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applying for disability work comp

Don’t Let The Insurance Company DENY YOU Medical Care!

Workers’ comp carriers, more than ever, look for ways to avoid paying expensive treatment.  Whether you’ve been ordered to have an MRI, surgery, a spinal cord stimulator or pain treatment, be aware that the workers’ comp carrier may seek to avoid paying for these necessary treatments.  Tactics used by these carriers may include utilization review, a second medical opinion, a psychological evaluation or simply denying the treatment.

Don’t let the insurance company get away with denying you needed medical care!  Under the law in Indiana, the workers’ comp carrier MUST provide you with all necessary care as deemed medically needed by the attending physician.  If you need assistance, please contact our office.

If you would benefit from legal counsel, our office does not charge for a consultation.  We’re here to offer our experience to make sure you receive what you’re legally entitled.

Did you know that all Indiana Worker’s Compensation attorneys charge the same fees? The fees are set by Indiana law.  Under the Indiana Workers’ Compensation Act, attorney fees are limited to 20% of the first $50,000.00, and 15% of any remaining balance.

Klezmer Maudlin can only charge a percentage of any recovery received and never charge you an up-front fee for our services.  With limited exceptions, we also will collect our out-of-pocket expenses from the recovery and not from you. If you hire us with an offer already given to you, we will typically agree not to charge an attorney fee unless we recover additional money.  For example, if you hire us with an offer already of $5,000.00 and 3 months later we tell you we can only get you $5,000.00, we will typically not charge you.

We will discuss this in more detail at the initial meeting and put our agreement in writing. If you have any questions regarding our attorney’s fee, please contact us at 1-800-809-3776.

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IME or Independent Medical Examination

What is an IME?

An independent medical examination (IME) occurs when a doctor/physical therapist/chiropractor who has not previously been involved in a person’s care examines an individual. There is not doctor/therapist-patient relationship.

An injured worker has THE RIGHT  to request a second opinion during his/her course of medical treatment . However, the IME will be at your own expense. If you feel strongly that you need a second opinion, you may consider requesting an IME through the Worker’s Compensation Board of Indiana.

This option is available to you once you are released from the worker’s compensation doctor to return to work.

If the Worker’s Compensation Board of Indiana agrees to schedule an injured worker for an independent medical examination, they will ask the employer’s insurance carrier to pay you, the injured worker, two (2) weeks of TTD benefits in advance of the appointment.  If the doctor for the independent medical examination (IME) suggests that the worker needs to be off work for two (2) or more weeks, then the lost wages paid to him or her in advance will be applied to the disability pay he or she should receive for this period of time off work.

But, if the independent doctor determines that the injured worker does not need to be off work, then he or she will have to repay the insurance carrier this money.

So, whether or not you cash the check is up to you. Don’t feel like a fish out of water. Call the law office Klezmer Maudlin, PC to assist you with staying afloat in the world of worker’s compensation law.

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What happens to my benefits when I am on workers’ compensation?

 

Indiana law does not specifically address whether the employer must continue to pay for the employee’s benefits (for example, health insurance) when the employee is on workers’ compensation. So, since the law is not specific, should the employer decide to stop paying for these fringe benefits, the employer may be required to add the amounts paid for these benefits to the employee’s average weekly wage calculations when determining his or her disability pay.

On the other hand, if you have a collective bargaining agreement, that agreement may require your employer to continue to offer these benefits when you are on workers’ compensation. Similarly, if you are out on FMLA leave, your employee benefits may be protected as well.

If you have any questions of concerns regarding your benefits during your workers’ compensation claim, you should consult a qualified Indiana workers’ compensation attorney.

Am I eligible for Permanent Total Disability (PTD) after my work injury?

 

Permanent total disability is a situation where an injured worker is unable to perform reasonable forms of work activity following his or her work accident. In other words, the individual is incapable of sustaining even the most limited work activities, like doing a sit down job, as a result of his or her work injuries.

Indiana Worker's Compensation

This type of disability takes into account the following about the injured worker:

  • Age
  • Mental Well-Being
  • Physical Impairment
  • Work Experience & Acquired Skills
  • Level of Education or Specialized Training (including Military Training)
  • Capacity to Function After Released from Medical Care

So basically, after taking into consideration the  items listed above, if an injured worker no longer has the job on which he or she was injured, and if it is likely that without this job, the injured worker would have a hard time getting another available job that is regular and continuous, then he or she will likely be awarded permanent total disability benefits.

A vocational expert will most likely be called on to help make the permanent and total disability determination for the injured worker. A psychologist may also be needed to evaluate the worker’s state of mind.

The Indiana Worker’s Compensation Act indicated that when a worker’s injuries leave him or her with a permanent and total disability, then the injured worker is to receive either the amount payable for his or her impairment OR 500 weeks of lost wage compensation, whichever of the two totals up to be the greater amount. If you receive some TTD benefits and are later found to be permanently and totally disabled, the TTD benefits received up to that point will be subtracted from the 500 week total.

If I receive a high impairment (PPI) rating from the doctor, will I qualify for Permanent Total Disability?

 

It depends.

Impairment and disability are different terms. Impairment refers to loss of physical function. Disability refers to inability to work. Your impairment rating is just one factor to consider in determining if you are permanently and totally disabled.

Again, permanent total disability (PTD) is based on your ability to perform reasonable kinds of work within today’s workforce.

Injured Worker Resource: The Second Injury Fund

The Second Injury Fund was originally meant to help workers who had a second injury, which when combined with the injuries from a prior accident, left the worker permanently impaired. It was later expanded to also include those individuals who were permanently and totally disabled and had reached their 500 week maximum for disability benefits, as well as, those who needed prosthetic replacements or repairs.

Benefits from the Fund are paid at the same weekly rate as that calculated for the employee’s 500 weeks of disability pay. They are distributed to the injured worker for no more than 150 weeks. An injured worker can seek renewal of benefits for another 150 weeks at the end of each 150 week period.

In order to renew your request for benefits from the Fund, it is very important that you do the following:

  • File prior to the end of each benefit period
  • Include with your petition for renewal all medical documentation that proves you are still permanently and totally disabled

A separate application for prosthetic repairs or replacements should be used to apply for funding to cover such costs.

For more information about applying for Second Injury Fund benefits, visit the Worker’s Compensation Board here.

Permanent Total Disability (PTD): What Injured Workers Need to Know

 

The law in Indiana provides injured workers with three forms of disability pay: Temporary Total Disability (TTD), Temporary Partial Disability (TPD), and Permanent Total Disability (PTD).

Permanent Total Disability (PTD)

Permanent total disability is a situation where an injured worker is unable to perform reasonable forms of work activity following his or her work accident. In other words, the individual is not capable of sustaining even the most limited work activities, like doing a sit down job, as a result of his or her work injuries. This type of disability takes into account the following about the injured worker:

  • Age
  • Mental well-being
  • Physical impairment
  • Work experience & acquired skills
  • Level of education or specialized training (including military training)
  • Capacity to function after released from medical care

According to the Indiana Worker’s Compensation Board’s Guide to Indiana Worker’s Compensation, when a vocational doctor says that the injured worker will NEVER be able to work again in ANY REASONABLE employment within society, then he or she is entitled to a total of 500 weeks of pay at the rate of 66 2/3%  of the pre-injury average weekly wage OR the amount payable for his or her impairment, whichever of the two totals up to be the greater amount. This means that if you have received lost wages up to the point that you are found to be permanently and totally disabled, the number of weeks that you were already paid will be subtracted from the 500 week maximum.

Example:

A fifty-six year old  male migrant worker, whose first language is Spanish, is involved in an industrial accident and loses his right leg. He now has a 100% permanent impairment rating to his lower extremity. Given the factors previously noted, this man would likely be limited in his ability to find other employment and may in fact, be unable to find any other reasonable employment after his accident.

If, however, the same incident happened to a fifty-six year old male attorney, who also received a 100% permanent impairment rating to his right lower extremity, is is less likely that he would qualify for PTD benefits because he would probably be able to do another form of work despite his impairment.

Determining PTD Eligibility

A vocational expert will most likely be called on to help make the permanent and total disability determination for the injured worker. A psychologist may also be needed to evaluate the worker’s state of mind.

More Options

The Second Injury Fund is available to employees injured on the job with resulting permanent and total disabilities. Those who apply and are accepted will receive additional income after the 500 week maximum. For more information regarding this fund, you can learn more here.