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Workers’ compensation is a no-fault insurance system established by the Utah Legislature in 1917. This system is intended to pay medical expenses and to help offset lost wages for employees with work-related injuries or illnesses. The rules and procedures involved in workers’ compensation coverage and benefits are complex and must be strictly followed to prevent interruption of or total denial of workers’ compensation benefits. For most injured workers, it is beneficial to hire an experienced workers’ compensation attorney if their workers compensation claim has been denied or if benefits were being paid but have been terminated.
Are all employees required to have workers’ compensation coverage?
Almost all employers must have workers’ compensation coverage. There are limited exceptions for real estate and insurance sales, certain small agricultural operations, household domestic work and occasional “casual employment.
How long do I have to work at a job before I am protected by the workers’ compensation system?
Protection begins as soon as you begin work. You are entitled to workers’ compensation benefits for work injuries and illnesses even if you have been on the job only a short time, or only work part-time.
Can my claim be denied because I was at fault for the injury?
No. Workers’ compensation is a no-fault system. However, workers’ compensation does not cover intentional self-inflicted injuries. Disability compensation (but not medical benefits) may be denied for injuries from alcohol or drug abuse. Also, disability compensation can be reduced by 15% for willful failure to use safety devices or follow safety rules.
Note: Disability compensation can also be increased by 15% if an injury results from an employer’s willful failure to follow safety rules.
What should I do if I’m injured at work or develop a work-related illness?
Report the injury or illness to your employer immediately. If you fail to report an injury or illness within 180 days, you may be disqualified from receiving workers’ compensation benefits.
How do I report my injury or illness?
You can use any method to report your injury or illness to your employer. It is a good idea to make sure your report is documented.
What happens when I report my injury or illness?
Your employer has 7 days to report the claim to its insurance carrier and the insurance carrier has 14 days to report the “First Report of Injury” to the Industrial Accident Division. Your employer or its insurance carrier must give you a copy of the report.
Is my doctor required to report my injury or illness?
Your doctor is required to complete a “Physician’s Initial Report of Injury of Illness” (Form 123) and submit the report to the Industrial Accidents Division within 7 days of your first visit. Be sure and explain to your physician HOW, WHEN, and Where the injury or illness occurred. As the patient, you can request a copy of this form from the medical provider.
What benefits does the workers’ compensation system provide?
Depending on your specific circumstances, workers’ compensation can pay one or more of the following benefits:
- Medical Care is the reasonable expense of medical care necessary to treat your work injury or illness. This includes doctor visits, hospital bills, medicine and prosthetic devices. It also includes reimbursement for the cost of travel to receive medical treatment. Other than in very limited situations, you are not liable for any cost of this medical care. If your employer or its insurance company has a preferred medical provider organization, you must go to that provider for your first doctor visit or you can be held responsible for your medical bills.
- Temporary Total Disability Compensation is paid for the time a doctor determines you are unable to do any work because of a work injury or illness. However, no compensation is paid for the first 3 days after an injury or illness unless the disability prevents you for working for more than a total of 14 days. In that case, you be paid for the first 3 days of disability. This type of compensation ends when you return to work or become medically stability.
- Temporary Partial Disability Compensation is paid if your work injury or illness prevents you from earning your full regular wage while you are recovering. For example, if you work fewer hours or work at a light-duty job that pays less than your regular job, you are entitled to temporary partial disability compensation in addition to your wages.
- Permanent Partial Disability Compensation is paid if your work injury or illness leaves you with a permanent impairment. The compensation begins when your doctor determines that you have reached medical stability; the duration of this compensation is determined according to an “impairment rating” provided by your physician.
- Permanent Total Disability Compensation is paid if your work-related injury or illness leaves you with a permanent disability that prevents you from returning to your former work or preforming any other work that is reasonably available to you.
Note: If you are totally disabled, you may also be eligible for Social Security disability benefits.
When do workers’ compensation benefits begin?
An insurance carrier or self-insured employer has 21 days after learning of your work injury or illness to either: 1) begin payment; 2) deny your claim; or 3) notify you that further investigation in required. If further investigation is necessary, the insurance carrier or self-insured employer has an additional 24 days to accept or deny your claim. If your claim is accepted, checks for disability compensation are usually issued every two weeks.
How much will I receive while I am unable to work?
Temporary total disability is computed at two-thirds of your pre-injury weekly wage, plus $5 for your spouse and $5 each for up to four dependent children. The maximum amount of your temporary total disability compensation cannot exceed the Utah average weekly wage issued by Utah Department of Workforce Services.
What if I work two jobs, and a workplace injury or illness from one job also prevents me from working at my second job?
Wages from the second job may be included in computing the amount of your disability compensation.
How long will I receive disability compensation?
You will receive temporary total disability compensation until you can return to your regular work, your employer offers you suitable light-duty work, or you reach medical stability. The maximum duration for temporary total disability compensation is 312 weeks within a 12 year period of time from the date of injury.
Note: If you have a permanent impairment after your temporary total disability compensation ends, you may be entitled to an additional award of permanent disability compensation.
Am I compensated for time and travel for medical treatment?
You may be paid temporary total disability benefits for time away from work for necessary medical care. You may be entitled to reimbursement for the expense of your travel to receive medical treatment.
How long am I entitled to medical care for my work injury or illness?
There is no time limit to your right to receive medical care necessary to treat your work injury or illness. However, the provider is required to submit a bill for services to your workers’ compensation insurance company within one year from the date of treatment.
Can I refuse an offer of light-duty work from my employer?
Not without a good reason. If your employer offers suitable light-duty work, you are required to accept the work or risk losing your temporary disability compensation.
What if my doctor says I can perform light-duty work and my employer does not have light-duty work available?
If your employer does not offer light-duty work, you are entitled to continue receiving temporary total disability compensation benefits until a doctor finds you are at medical stability or you exhaust your 312 week entitlement.
Can my employer or its insurance carrier require me to go to a specific doctor of hospital for treatment?
Only for the first visit. Specifically, if your employer or insurance company has notified you of a “preferred provider organization” (PPO), you must go there for your first medical treatment; if you do not, you may be liable for part of the initial treatment cost. But after your first visit to the PPO, you can obtain treatment from the medical provider of your choice.
If you have not been notified of a PPO, you can obtain your initial medical treatment from the provider of your choice. Remember to choose a medical provider that accepts workers’ compensation cases.
Can I change medical providers?
You can change medical providers one time. You must notify your workers’ compensation insurance carrier of the change. After the one time change has been exercised by the injured worker, any subsequent change of provider would need to be approved by the insurance company. A referral from one medical provider to another is not considered a change of medical providers.
Can I choose a chiropractor as my medical provider?
Yes, but chiropractic treatment after the initial 8 visits must be pre-authorized by the insurance company.
What happens when my doctor releases me to work but I can’t do the job I was doing when I was injured?
If your doctor has determined that you have a permanent impairment from your work injury or illness, you are entitled to permanent partial or permanent total disability compensation. Also, you should check with your employer to see if there is a different job you can do that is within your capabilities.
If my employer does offer me a different position within my capabilities, am I entitled to the same wage I was earning before I was injured or ill?
No. Your employer may pay you at the new position’s wage rate. You may be eligible for an award of temporary partial disability compensation to help offset the difference between your old and new wage rates.
Is my employer required to provide a new job or retrain me?
No, but you may be eligible for rehabilitation services through the Utah State Office of Rehabilitation. The Utah Office of Rehabilitation phone number is 1-800-473-7530.
Can I receive unemployment benefits while on workers’ compensation?
You are not eligible for unemployment benefits while receiving temporary total disability compensation or permanent total disability compensation. You may be eligible for unemployment benefits while receiving permanent partial disability compensation if you are able and available for full-time work and can reasonably expect to obtain work despite your disability. Once you have reached medical stability from your work injury or illness and are released to go back to work, you have 90 days to apply for unemployment benefits.
Questions about unemployment insurance benefits should be directed to the Department of Workforce Services at (801) 526-4400 or toll free (888) 848-0688.
If the workers’ compensation carrier denies my claim, can I have my health insurance company pay for my medical treatment?
Yes. You may file an application for hearing on the application, you can fill out the Coordination of Benefits section providing your private health insurance information. The Adjudication Division would then send a notice to your private health insurance letting them know of their duty to pay. The medical claims would be paid at the same extent it would be if your accident or injury weren’t related to work. In other words, if your private health insurance policy doesn’t normally cover certain procedures or expenses, it’s not obligated to cover those expenses just because you claim that accident or injury is related to work. You will also be responsible for any co-pays or deductibles you would otherwise be obligated to pay.