If you have been injured on the job, Workers’ Compensation can be a confusing process. Each employee is different and each injury is unique. Workers’ Compensation is not a straight-forward process and, depending on your injury, you may need someone to guide you through it.
The skilled attorneys at Shankman & Associates will stand by you every step of the way and will only be paid if and when your claim is successful.
WHAT IS WORKERS’ COMPENSATION?
Workers’ Compensation is an employee’s “sole remedy” against his or her employer for work-related injuries. This means that an employee cannot sue his or her employer in court. The rationale for choosing this process is efficiency. Generally, injured employees need immediate medical treatment and money to pay their bills. If employees were required to file suit in court, no compensation would be made until the case was settled or won. This can take months, even years. As a result, an injured employee could face multiple consequences including, but not limited to, remaining injured, sustaining more injuries, further complicating the current injury or even losing their home.
Workers’ Compensation is facilitated by the Maine Workers’ Compensation Board. It is not a court of law but its functions are similar. Rather, it is the program that has been created to enable employees to be compensated for work-place injuries on a theoretically expedited basis.
The employer must report the injury to the Board. From there, the Board, similar to a court, will accept correspondence and pleadings from both parties and make any final decisions. For example, the insurer is responsible for reporting what it has paid on the employer’s behalf. If benefits are modified or terminated by the employer, an employee must file a petition to restore benefits.
WHAT DOES WORKERS’ COMPENSATION PAY?
It is a common misconception that benefits are paid by the Workers’ Compensation Board. In fact, it is the employer’s insurance carrier who is paying. This insurance will pay for any damages as a result of the work-related injury. Damages include lost wages and medical bills.
Lost wages are calculated based on your average weekly income. The insurer will calculate this figure and file it with the Board. An employee is entitled to 66% of his or her average weekly income. However, there may be issues with this amount. While this calculation should be relatively straightforward and objective, issues may arise when employers try to play games by including “short weeks.” Keep in mind that the insurer has the right to discontinue or reduce your lost wages benefits if you show that you are able to work or you return to work. You have the right to challenge these conclusions.
Medical bills are fully covered for all reasonable and necessary treatment sought as a result of a work-related injury. These types of damages may not be so clear if you have had a prior injury or suffer a subsequent injury to the same body part. The insurer has the right to dispute any and all medical treatments. The folks at the insurance companies are not your friends. Their sole purpose is to get you returned to work, pay as little as possible, minimize claims of permanent impairment and enable corporate profits to grow.
WHAT DO I DO IF THE INSURER STOPS PAYING?
The insurer must file a Notice of Controversy to discontinue benefits. They must include the reason why they are discontinuing your benefits. At this point, you are entitled to mediation and a hearing before a Hearing Officer.
WHAT IF I WANT TO SETTLE?
The Board allows employees to settle a workers’ compensation claim if the injury is at least six months old and it is in the best interest of the employee. It is called a Lump Sum Settlement.
Negotiations will take place between the employee and the insurer. Hopefully, the parties will agree on a settlement amount. The number will represent what the injury is “worth.” Many factors are used to arrive at this number, including but not limited to, age, severity of injury, whether there is a partial or permanent impairment, whether there was a loss of a limb, and life expectancy of the employee.
HOW DO I PAY MY LAWYER?
Your attorney only gets paid if you receive benefits or settle your claim. Your attorney’s fees are capped at 30% of workers’ compensation benefits you have received. These benefits include past due benefits, benefits paid voluntarily by the insurer and with the help of an attorney, and unpaid medical bills.
In a Lump Sum Settlement, attorneys must follow a strict fee schedule. Your attorney will be paid 10% of the first $50,000.00. Thereafter, your attorney will be compensated a percentage for each additional $10,000.00.