When a worker injures a body part that had previously been injured or had a pre-existing problem, employers may not deny benefits for the injury simply because a pre-existing issue existed with the newly injured body part.  Instead, the employer must pay for treatment that deals with the subsequent injury, regardless the prior condition.  However, the employer is only liable for treating the amount of damage done by the subsequent injury, not for remedying the prior condition.

Workplace injuries include more than injuries incurred while actually working.  Injuries that result from activities related to work, what are generally called incidental to work, are also covered as “workplace” injuries.  Such activities may include lunch and breaks, parking lot accidents, and accidents that occur at work functions, e.g. luncheons, seminars, and meetings, are covered activities, in most cases.

Employers may be liable for psychological injuries of employees.  Psychological injuries are much easier to prove when they arise out of some physical injury than are psychological injures that do not accompany a physical injury.  But the later may be compensable so long as they can be tied to a condition of employment.

For the most part, a worker’s compensation hearing involves the testimony of the injured worker before the judge and any witnesses for, or against, the worker.  Most hearings take less than an hour.  There are exceptions.  The hearing takes place before 1 judge typically in a smaller room.  The judge is an administrative law judge and usually makes a decision anywhere from 30 to 120 days after the hearing.  In most cases, the most important evidence in a hearing is the medical records.  Most disputes in worker’s compensation cases revolve around the medical aspects of the case such as whether an injury is work related and/or whether the worker requires more treatment.  After the injured worker and the witnesses testify, the judge will make a decision after the hearing.  If the outcome of the hearing is not acceptable to either party, either party does have the right to appeal to the Full Board which consists of 7 judges.  In most cases, the full board gives a lot of weight to the decision of the original judge and it is typically difficult to receive a reversal of the single hearing member’s decision.  Beyond the Full Board, either party can try to appeal to the Indiana Court of Appeals and eventually the Supreme Court.  The Supreme Court does not have to accept every case.  The Supreme Court can reject hearing a case.

Under the Indiana Worker’s Compensation Act, if an injured worker receives weekly worker’s compensation checks in excess of 125 weeks, the insurance company can deduct any weekly check payments after the 125^th week from any lump sum settlement.  An exception to this rule would apply to workers that are permanently and totally disabled (unable to perform reasonable types of employment for an indefinite period of time).  If you have received weekly worker’s compensation checks in excess of 125 weeks, remember that the insurance company can deduct the payments beginning with week 126 from your settlement.  Please let us know if you have any questions.

Under the Indiana Worker’s Compensation Act, as a general rule, the insurance company has a right to pick the doctor.  If the doctor selected by this insurance company provides inadequate treatment, you can get treatment with your own doctor if you have “good cause”.  Good cause is something that needs to be defined by a judge, but generally means that the worker’s compensation doctor has provided inadequate treatment and the doctor you selected has effectively made you better.  It is generally difficult to prove to a judge that you had good cause to get your own treatment, especially if the doctor the insurance company has selected has a good or excellent reputation.  Be careful in getting treatment with your own doctor because the judge may not feel that you had good cause to do so.  Feel free to consult with one of the attorneys in our office for more information.

Your time limitation to file an Application for Adjustment of Claim (this form will toll/stop the 2 year statute of limitation from running any further) is a difficult concept in an Indiana worker’s compensation case.  To be safe, you should file this form no later than 2 years from the date of accident.  You have an argument that you have 2 years from the date you last received the weekly worker’s compensation check to also file this form.  However, the law in Indiana is not very clear on whether your 2 year time period starts to run on the date of your accident or on the date of your last weekly worker’s compensation pay check.  For injuries that develop over the course of time, called repetitive trauma injuries, the 2 year statute of limitation begins to run on the date the injury is “discernible”.  The definition of discernible is generally thought to be the point in time when a physician diagnoses the injury as work related and offers a course of treatment.  Many cases involve litigation that argue over the word “discernible”.  To be safe, as soon as you have a repetitive trauma injury claim, you may want to consider filing an Application for Adjustment of Claim.  Finally, for occupational disease claims (these are cases where you were exposed to a chemical or other foreign agent at work), the statute of limitation is even trickier.  To understand the time period on this type of case, you may want to consult an attorney.  A discussion of the statute of limitation for occupational disease claims it outside the scope of this paragraph.

As a general rule, when you are injured at work in the State of Indiana, your only remedy is against your employer for worker’s compensation benefits.  However, if your injury happened due to the fault (negligence) of a party other than your employer, you may have the right to sue that other party (called a “third party”).  The advantage of suing this other party is that the damages that are available in a third party case are generally much greater than that available in a worker’s compensation case.  An example of a third party case might be a claim against the manufacturer of a defective machine or an employee of another contractor who caused your accident.  If you think you might have a third party case, please consider contacting one of the attorneys at Klezmer Maudlin for advice.

Of the numerous examples of nurse case managers and adjusters providing incorrect information to injured workers, one common example is the following:  An injured worker has a work related injury (for example, a broken arm).  In order to have surgery on that broken arm, the injured worker needs a cardiologist to perform a heart test and clear the injured worker to have surgery.  The insurance company and/or nurse case manager will tell the injured worker that the test must be paid for out of pocket.  This is obviously incorrect.  The only reason the injured worker needs the arm surgery is due to a work related injury and any testing necessary to clear the worker for the work related injury should be covered by worker’s compensation.  It is unfortunate that nurse case managers provide injured workers with false information.  Again, be careful what you hear and do not believe a nurse simply because she is a “nurse.”

Throughout your worker’s compensation case, you may or have one or more disputes with the insurance company regarding whether wages are owed for a certain period of time, whether mileage is owed, whether bills you incurred for going to your own doctor must be paid, etc.  Please make sure you keep a record of any such dispute so they are addressed at the end of your case.  Sometimes insurance companies might take hard line positions on disputes in hopes that you forget about the dispute and that the case settles without requiring the insurance company to pay the additional money.