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Question about Attorney Fees?
I have been receiving a weekly check from workers comp for over a year now. I am permanently disabled and they are asking me if I would like to settle. First, what are attorney fees in Massachusetts for this and if I don’t settle how long will I continue to collect a weekly check? Is a settlement favorable to the insurance company or me?
Reply:
First, if you are permanently disabled, you should also consider applying for Social Security Disability Income benefits.
Generally, you cannot receive benefits for permanently disability under Massachusetts Workers’ Compensation law until you have been out of work and collecting temporary total disability benefits for 3 years. Then, if you qualify, the rate of payments increases from 60 % to 66 2/3 %.
A lump sum settlement generally does not occur as early as one year from the injury, unless everyone agrees that you will not work for a considerable time in the future and the settlement amount itself is quite substantial. All settlements have to be approved by an administrative judge or administrative law judge at the Department of Industrial Accidents as being in your best interest, NOT the insurance companies’ best interest.
Attorney’s fees are generally 20% of the settlement amount. Under certain circumstances (which may not apply here) the Attorney’s fee can be 15%.
It is good practice to consult with an attorney before accepting a lump sum settlement if your injuries are serious, as they may well impact your future livelihood.
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Question: I was burned at work. Should I contact a lawyer?
I was seriously burned on my foot at work with boiling water. I’ve missed 15 days of work. Although I’m getting paid for the time I’ve missed, nobody from workers’ comp has contacted me. My physician says my foot will be scarred. Should I contact a lawyer about scarring or will the insurance co. contact me?
Reply:
Unfortunately, you can only be compensated for scarring (a common type of disfigurement) if it on the hands, face or neck areas under Massachusetts Workers’ Compensation law.
However if you have a limp (a less frequent kind of disfigurement) as a result or if there is loss of sensation (a type of loss of foot function) the insurance company may owe you more money. This is true whether or not you are currently working or disabled, unless you have already settled your case.
It is good to check with your doctor about these issues first. A good rule of thumb is to ask your doctor about one year after the accident.
Don’t expect the insurance company to contact you! A lawyer can advise you concerning your specific rights.
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Question: what do you do when the Insurer does not abide by the Judge’s Order:
I was injured on 04/25/00,while working. Since this time I have had to battle the company that represents my employer for any and all Workers Compensation claims. I now suffer from Reflex Sympathetic Dystrophy.
On February 18,2002, my Attorney presented my claim to an Administrative Judge. On February 19,2002, my Attorney received the order of payment. This states that the insurer was ordered to pay my medical treatment, including payment for outstanding prescriptions, mileage reimbursement and continued pain management.
As of this date the Insurer has not abided by this judgment, nor have they filed an appeal. I was told by my Attorney that there is nothing I can do. The insurer has now offered to settle. My Attorney advises me to accept this offer. I am confused as to why a Judge’s order does not need to be enforced. Do I have other options?
Reply:
Yes you do!
While the administrative judge cannot enforce his own order, a justice in the Superior Court can enforce the administrative judge’s order. If the administrative judge’s order was not complied with, even in part, your attorney could file for enforcement of the order requiring payment of your disability benefits and / or medical treatment.
You should discuss this option with your lawyer as the wait for a hearing to begin can be a lengthy one and the time needed for the administrative judge to file his or her decision can be months after the hearing ends.
You do have options and of course it is best to have access to the medical treatment ordered for pain management and RSD while the hearing process moves along at its own pace.
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Question: who pays workers compensation benefits?
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Reply:
In most states, employers are required to purchase insurance for their employees from a workers’ compensation insurance company — also called an insurance carrier.
However, in some states, smaller companies (with fewer than three or four employees) are not required to carry workers compensation insurance. In some states, larger employers who are clearly solvent are allowed to self-insure, or act as their own insurance companies.When a worker is injured, his or her claim is filed with the insurance company — or self-insuring employer — who pays medical and disability benefits according to a state-approved formula.
Copyright 2005 Nolo
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Question: does my health insurance coverage or paid sick leave from work limit my compensation for an accident?
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| Whether you paid for medical care out of your own pocket or your health insurance covered it is none of a claims adjuster’s business. The same goes for whether your lost time at work was covered by sick leave or vacation pay. In fact, it is improper for an adjuster even to ask about such payments. You paid for your health insurance and earned your sick leave or vacation pay; now the insurance for the person who caused the accident has to pay.Your own health insurance, however, may require that, out of your settlement, you reimburse it for some or all of the amounts it has paid to treat your injuries.
Copyright 2005 Nolo
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| Question: if all on-the-job injuries are covered by workers compensation? |
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Most are. The workers compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer’s or employee’s carelessness. But there are some limits. Generally, injuries that happen because an employee is intoxicated or using illegal drugs are not covered by workers compensation. Coverage may also be denied in situations involving:
- self-inflicted injuries (including those caused by a person who starts a fight)
- injuries suffered while a worker was committing a serious crime
- injuries suffered while an employee was not on the job, and
- injuries suffered when an employee’s conduct violated company policy.
Copyright 2005 Nolo
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| Question: if workers compensation cover only injuries, or does it also cover long-term problems and illnesses? |
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Your injury need not be caused by an accident — such as a fall from a ladder — to be covered by workers’ compensation. Many workers, for example, receive compensation for repetitive stress injuries, including carpal tunnel syndrome and back problems, that are caused by overuse or misuse over a long period of time. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions — for example, heart conditions, lung disease and stress-related digestive problems.
| Are You Covered by Workers Compensation? |
Most workers are eligible for workers compensation coverage, but every state excludes some workers. Exclusions often include:
- business owners
- independent contractors
- casual workers
- domestic employees in private homes
- farm workers
- maritime workers
- railroad employees, and
- unpaid volunteers.
Check the workers’ compensation law of your state to see whether these exclusions affect you.
Federal government employees are also excluded from state workers’ compensation coverage, but they receive workers’ compensation benefits under a separate federal law.
In addition, about one-third of the states do not require workers’ compensation coverage of employers having fewer than a designated number of employees — three to five, depending on the state. So, if you work for one of these employers, you may be excluded from the state program.
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Copyright 2005 Nolo
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| Question: if I can be treated by my own doctor and, if not, can I trust a doctor provided by my employer? |
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| In some states, you have a right to see your own doctor if you make this request in writing before the injury occurs. More typically, however, injured workers are referred to a doctor recruited and paid for by their employers.Your doctor’s report will have a big impact upon the benefits you receive. While it’s crucial that you tell the doctor the truth about both your injury and your medical history (your benefits may be denied based on fraud if you don’t), be sure to clearly identify all possible job-related medical problems and sources of pain. In short, this is no time to downplay or gloss over the presence of a pain.
Keep in mind that a doctor paid for by your employer’s insurance company is not your friend. The desire to get future business may motivate a doctor to minimize the seriousness of your injury or to identify it as a pre-existing condition. For example, if you injure your back and the doctor asks you if you have ever had back problems before, it would be unwise to treat the doctor to a 20-year history of every time you suffered a minor pain or ache. Just say “no” unless you really have suffered a significant previous injury or chronic condition.
Copyright 2005 Nolo
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| Question: if I am initially treated by an insurance company doctor, do I have a right to see my own doctor at some point? |
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| State workers’ compensation systems establish technical and often tricky rules in this area. Often, you have the right to ask for another doctor at the insurance company’s expense if you clearly state you don’t like the one the insurance company provides, although there is sometimes a waiting period before you can get a second doctor. Also, if your injury is serious, you usually have the right to a second opinion. And in some states, after you are treated by an insurance company’s doctor for a certain period (90 days is typical), you may have the automatic right to transfer your treatment to your own doctor or health plan with the cost being paid for by the workers’ comp insurance company. Because the insurance company is footing the bill, don’t hesitate to go to a doctor who specializes in your injury or illness — even if the cost is great.To understand your rights, get a copy of your state’s rules or, if necessary, research your state workers’ compensation laws and regulations in the law library.
Copyright 2005 Nolo
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