Workers' Compensation FAQ

Below you will find answers to many commonly asked questions.  Of course this isn't mean to cover every situation.  If you don't find an answer to your question or would like to learn more about the rights and benefits the Law affords and injured employee, please send me an email or call today for a free consultation!

Why should I hire an attorney?

- The workers' compensation system can be confusing and frustrating especially when you don't know your rights. You can't rely upon the adjuster to look after your best interests when their first responsibility is to pay you as little as possible or not at all. Having an experienced attorney assisting you in your workers compensation claim you can be assured that you will recieve all the benefits you are entitled to receive like scarring, loss of use, weekly checks and payment of medical expenses.

How much does it cost to hire a lawyer?

- Nothing! The Rhode Island Workers' Compensation system is designed whereby if the Attorney is successful in obtaining benefits for  an injured worker, a fee is awarded by the Court and the insurance company is responsible for paying the fee.

I don't want to sue my employer

- Don't worry, you can't.  An employee injured at work cannot sue their employer (unless they reserve their common law rights to sue at the time of hire which I've never seen happen). Filing a claim with the Worker's Compensation Court is NOT a lawsuit!!! The only exception being if the employer did not carry workers' compensation insurance coverage at the time of the injury. In these cases, the injured employee can file a lawsuit and pursue any cause of action available to them.

Can I receive Pain and Suffering?

- No, not as part of the workers compensation case (with few exceptions).  However, if the injury was the result of a third party's negligence (like an auto accident) the employee can be compensated by the third party insurance carrier for damages such as pain and suffering.  The only other exception is if the employer did not have workers compensation insurance and the employee sued the employer for negligence.  If successful, the employee would be entitled to recover damages such as pain and suffering.

Can I settle my case for a lump sum of money?

- Yes. A settlement of an accepted case is called a Commutation and a settlement of a case where the insurance company has not accepted responsibility for the injuries is called a Denial and Dismissal (D&D). The counsel fee on a Commutation is 20% of the settlement amount. The counsel fee on a D&D is typically also 20% but can be higher depending upon the case and with the Court's approval.

The two most important aspects of any settlement are that the employee is typically asked to sign a resignation from their employment and any further medical bills incurred after the settlement is the employee's responsibility.

Can my employer fire me if I am out due to a work related injury?

- Simple answer is yes. Employers are not obligated to hold the employee's position open forever, however employees in a union or who have an employment contract often are more difficult to terminate. An injured worker may have a right to reinstatement to their former position once they are cleared by their treating doctor but they must make a demand for reinstatement within 10 days from the date they are released back to work full duty.

Can I collect TDI Benefits?

- Yes, but an injured worker cannot collect TDI (assuming the employee is a Rhode Island employee and pays into TDI) benefits and weekly workers compensation checks at the same time. If an employee collects TDI as a result of a work injury and their injuries are subsequently accepted as being work related, the workers compensation insurance carrier will reimburse TDI for the period TDI paid weekly benefits.

What are my responsibIlities if I get hurt at work?

- You must tell your employer.  It's even better if a written incident report is completed.  If an employee hurt at work seeks medical treatment, they must also tell the doctors that the injury occurred at work and how it happened. An injured worker should keep all their medical appointments and provide updated out of work notes to the employer.

What is an IME?

- It stands for Independent Medical Exam, but don't kid yourself, there is nothing "independent" about it.  They should really be called DME or Defense Medical Exam!  An IME is an examination of the injured employee by a doctor chosen by the workers compensation insurance company and asked to write an opinion for the insurance company. By law the insurance company has the right to have an injured worker examined and a failure to attend can result in the suspension of a worker's weekly compensation checks.

What is my scarring worth?

- This is one of the most common questions injured employees search for on the internet.  First, the maximum amount an injured worker can receive for scarring iin Rhode Island is currently $45,000.00. Scarring in Rhode Island is very subjective and can depend up several factors including what the scar looks like, where on the body the scar is located and the age and gender of the employee.

Some common scars are easy to value such as arthroscopic portals. However, scars and burns that are unique in nature are more difficult to value. A value cannot be determined until the scarring has fully healed.

In Rhode Island, an employee is entitled to scarring benefits regardless as to where on the body the scar is located.  Rhode Island Workers Compensation is drastically different than Massachusetts Wokers Compensation where an employee can receive pure scarring benefits if the scarring is on the hands, neck or face only and the maximum awarded is $15,000.00.

If you have scarring as a result of a work related injury, please call today for a free consultation and evaluaiton.

CAN I RECEIVE SCARRING BENEFITS EVEN IF I NEVER MISSED TIME OUT OF WORK FROM THE INJURY?

Yes.  As long as the employee notified the employer of the injury and the workers compensation insurance company is aware of the injury, the employee is entitled to receive scarring benefits once the scar has reached an end result.  However, there is a two statute of limitiations so the employee shold not wait to seek compensation.

How are my Loss of Use Benefits Calculated?

- For injuries that occurred before January 1, 2012, the following is the formula to calculate loss of use benefits - (Percentage loss of use)(312)($90). For example, if the loss of use is 15%, the LOU would be (.15)(312)($90) or $4,212.00

For injures that occured after January 1, 2012, the loss of use calculation is as follows: (Percentage loss of use)(312)($180). Using the same 15% LOU would yield a payment of $8,424.00.

The perecentage loss of use is determined by the treating physcian using the 6th Edition of the American Medical Associations Guidelines to Permanent Impairments.

What if I return to work?

- If an employee returns to work earning the same if not more than what they were receiving in weekly workers compensation checks, the workers compensation insurance company will look to stop paying you on a weekly basis. That can be accomplished by voluntarily signing a Suspension Agreement or by a Court Order if a Petition is filed with the Court.

If an employee returns making less than their weekly workers compensation check, the insurance company is obligated to pay "varying partial" or the difference between your actual earnings and the amount of your weekly comp check.

A return to work however does not end the responsibility of the insurance company to pay for any ongoing medical treatment that is necessary to cure, relieve and/or rehabilitate the employee from their work related injury.

What if I owe child support?

- If an injured worker is under an order to pay ongoing child support, the workers' compensation carrier will deduct the child support obligation from their weekly comp check. If the employee's case is going to be settled and there is an outstanding child support lien for monies owed, the amount in arrears will be deducted from the settlement amount.

What if I get hurt in a car accident?

- If you are injured in an auto accident while working, if the accident was due to the fault of another, the injured worker will not only have a workers' compensation case, but also a third party case against the person who caused the accident. The injured worker will be entitled to weekly checks during the time they are unable to work as well as payment of medical expenses. These can also be recovered in a third party case against the at fault driver as well as pain and suffering. The workers' compensation carrier will be entitled to recover a portion of the benefits it paid to the injured employee out of any third party settlement or verdict.

What if the work injury results in the death of the employee?

- If a work injury causes the death of the employee, his or her dependants (spouse and children) are entitled to weekly benefits. A cost of living (COLA) increase of 4% is paid annually beginning on the one year anniversary of the death. In addition, there is a burial allowance in the amount of $15,000.00.

I'm getting weekly checks, why should I call a lawyer?

- Just because the insurance company is paying weekly benefits doesn't always mean that they have assumed liability for the injuries. The workers compensation insurance companies can provide all the benefits without accepting responsibility. This is extremely important because if an injury is not officially accepted within the statute of limitations, an injured worker may be unable to obtain additional weekly benefits or payment of medical expenses.

MY DOCTOR RELEASED ME BACK TO WORK LIGHT DUTY, DO I HAVE TO RETURN TO WORK?

- No.  If the worker's injuries have been accepted by the workers compensation insurance company, the legal burden shifts to the insurance company to prove, through medical evidence, that the injured employee is capable of returning to their normal job duties without any restrictions.  An injured employee is not obligated to return to work on a "light duty" basis unless the light duty job is offered by way of a Suitable Alternative Employment (SAE) offer.

WHAT IS A PRETRIAL CONFERENCE AND WHAT CAN I EXPECT TO HAPPEN?

A pretrial conference is the first step in the process after a petition has been filed.  The pretrial conference is a fairly informal hearing where the attorneys present to the Judge the issues surrounding whatever is being requested in the petition.  For instance, if it is an Original Petition, the employee's attorney will describe how the injury occurred, what the injuries were, who the employee notified and what the the medical treatment has been to date.  The employer's attorney can present any defenses they may have and the Judge will decide if the employee will be placed on workers compensation benefits or not.  Either party can appeal the Order given by the Judge at a Pretrial and take a claim for trial where parties will be questioned under oath and depositions of any relevant physicans will be conducted.  No formal testimony is taken at a Pretrial and typically the employee does not need to speak unless there is a question asked by the Judge.

AM I A RHODE ISLAND EMPLOYEE?

If you work for an employer that is located in Rhode Island, then you are considered a Rhode Island employee regardless as to where the injury occurred.  For example, if the employer is based in Rhode Island but the employee was hurt working in Connecticut, it would be a Rhode Island workers compensation case.  Determining if someone is a Rhode Island employee sometimes can be a bit more difficult if the company is not based in Rhode Island.  If unsure, its best to consult with an experienced workers compensation attorney to determine the appropriate jurisdiction the case belongs, especially since there are some situations where there is concurrent jurisdiction whereby the employee can chose to seek benefits from one of two or more workers compensation systems.

IF AN EMPLOYEE WINS AT THE PRETRIAL, HOW LONG DOES THE INSURANCE COMPANY HAVE TO PAY?

If a pretrial order has entered in favor of the employee to pay weekly checks, scarring or loss of use benefits, the insurance company has 14 days from the date of the pretrial order to pay.  If a case is settled for a lump sum, the carrier also has 14 days from the date of the court hearing to pay the settlement.

what if the insurance company's doctor (IME) says i can go back to work but my doctor disagrees?

Typically when there is a conflict of opinion between two doctors on issues such as the cause of an injury (causation or liability), whether the employee needs further treatment for the injury or whether the employee is capable of returning back to their normal full time job duties, the Workers' Compensation Court will refer the matter to a Court Ordered Impartial doctor to address the issue.  There are certain risks associated with letting an issue go to an Impartial, especially those dealing with an employee's ability to return to work.  Employee's should seek legal counsel to go over the pro's and con's.

WHAT IS A DENIAL AND DISMISSAL?

A Denial and Dismissal (D&D) is a settlement of a disputed workers' compensation case where the insurance company pays the employee a lump sum of money but does NOT accept responsibilty for the injury.  In these types of settlements, the employee is typically responsible for paying any outstanding medical bills they have incurred.  Furthermore, the employee will have to sign a resignation from the employer as well as a release that essentially bars the employee from bringing any future claims against the employer as a result of the alleged work injury. One of the upsides to this type of settlement is that if the injured worker has recieved TDI, they will not have to pay it back as the injury will be deemed by the Workers' Compensation Court as not work related.

WHAT IS A COMMUTATION?

A Commutation is a settlement of a work injury that HAS been accepted as being work related (unlike a Denial and Dismissal).  These types of settlements typically occur once the employee has exhausted all medical treatment and are no longer able to return to their normal job duties.  Once the settlement is approved by the Workers' Compensation Court, the employee will no longer receive weekly workers compensation checks and the cost of any medical treatment rendered for the work related injury AFTER the settlement will be the responsibility of the injured worker.

WHAT IS THE MAXIMUM WORKERS' COMPENSATION RATE?

- As of September 1, 2013, the maximum workers' compensation rate (the amount an injured employee can receive on a weekly basis) is $1,107.00 per week.

Can i recieve compensation for disfigurement?

- In addition to pure scar based compensation, employees may also be entitled to additional money for the disfigurement caused by an injury.  For example, an injury to one knee may result in the permanent loss of symmetry when compared to the uninjured knee due to permanent atrophy or surgery.  Employee's are also entitled to compensation if an injury leaves them with a permanent limp.  If you believe you have suffered disfigurement to their body as a result of an injury, please call today for a free consultation!

WILL I BE PUT UNDER SURVEILLANCE BY THE INSURANCE COMPANY?

- Not every injured employee will be targeted by investigators filming their daily activies but it certainly does happen.  It is more likely in cases where the employee has been deemed totally disabled where the carrier tries to catch the employee doing something to use as evidence that the employee is capable of performing some type of work and thus try to reduce the employee from total to partial disability.  It also often occures when an employee has been out of work for a soft tissue injury or muscle strain for an extended period of time and the carrier is looking for video proof that they are no longer injured.  An injured worker in Rhode Island must always assume that they will be videotaped at some point in time during the life of the workers compensation case.  And no, the carrier does not have to tell the injured worker they are under surveillance, kinda defeats the purpose ;)

WILL MY WORKERS' COMPENSATION CHECKS STOP IF I HIRE AN ATTORNEY?

No.  The hiring of a workers' compensation attorney will have no impact on an injured employee's weekly checks.  Also, if an employee's injuries have been accpeted by the insurance company, either voluntarily or by Court Order, the weekly checks cannot be stopped uless the employee returns to work or if it is proven by medical evidence that they are capable of returing to their regular job without restrictions or the case is settled.

i OWE CHILD SUPPORT, HOW WILL THIS IMPACT MY BENEFITS?

When a injured employee owes child support, the lien must be repaid out of the proceeds of any settlement.  If the amount owed is to the State only, the arrearage may be negotiated down but that isn't a guarntee.  If the injured worker is due scarring, disfigurement or loss of use benefits, child support liens are typically paid out of the proceeds of those monies as well.  Can't run from the man!