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indiana workers comp

When a Work Injury Claim is Denied

Sthethoscope and medical documentsSometimes a work injury claim is denied by the worker’s compensation insurance carrier. The Indiana law indicates that no compensation is allowed for an injury or death due to an employee:

  • Knowingly self-inflicting the injury or death;
  • Being intoxicated at the time of accident which is proximate cause of the injury;
  • Committing an offense which led to the injury;
  • Knowingly failing to use safety equipment or apparatus;
  • Knowingly failing to obey a reasonably written or printed rule of the employer which was posted in an obvious place;
  • Knowingly failing to perform an official duty of the job which directly led to the injury.

However, it is the employer’s responsibility to prove that such behavior on the part of the employee resulted in his or her work injury. If the employer is able to prove such, then the injured worker is barred from any compensation for his or her work injury.

In other cases, an injured worker’s claim may be denied for reasons that are not so clear. Regardless of the circumstances, all injured workers should receive written notification from the employer if their claim is being denied approximately thirty (30) days after the employer is first made aware of the work accident and injury(s).

Filing a Claim With the Worker’s Compensation Board of Indiana

If a claim is denied, the employer or the worker’s compensation insurance carrier must let the employee as well as the Board know through a written form called a Report of Claim Status/Request for Independent Medical Examination (Form 38911) within thirty (30) days of the employer’s knowledge of the accident.

Thereafter, the injured worker has the right to file a claim on his or her own with the Board, but this must be done within two (2) years from the date of the work accident.

To file a claim, the injured worker must complete and send to the Board an Application for Adjustment of Claim (Form 29109). The injured worker may also want to contact an Ombudsman at the Board for further information about this application.

Medical Treatment

Medical treatment will be on your own if worker’s compensation denies your work injury claim. Your options are to:

  1. Pay out of your own pocket, OR
  2. File with private health insurance.

Keep accurate records of the expenses your accumulate for treatment related to your work injury because this information will be needed if you contest the denial of your claim. If you do contest the fact that your claim was denied by your employer’s insurance carrier, and you file an Application for Adjustment of Claim with the Board, then medical providers who have provided treatment for your work injury cannot try to collect payment from you until it is determined who – either you or your employer’s insurance carrier – is responsible to pay.

In order for medical providers to be considered for payment when the Board determines who is responsible to pay for your medical treatment, the provider should file an Application for Adjustment of Claim for Provider Fee (Form 18487) with the Board.

This rule only applies to those who treat you for the work injury. So, if your credit card company is coming after you for not making the required payments, even if the reason you cannot make these payments is because you are not working now as a result of your work accident, you will not be protected by your worker’s compensation case. Similarly, if you have a collector calling you about a dental bill that is unrelated to your work accident, there is nothing you can do about it through your worker’s compensation case.

Have a question about a denied worker’s compensation claim? Call us at 317.569.9644 for a free consultation to see how we can help.

Workers’ Compensation, Personal Injury, or Both?

construction accident 1Construction sites are one of the most hazardous workplaces with construction workers risking their lives every day to earn a living. From heavy equipment to falling objects, thousands of workers are injured and even killed each year at construction sites.

Even though we have OSHA and construction site safety standards, construction environments are still dangerous. This is where workers’ compensation laws come into play.

If you are hurt on the job, it is imperative to immediately report the accident to your supervisor. If you do not report your injury within 30 days, you may lose your right to collect workers’ compensation benefits. You can find all forms at the Worker’s Compensation Board of Indiana website.

After you fill out the workers’ compensation claim form, give it to your employer and keep a copy for yourself. From this point on, it’s important to keep track of several factors for your records, including:

  • How your injury has impacted your ability to work.
  • All receipts including medicine and travel to doctor’s appointments.
  • All people involved in your claim, including discussions you have with them and the dates of these discussions.
  • Copies of all forms and documents you receive. Include copies of envelopes with postmarks.

But what if your accident happens due to the fault of another company or faulty machinery? Your work-related injuries may involve more than a workers’ compensation claim. If you were injured using defective or faulty equipment, you could have a personal injury claim such as product liability.

There are differences between a workers’ compensation claim and a third-party lawsuit. For example, workers’ compensation claims are handled by the Workers’ Compensation Board of Indiana while third-party lawsuits are handled by civil courts. There are also differences in the type of compensation you will receive, whether you are awarded benefits for pain and suffering or future financial losses due to your accident.

Multiple claims are never simple. The lawyers at Klezmer Maudlin have the knowledge to identify and manage all of your claims simultaneously to help get you the compensation you deserve. Call us at (317) 569-9644 to discuss your situation and see how we can help.

How Do Workers’ Comp Attorneys Charge?

Hiring an attorney for your workers’ comp claim can be looked at as an investment to make sure you receive the maximum benefits that you are eligible for. Although it is your right to either represent yourself in a workers’ compensation dispute or hire an attorney, keep in mind that our workers’ comp attorneys are highly experienced regarding the laws and system here in Indiana. But many people are hesitant because they don’t know how workers’ comp attorneys charge.

Our workers’ compensation attorneys do not ask for money up front and get paid only if there is a recovery.

Our attorney fee is set by State law and is set at 20% of any recovery up to $50,000 and 15% of any portion over $50,000. If we have any expenses, such as hiring a medical expert or collecting copies of your medical records, we deduct these expenses from the recovery.

If there is no money recovered, there is no attorney fee owed.

When deciding whether or not you want to involve an attorney, keep in mind that Indiana workers’ compensation laws are written in a way which tends to favor the employer as opposed to the injured employee. A free legal consultation with an experienced attorney may help you better determine if legal representation is needed for your situation.

Our office, from speaking to injured workers, knows that workers are oftentimes intimidated by the prospect of contacting an attorney and/or hiring an attorney. Hopefully, this information will ease that transition.

Usted Tiene el Derecho Recibir Beneficios de Compensación

Si usted se lesiona en el trabajo en Indiana, usted tiene el derecho recibir beneficios de compensación. Por lo general, bajo nuestra ley en Indiana, los beneficios son:

 

  1. 100% de sus gastos médicos,
  2. 66 2/3% de su salario medio si no puedes trabajar y has perdido pago por más de 7 días, y
  3. Si su lesión es considerada permanente, usted tendrá derecho a un arreglo de dinero.

 

Si usted se lesionó en el trabajo, es posible que tenga el derecho de interponer una demanda por daños y perjuicios adicionales. Este seria el caso si el accidente fue culpa o negligencia de un individuo o empresa afuera de tu empleador. Estos casos se conocen como las reclamaciones de terceros o acciones de lesiones personales.

Por ejemplo, si experimentas lesiones en el sitio de trabajo y sus lesiones fue culpa de un empleado de otra empresa, podria presenter una demanda contra esa empresa para cobrar daños y perjuicios adicionales que la compensación de su empleador no paga. Un ejemplo de este tipo de caso sería alguien trabajando en construcción debajo de una subcontratista y ese empleado sufre lesiones por culpa de un empleado de otra subcontratista o porque el contractor general no aplicaba los reglas de seguridad.

Si usted tiene un caso similar al ejemplo referido arriba, por favor, considere uno de los abogados de Klezmer Maudlin. Nuestro asistente de abogado bilingüe, Janell, puede hablar con usted y remitir su mensaje a uno de nuestros abogados. Gracias.

You May Be Entitled to Workers’ Comp Benefits

If you are injured on the job in Indiana, you may be entitled to Indiana workers’ compensation benefits. Under our law in Indiana, these benefits pay you, generally, three items:

  1. 100% of your medical expenses without any payment by you,
  2. Lost wages at a rate of 66 2/3% of your average pay if you are unable to work for more than 7 days, and
  3. If your injury is considered permanent or long term, you will be entitled to a settlement.

If you were hurt at work, you may also have the right to pursue a claim for additional damages. This will be the case if your accident was due to the fault or negligence of another party. These cases are referred to as third party claims or personal injury actions. If you were injured on a job site, for example, and your injuries were due to the fault of an employee of another company, you could file a lawsuit against that company and collect additional damages that workers’ compensation does not pay.

A typical example of this type of case would be a construction worker who works for a sub-contractor and is injured either due to the fault of another sub-contractor’s employee or because various safety rules were not enforced by the general contractor and the failure to enforce the safety rule(s) caused your injury.

If you have such a claim, please consider one of the attorneys at Klezmer Maudlin at 317.569.9644.

Personal Experience With Unfair Treatment of Injured Workers

As an attorney, I see many cases where adjusters and employers are fair and try their best to follow the law. However, I see cases where adjusters and employers try to skirt the Indiana Workers’ Compensation Act laws at every turn.

The more I practice law, the more I feel like employers, in many cases, look for any reason to take advantage of injured workers.  Two recent examples really make me wonder about what rights injured workers may have.

In a recent case, my client, an employee of a nursing home, was injured at work and offered light duty which consisted of remaining at the nursing home for a period of 13 hours a day and working three separate work shifts with 2-3 hour breaks in between.  I truly feel that the employer designed this offer of light duty so that she would refuse it, then lose her job and not be paid workers’ compensation benefits.  The employer later modified this offer of light duty to include only 3 hours a day of work.  My client lives 25 minutes from this nursing home and to work 3 hours a day after taxes would put approximately $35 in her pocket a day.  I assume gas money would probably cost 1/3rd of that amount.

Another scenario I saw recently, and I see all the time, is an insurance adjuster or an employer ignoring treatment recommendations of doctors they select.  Under our Indiana Workers’ Compensation Act, an employer is allowed to select the physician, but is required to provide the treatment, medical services or supplies recommended by that physician.  An adjuster or an employer is not free to pick or choose what it will authorize or what it will not.

Worker’s Compensation and The Family and Medical Leave Act (FMLA)

 

The Family and Medical Leave Act (FMLA) is a federal law that gives qualifying employees an opportunity to take up to 12 weeks of unpaid time off from their job with a guarantee of their job still being available as long as they return at the end of this period. One of the purposes for this policy was to allow employees with serious health illnesses or injuries, such as an injury from a workplace accident, the time off they needed without the risk of losing their job.

Those interested in using FMLA should notify their employer 30 days prior to their intended date of leave. If it is not possible to give this much advance notice because of an emergency or urgent medical situation, then you should notify your employer as soon as possible.

One concern that many injured workers raise is whether  FMLA can run concurrently with their worker’s compensation benefits during the time that the worker is ordered off. The answer is YES, the employer can run FMLA during the period you are ordered off to heal from your work injury. Although this may seem unfair, using FMLA while off for a work injury can be a good thing if you are able to return within 12 weeks because you will be guaranteed your old job or something very similar.

How to Give a Recorded Statement in a Worker’s Compensation Case

It is not unusual for an insurance adjuster to ask the injured worker, or a witness, for permission to take a recorded statement. A request to take this kind of statement does not mean the claim will or will not be accepted.

workers compensation

 

If you do give a statement, questions asked may include topics like your job, how the accident occurred, if you had prior medical problems, and so forth. Here are some suggestions to follow if you give a recorded statement:

  1. Be honest and truthful. This statement may be used against you later on (if you are dishonest).
  2.  Do not guess. If you don’t know the answer, say that you don’t know or don’t recall. Otherwise, you will be held to your answer.
  3. You only have to answer the question. You do not have to give more information than asked for.

You do not have to agree to give a recorded statement in order to receive worker’s compensation benefits. The statement will likely be taken before any decision is made with regard to the injury claim. It is done as part of the insurance carrier’s investigation into the incident. If you have any questions or concerns regarding a recorded statement for a worker’s compensation case, you should consult a qualified worker’s compensation attorney.

Can an Employer use Surveillance Video Against You in an Indiana Worker’s Compensation Case?

Yes.

It is legal for an employer or their insurance carrier to use surveillance videos as part of their investigation.

And–if properly entered as evidence before a hearing– the video can be used against you if you were caught being dishonest. For example, if your employer has you on video tape hanging party decorations after claiming a shoulder and back injury, your employer may use this video evidence against your claim.

Is an injury resulting from horseplay at work covered under the Indiana Worker’s Compensation Act?

It depends.

If your employer is aware of and has gone along with this kind of activity in the past, then your injury may be considered in the course of the employment. Similarly, if you were horsing around but stopped so you could get back to work, and the other person kept messing with you leading to your injury, you may meet the standard.

In other words, if you were the innocent victim of another person’s horseplay, or if your employer allows the horseplay to proceed without intervening, the injury may be compensable. Otherwise, a worker injured while participating in horseplay is not entitled to worker’s compensation.