Workers'
Compensation BrochureMethod 6:
Seasonal Employees
A seasonal employee’s
AWW is calculated by adding employee’s total
earnings for a period of one year pre-injury and
dividing by 50. Unless by reason of “exceptional
causes,” the computation does not “ascertain fairly”
the earnings of an employee, the calculation can be
“extended” to give a basis for “fair ascertainment”
of a seasonable employee’s AWW.
Fringe benefits, including retirement,
pension, health insurance, life insurance, Social Security, or any other
plan of benefit to employees or their dependents are not included in the
computation of a worker’s AWW.
Death Benefits
Workers’ compensation covers funeral
expenses up to $1,500. The law also covers dependents who lost
loved-ones to a work related injury, disease or illness. A dependent is
someone who relies on the worker’s income for support. Dependents
include a spouse, parent(s) or children.
Medical Benefits
Workers’ Compensation covers all
necessary costs associated with medical care and treatment of your
injury, illness or disease, even if you have lost no time from work. The
amount paid by an insurance carrier for medical care and treatment is
equal to 113 percent of the amount the health-care provider would
receive from Medicare for the same service. The health-care provider may
not bill you for the difference of the total bill for services rendered
and the amount paid by the insurance carrier. If your injury causes you
to receive life-long treatment, you may continue collecting payments for
your medical bills from the insurance carrier.
Giving Notice: The “ASAP” Rule
The sign in the employees’ washroom in
the machine shop read: “If you are injured at work, tell your supervisor
as soon as possible.”
The sign in the cafeteria read: “If you
are injured at work, tell your supervisor as soon as possible.”
Get the message?
Do not play games with your illness,
injury or disease. Do not keep the pain to yourself.
Typically, an injured worker will
complete the shift and go home thinking that the pain will subside. Some
workers return home injured because they either do not want to bother
with the dispensary, or think that the injury is not serious. Such a
person may not be able to get out of bed the next day.
The phrase “as soon as possible” applies
here and is of extreme importance.
An employer is likely to fight a workers’
compensation claim if an employee did not “give notice in a timely
fashion.” Translation: “ASAP.”
The law says that you have 120 days to
tell your employer about your work related injury, illness or disease.
The first day starts with the day of injury, or the day you discovered
the illness or disease.
If you notify your employer within the
first 21 days of the injury date, benefits are payable retroactive to
the injury day. Within 21 and 120 days, benefits start the day you give
notice.
Once again, for the sake of sounding
redundant, it is important to give notice “as soon as possible.”
Insurance companies, in order to provide
your employer with an affordable rate, are checking continuously for
fraudulent claims. Fraud drives up the workers’ compensation premium.
Claims filed days, weeks or months after an injury occurs are more
likely to be investigated, challenged and/or denied.
Communicate With Your Doctor
Do not hesitate to speak with your doctor
about work and the hazards exposed to you day-to-day. If you suspect
that work caused your injury or illness, you have to tell your employer.
“Giving notice” to the employer means informing him or her about the
work-related illness, injury or disease.
This is where your doctor comes into the
picture. He or she is the one person who has the authority to say
whether or not you can safely return to work after being injured.
It’s important to be pro-active with your
health. The average physician does not have time to ask you question
after question in order to obtain a medical history. More often than
not, the doctor says hello, where does it hurt and leaves the rest of
the conversation up to you. Doctors are not mind readers; they can only
work with what you tell them. If something is wrong and you suspect that
it is job related, tell your doctor. Inform him or her about the work
place and the hazards you suspect are causing the pain or sickness.
When Will You Receive Benefits?
Unless you are denied compensation,
benefits should start arriving within 21 days of the time your employer
received notice of the injury. If within this time you are denied,
contact an attorney immediately and file a claim
You Are Entitled To Have The
Compensation Check Mailed To Your Home
That’s the law. No one should tell you
that “checks must be picked up at the office.” Contact a lawyer or a
union official if your employer tells you something other than what is
in the law.
Choice Of Doctor
For the first 90 days of medical care,
the law requires you to select from a list of doctors chosen by your
employer. The law says that there must be at least six doctors for you
to choose from. Your employer cannot (and should not) make the choice
for you. You are free to choose your own doctor if your employer does
not have a list available. You are free to select another doctor on the
list if the first choice was unsatisfactory. The list usually appears on
letterhead from the workers’ compensation insurance carrier. The sheet
should explain your rights and obligations under the law.
Should your work-related injury, illness
or disease require treatment beyond 90 days, you then have the option of
choosing your own doctor. Should your choice stray from the employer’s
list after the 90 day period, you must tell your employer within five
days after your first visit. During treatment, the employer or
employer’s insurance company is entitled to receive monthly reports from
your physician or provider.
The word “doctor” in this legal sense,
means any licensed practitioner of medicine, or what is called the
“healing arts.” A doctor includes chiropractors, medical (MD) and
osteopathic (DO) doctors. During the initial 90 day period, the company
doctor may certify you to return to work. If this happens, seek a second
opinion from your doctor. Please note, if this occurs during the first
90 days you will have to pay for the visit to your doctor. You do not
have to return to work regardless of what your employer may suggest (or
demand) if your doctor does not permit you to return to work. After 90
days has lapsed, you may continue treatment with your doctor and have
his services paid for by worker’s compensation insurance. If you have
questions concerning this matter, consult a lawyer as soon as possible.
Workers’ Compensation Benefits Versus
Group Benefits
Sometimes an employer or injured worker
may confuse workers’ compensation and group benefits. There should be no
confusion. The two benefits are distinctly different.
Group benefits are disability payments
received for a non-work-related injury.
Termed “sickness and accident (S & A)
benefits,” the group provision is no substitute for workers’
compensation, which covers an on-the-job injury. If you become injured
at work, you should apply for workers’ compensation.
There are other reasons why workers’
compensation benefits are better than group benefits:
1. Taxes - Unlike group benefits,
workers’ compensation payments are not subject to taxes. Withholding
taxes are deducted from group benefits.
2. More Money - Workers’
compensation pays better benefits. Under workers’ compensation
insurance, you receive two-thirds of your gross pay or $779 per week,
whichever is lower. Group benefits are usually less than $150 per week.
3. Longevity - Workers’
compensation covers the total disability with payments for as long as
you need it. Depending on the injury, the payments can last for the rest
of your life. Generally, group benefits last for up to 26 weeks -usually
less.
4. Pay Scale Adjustment - A person
injured, who goes on workers’ compensation and works certain tasks
because of his or her injury, will not suffer a substantial pay loss.
Workers’ compensation pays two-thirds of your pay loss if you return to
work at a lower-rate, limited- duty job because of your injuries. Group
benefits do not pay this adjustment.
5. Medical Coverage - Workers’
compensation pays all of your work related medical bills. Under a group
benefits plan, your coverage may be limited depending upon the insurance
carrier your employer selects.
In some cases, employers may deny you
workers’ compensation benefits. Should this happen, apply for group
benefits. Once you start receiving payments, contact an attorney and
file for workers’ compensation.
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