Workers’ Comp Lawyer in Nashville
Here is a common situation that happens far too often: an employee suffers an injury during the course of employment that requires the employee to seek medical attention or keeps the employee out of work for a period of time, or both. As a result of the workplace injury, the employee is required to seek medical attention and may have to spend a significant amount in medical costs. What is more, the injured employee may not be able to return to work while recovering from the injury. This time off from work may result in a significant loss of wages that are necessary to support the worker and the worker’s family.
How does the employee pay for the medical expenses that may result from a work-related accident? What is more, how does the employee support one’s family if the employee has to take time off
from work and will not be paid? Fortunately, Tennessee (and other states throughout the United States) has a law that requires certain employers to obtain insurance for their employees in the event that they suffer work-related injuries. This is known as workers’ compensation insurance benefits. These benefits may cover medical expenses and loss of wages that result from having to take time off work to recover from an injury.
Under Tennessee’s Workers Compensation Reform Act, Tennessee companies that employ five or more full- or part-time employees are required to obtain insurance for their employees. What is more, employers in the construction business or trades or coal-mining industry must obtain insurance even if there is only one employee. If the employer does not obtain insurance when it is required to obtain insurance for its employees then the employer is potentially subject to significant monetary fines. Employers subject to the Workers’ Compensation Reform Act are required to display the Tennessee Workers’ Compensation Insurance Notice for employees. This notice must be conspicuously posted at the business so the employees can easily view the notice. The notice informs employees if the employer is subject to the state’s workers’ compensation law and alerts the employees what they should do in the case of an injury at work.
Work-Related Statistics and Injuries
Every year in Tennessee, thousands of work-related injuries occur across a variety of businesses, including health care, manufacturing, government, transportation and warehousing, construction and private industry. According to the United States Department of Labor, Bureau of Labor Statistics, in 2013, the incidence rate of work-related injuries in Tennessee was 3.4 injuries and illnesses per 100 equivalent full-time workers. Not surprisingly, the manufacturing and health industries had high incidence rates of injuries and illnesses with 4.1 and 4.6, respectively. Workers between the ages of 45 and 54 experienced 27.3 percent of all nonfatal occupational injuries and illnesses resulting in days away from work in Tennessee during 2013. The next largest group was workers between the ages of 35 and 44 who accounted for 21.7 percent.
As a result of work-related injuries occurring across all different business sectors, the causes of work-related injuries are also varied. One of the most common causes of work-related accidents is overexertion. Overexertion often involves lifting, pushing, pulling, holding, carrying, or throwing. Common examples of other causes of work-related injuries include falling from equipment, vehicle accidents, slipping or tripping, struck by equipment, repetitive motions, or machine or equipment malfunction.
The most common work-related injuries are sprains, strains, and tears. In 2013, sprains, strains, and tears accounted for 39.8 percent of nonfatal occupational injuries and illnesses involving days away from work, followed by other injuries and illness at 16 percent, soreness and pain at 12.1 percent, bruises and contusions at 10 percent, fractures at 8 percent, cuts, lacerations and punctures at 7.2 percent, multiple traumatic injuries at 3.7 percent, burns at 8 percent, carpal tunnel syndrome at .7 percent, tendonitis at .3 percent, and chemical burns and corrosions at .1 percent. When a worker suffers an injury at work, the consequences can be severe. The employee may need significant medical treatment and may need to be away from work for a long period of time. As such, workers’ compensation is an effective tool to help injured workers manage the costs associated with the work-related injury or illness.
In order to be entitled to receive workers’ compensation insurance benefits, the employee must suffer a work-related injury. Under Tennessee law, an “injury” means “an injury by accident, a mental injury, occupational disease including diseases of the heart, lung and hypertension, or cumulative trauma conditions including hearing loss, carpal tunnel syndrome or any other repetitive motion conditions, arising primarily out of and in the course and scope of employment, that causes death, disablement or the need for medical treatment of the employee.”
It is important that the injury occur during the course of employment. If it does not then the employee will not be entitled to receive workers’ compensation insurance. This does not necessarily mean, however, that a pre-existing injury will preclude an employee from receiving workers’ compensation insurance benefits. As long as the employee can show that the work-related accident advanced the severity of the pre-existing condition then the employee may still be entitled to insurance benefits.
Medical, Wage Replacement and Death Benefits
Employees who suffer a compensable work-related injury may be entitled to receive workers’ compensation benefits. The are two main forms of workers’ compensation benefits: medical care and wage replacement benefits. These benefits are meant to help employees handle the monetary costs associated with suffering an injury at work. Work-related accidents can cause serious injuries, which can result in significant medical costs. Fortunately, workers’ compensation insurance benefits will cover the costs of these medical expenses. What is more, these benefits may also cover a portion of an employee’s wages while the employee is away from work to recover for injuries.
To receive compensation for medical benefits, the medical expenses must be authorized by the employee’s treating physician. The physician may authorize compensation for a variety of different medical expenses, including medical/surgical treatment and supplies, medicine, crutches, nursing or psychological services. The injured employee is entitled to have these benefits paid for by workers’ compensation insurance as long as they are authorized by the treating physician. Under Tennessee’s Workers’ Compensation Reform Act, there is a Medical Fee Schedule that sets forth the value of the medical services, equipment or supplies. The Medical Fee Schedule does not set predetermined values for the compensation of the medical services, equipment, or supplies. Rather, it sets a maximum amount that can be paid.
Temporary and Permanent Disability Benefits
In addition to covering medical expenses, workers’ compensation insurance also provides wage replacement benefits for injured employees. There are two types of wage replacement benefits: temporary disability benefits and permanent disability benefits. Under temporary disability benefits, these benefits are further broken down into temporary total disability benefits and temporary partial disability. Temporary total disability benefits apply when the treating physician authorizes the worker to take off work. These benefits are payable starting on the eighth day of the disability. If, however, the disability lasts longer than 14 days then the benefits will be paid starting on the first day of the disability. Temporary total disability benefits are paid at the rate of 66 ⅔ percent of the employee’s average weekly wages. The employee’s average weekly wages are determined by looking at the employee’s gross earnings for the prior 52 weeks, including overtime and bonuses.
An employee may receive temporary partial disability benefits if the employee is placed on light duty by the treating physician or restricted in the number of work hours. Similar to temporary total disability benefits, temporary partial disability benefits are paid at the rate of 66 ⅔ percent of the difference between the gross light duty wages and the employee’s average weekly wage. Temporary partial disability benefits stop when the physician allows the employee to return to work without restrictions, when the employee refuses to submit to a medical examination or comply with treatment, or when the physician determines that the employee has reached maximum medical improvement and the injury has not been contested. Temporary total and partial disability benefits are both subject to maximum and minimum amounts.
While temporary disability benefits help compensate the injured employee for lost wages while recovering, permanent disability benefits help compensate an employee for injuries that are permanent or if the employee is unable to return to work. Depending on the situation, an injured employee may be entitled to permanent partial or total disability benefits. Permanent partial disability benefits compensate an employee if a work-related injury prevents the employee from returning to a job in the open market. On the other hand, permanent total disability benefits apply if the injured worker is unable to return to any job in the open market because of the work-related injury. These permanent benefits are paid at the rate of 66 ⅔ percent of the employee’s average weekly wages. Importantly, permanent partial disability benefits are payable to the employee until the employee is eligible for retirement under social security law.
In situations where the employee dies from a work-related injury or illness, the employee’s surviving dependents may be entitled to death benefits. As with medical and wage replacement benefits, death benefits are also paid by the employer’s insurance company or the employer, if it chooses to be self-insured. The Tennessee Bureau of Workers’ Compensation is not responsible for paying these benefits.
The deceased employee is entitled to burial expenses, which are not to exceed $7,500. What is more, Tennessee workers’ compensation law provides that $20,000 will be paid to the deceased’s estate if the deceased employee does not have any dependents. In situations where the employee leaves dependents, the apportionment of the benefits depends on how many dependents there are and the category of dependent, such as spouse or child.
For example, if the deceased employee has only a surviving spouse as a dependent then the surviving spouse will be entitled to receive 50 percent of the employee’s average weekly wages. This amount is subject to the maximum weekly benefit of 400 weeks. If, however, the deceased employee leaves behind a surviving spouse and one or more dependent children then the surviving dependents will be entitled to 66 ⅔ percent of the employee’s average weekly wages. The compensation is paid to the spouse for the benefit of the surviving spouse and the child or children. The court, however, has authority to determine in its discretion what portion of the compensation will be applied for the benefit of any child or children, and may order the compensation paid to a guardian. Other dependents may also be entitled to benefits include parent, grandparent, brother, sister, mother-in-law, father-in-law, and dependent orphan.
Reporting Injury and Obtaining Compensation
When an employee suffers a work-related injury or illness, the employee must act promptly in order to protect one’s rights. Immediately after suffering a work-related injury or illness, the employee needs to report the injury to the employer by contacting the employee’s supervisor or manager. Employees typically have 30 days from the date of work-related injury or illness to report the injury to the employer. The employee should give notice to the employer in writing so that there is evidence that the employee provided notice to the employer. Notably, the employer cannot terminate or otherwise penalize an employee for reporting a work-related injury or illness. If the employer does terminate the employee then the employee may have a claim for wrongful termination.
After the employer receives notice of the work-related injury or illness, the employer must complete Tennessee Employer’s First Report of Work Injury or Illness (Form C-20). The form must completed and filed with the employer’s insurance adjuster as soon as the employer has knowledge of the injury. Even if the employer does not believe that the injury occurred during the course of employment, the employer is still required to report the injury to its insurance adjuster. If the employer chooses to be self-insured then the injury must be reported to its Third Party Administrator or internal claims handling program.
If the work-related injury or illness is serious then the employee should seek immediate medical attention at a nearby hospital emergency room. In non-emergency situations, the employer is required to provide the employee with a list of approved physicians who are willing and able to provide workers’ compensation insurance treatment. The employer is required to provide this information on An Agreement Between Employer/Employee Choice of Physician (Form C-42). The employee will then select a physician from the list, and the physician will be responsible for treating the employee and providing a recommended course of treatment. It is important that the employee follow the physician’s recommendations. Failure to follow the physician’s recommendations may prevent the employee from receiving workers’ compensation insurance benefits.
Once an employee is entitled to receive workers’ compensation insurance benefits, compensation will paid by the employer or the employer’s workers’ compensation insurer. The Tennessee Department of Labor and Workforce Development does not provide workers’ compensation benefits to injured employees. Sometimes dispute arise between the injured employee and the employer or insurance adjuster concerning the payment of workers’ compensation insurance benefits. In these situations, the Tennessee Department of Labor and Workforce Development has a Benefit Review Program set up to help resolve these disputes. The Benefit Review Program is a three-stage process that helps resolve disputes between injured employees and an insurance adjuster or employer in a workers’ compensation claim. The first stage is mediation, which helps the parties avoid having to proceed through a lengthy and expensive court proceeding. If mediation is unsuccessful then a division of the Tennessee Department of Labor and Workforce Development will issue a decision. Finally, the third stage is settlement, which allows the employee and the employer and insurance adjuster to resolve the dispute out of court.