You should have received an initial Award of Compensation from the Workers’ Compensation Commission. I receive a copy, and one is supposed to go to you in the mail. If you do not have it yet, it is coming soon.
Congratulations! This means that the insurer will not be contesting your claim. It means you do have a valid workers’ compensation claim and you are entitled to all the benefits we discussed at our first meeting.
The order sets your average weekly wage and orders the insurance company to pay you a set amount of money per week (two-thirds of your average weekly wage) IF you are still off work as a result of your injury. It also says you are entitled to medical care.
I think these Orders are confusing, and look better than they really are. So I created this post to explain them, and to reiterate some very important instructions that will apply to the remainder of your workers’ compensation case. Read it over carefully. It is a little long, but everything in here is very important. Call my office if you have any questions.
Very important! If your doctor has ordered you to remain off work, please be sure to provide my office with disability slips so we can make sure the insurance company pays you. They will not pay you without a disability slip. You have to get this from your doctor directly. This is always true during your comp claim and you need to be sure to always get a disability slip from the doctor when you see him or her (if, of course, you are still disabled).
Sometimes have to get the actual medical records the doctor dictated before they will pay you. If they ask for that, I may send you to get them. It usually takes me 30 days minimum to get your medical records. This is due to the well intentioned, but poorly implemented, HIPPA laws safeguarding the privacy of your medical records. HIPPA makes my office and the doctor’s office jump through hoops. You can often walk right in the office and get them handed to you, because they are your records and you have that right. Obviously, if we have a quick need for records, it is smartest to enlist your help in obtaining them. I may have to do that.
Average Weekly Wage
The order you received shows the average weekly wage we claimed for you on the claim form. It may not be 100% accurate. Often, I have to guesstimate your average weekly wage when I file your claim. I do this to make sure we never underestimate it.
The insurance company must pay you according to your actual average weekly wage. If the average weekly wage we claimed is higher than your actual average weekly wage, the insurer must send a wage statement showing how they calculate it differently. If you receive benefits that are less than what this order says you should receive, please let us know. If the insurance company claims you should receive less, they must back that up with documentation. If they send documentation to me, I will send you a copy with a letter asking you to make sure it is correct.
Details, Details, Details . . .
Please note this Order is automatically issued when the insurer fails to challenge your claim. All the details in it are subject to revision after a real hearing. If we have a dispute, this Order does not force them to pay before the dispute is settled. They can still fight out any dispute at a hearing.
If they are not paying you, or not paying you the right amount, it could be that we have a dispute over your case, your entitlement to specific medical care, or payment, or your correct average weekly wage. It may be that WE have to file for a hearing. If so, we will be doing that shortly. You can call my office to ask about the status if you are unsure.
What You Should Do Now
- Keep Treating: For now, your responsibilities are to continue treating with your doctor until you reach maximum medical improvement. When your doctor releases you from his or her care, or says that you have reached maximum medical improvement, then we can move towards obtaining your permanent disability benefits.
- Pray For Smooth Sailing: Hopefully, your case will be smooth sailing. Keep your fingers crossed – but don’t hold your breath! Very few workers’ compensation claims proceed smoothly without some sort of fight we have to make with the insurance company. That is just the way the system works. It isn’t fair. But it is reality.
- Tell Us About Any Problems: Sometimes I may not even know about a problem until you tell me. If they cut off your check, or deny medical care requested by your doctor, nobody tells me! I also think that is incredibly unfair, and it is one of many things I would change about workers’ compensation law if I were a politician. But the reality is that sometimes I have to rely on YOU to tell me when something goes wrong. You will know when your check doesn’t come, or when the doctor’s request for medical care is turned down. When that happens, I need you to call my paralegal and report it. Then we can take care it.
- Keep Us Updated: This is an important and sometimes overlooked job I need you to do. You should be sure to keep me updated of any change in your medical status. This includes seeing new doctors, any surgical procedures you undergo, etc. The doctors do NOT tell me when you see them, and do NOT automatically send me records. I have to request them directly from each medical provider you see. So obviously, we have to know who to request them from.
Also keep in mind one very important deadline in your case. You must apply for new benefits within 5 years of the date of accident or the date on which you received your last payment from the insurer. That means we must file for permanent partial disability benefits within 5 years of the later of those two dates. I know that sounds like a long time, but it can creep up faster than you think. Please keep this in mind as we go forward.
Congratulations on successfully completing step one of your workers’ compensation case! Please feel free to call me or e-mail me if you have any questions or concerns.
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