, and phone comfortably. Keep the monitor at eye level, sit with proper posture, and take regular breaks. Stand up and move around a bit when you can.

In the event that you are injured or suffer a job-related illness while working from home, report the incident to your employer as soon as you can. Keeping records of work hours and assigned tasks can also help support a workers’ compensation claim. In turn, an experienced workers’ compensation attorney can help ensure your claim is handled smoothly and fairly. Rose Legal can give you the legal advice you need, and then guide you through the process.

• 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.

When Employees Commit Fraud

An employee fraudulently claiming workers’ compensation benefits is subject to criminal prosecution. One can commit workers’ comp fraud in many ways, such as the following:

• exaggerating the effects of an injury (making it appear worse than it actually is)
• making a claim for an illness unrelated to the employee’s job
• failing to report income on other jobs
• misrepresenting an inability to work while receiving temporary disability benefits

When Employers and Health Care Providers Commit Fraud

In turn, an employer will be subject to criminal prosecution when committing acts such as these:

• obtaining workers’ compensation insurance by fraudulently underreporting payroll
• discouraging an injured worker from making a claim
• misclassifying employees as independent contractors to avoid paying insurance premiums
• engaging in other material misrepresentations

Health care providers can also commit workers’ comp fraud in order to support a false claim for benefits. For example, a hospital could bill for services that were not performed or for medical care that was not provided.

The Consequences of Workers’ Compensation Fraud

The penalties for workers’ comp fraud can vary depending on the jurisdiction and a wide range of other factors. Such factors include the severity of the offense and whether or not the accused is a repeat offender. The conviction may then be deemed either a misdemeanor or a felony. Either way, these are some of the possible penalties:

• a hefty fine (potentially double the amount of the fraud)
• restitution orders to repay all unlawfully obtained benefits
• years of jail time

Long-term effects of this would be a tarnished reputation and damaged credibility. This in turn can make it more difficult to secure future employment or obtain insurance coverage.

When individuals seek to exploit the workers’ compensation system dishonestly, they undermine the integrity of the system and compromise its effectiveness. This means that those who do have legitimate claims may consequently face greater scrutiny, making it harder for them to obtain their rightful benefits. A foundation of trust between employers, employees, health care providers, and insurance companies is important for workers’ compensation programs to run as effectively as possible.

How You Can Combat Workers’ Comp Fraud

The best way to protect your claim is by being truthful about the incident and your medical history. It is important to report work-related injuries and illnesses as soon as possible, then receive the medical evaluations and treatments prescribed by doctors and other professionals. Your claim will be strongest when you go through the proper channels and have a medical history that is similar to the injury or illness you’ve declared to have received from your job.

If you are accused of workers’ compensation fraud or feel your employer has failed to provide an appropriate workers’ compensation insurance plan, Rose Legal can help you through the ordeal. Call or text us with your questions today at 801-810-7673.