Workers’ compensation is a “no-fault” system.
Employees injured on the job don’t need to prove an employer was negligent, and an employee can make a claim even if he or she was negligent when the injury occurred.
You can file a claim if your injury is work-related and occurred during your employment and regular job duties.
Those facts should make the workers’ compensation process easy, but frequently it’s not.
If you’re not aware of the pitfalls in the system, your injuries can be financial as well as physical.
Here are five things to know when you’ve been injured at work:
• Always make sure your employer turns in the claim.
Some employers try to dodge a workers’ compensation claim by simply ignoring the employee’s report of injury. Avoidance tactics can include sending a worker to his or her own doctor and hoping the employer won’t get charged with medical costs that are supposed to be covered by workers’ compensation benefits.
Usually the worker doesn’t know any better and gets stuck with copays and deductibles and risks being fired if their own doctor takes them off work for the work comp injury.
• The insurance company is not your friend.
Most employers have workers’ compensation insurance; it is the insurance company and its adjusters who handle your claim. Bottom line — insurance companies are for-profit entities.
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Regardless of how nice or concerned the insurance company’s representatives may seem, their goal is to get you back to work as quickly, quietly and cheaply as possible. They are not paid to get you all the benefits you’re entitled to under the law.
• Make the insurance company show their math.
When a worker is taken off work to recover from an injury, the insurance carrier is supposed to review a worker’s earnings’ history and follow a specific formula to determine what the carrier should pay the worker while the worker is trying to heal.
Frequently, the insurance carrier includes improper calculations, even counting past earnings from a time period the employee worked less than the standard 40-hour week in a ploy to drive down the benefits they pay. This is contrary to law.
You should demand they show you the “Statement of Earnings” they used, per Iowa Code Chapter 85.40.
• If you receive a check at the end of your treatment, don’t assume it’s over.
A common tactic by insurance companies to avoid further liability is to send claimants a brief letter and a check (usually around $5,000 to $15,000) to “close the case.” Often this check just covers what the insurance company’s own doctor estimates is required to cover “permanent partial impairment” to your body.
What they don’t tell you is that you have a right for your own doctor to provide a potentially higher rating at the insurance company’s cost.
They also don’t mention that if your injury qualifies as a “body as a whole injury” (head, neck, some shoulders, back or hip), the amount they are sending is likely the tip of the iceberg for what they owe — especially if you’re not back to work full-time, with the same position and responsibilities you had before you were injured.
• You don’t need money to get a lawyer.
Lawyers who handle workers’ compensation cases in Iowa use a contingency fee.
This means the injured worker never owes the lawyer money unless the lawyer accomplishes the goal of the representation: winning a settlement or convincing a judge to side with the worker and order the other side to pay unpaid benefits.
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Never be fooled by an insurance representative who suggests getting an attorney will be expensive to you. For every extra dollar gained from the lawyer’s help, the worker typically keeps two-thirds.
Darin Luneckas, of Luneckas Law P.C., is a Cedar Rapids lawyer who focuses on workers’ compensation and personal injury cases.