Workers’ Compensation Claims: Three things that can happen

Three (3) things can happen if you file a workers’ compensation claim. The insurance carrier may accept the claim and pay your medical bills and send you weekly checks, which are two-thirds of average weekly wage over the last fifty-two (52) weeks. The carrier may agree to pay only medical expenses, and only while the company is trying to determine if your injury is work-related. If they decide that it is NOT work-related injury, then they can stop paying for medical treatment. Finally, the carrier may deny your injury was work-related.

A claims adjuster will be assigned to your case to help ensure your weekly checks and medical bills are paid, as well as to arrange recommended medical care. However, a claims adjuster works for the insurance company and his or her goal is to get an injured worker back to work as quickly as possible while spending the least amount of money on medical treatment.

Adjusters are always on the lookout for ways to stop weekly checks. The law requires them to get a court order before checks can legally be stopped. Before a court order can be signed, adjusters or their lawyers must file a written application to terminate a worker’s benefits (Form 24). The most common grounds for stopping checks are non-compliance (such as failing to attend physical therapy, training classes, or doctor appointments) and refusal to return to work when offered a job position.

An injured worker is given seventeen (17) days to respond to the Form 24. If the Form 24 was filed for non-compliance, the defendants must prove that the employee had not been compliant, and the employee must then prove that that he or she has complied, or has a good reason for not complying.

If the Form 24 was filed as a result of an employee refusing to return to work to a job the employer has deemed to be suitable position, the injured worker must prove that the job was unsuitable. Form 24 hearings are held by telephone conference.

This information is only a generalization and should not be construed to be legal advice. Every workers’ compensation case has different facts that must be evaluated by an experienced workers’ compensation attorney.