Many courts continue to struggle to decide if the cost of medical marijuana should be covered by worker’s compensation. In fact, many courts are ruling for the costs to be covered and having the injured compensated for reimbursement of medical marijuana purchases and to cover costs in the future.
Not only that, but many state supreme courts are also ruling to allow medical marijuana to be covered and reimbursed for injuries reported to worker’s compensation. Plus, with many states adopting medical marijuana as a law, many states require that it be covered. Despite this, there are some states that do not require medical marijuana to be covered and do not mandate the reimbursement of costs. Within Pennsylvania, an initial ruling allowed medical coverage, while a bill has been floating around that would not require the coverage of medical marijuana.
Other states have tried to deny the coverage of medical marijuana and any reimbursements but only failed in the process. Within Alabama, a law exists that protects an employer and its insurers from covering medical marijuana along with any reimbursements.
Determining Under the Influence
When it comes to determining if worker’s compensation will be approved, it must be determined if a worker was under the influence at the time of injury. Many standards are set in place that can recognize whether under the influence took place. However, each state has different standards. Other differences involve other impairments and intoxication indicators. This is making states consider whether an impact is made on marijuana that has been legalized for workers’ compensation purposes and the way to decide if marijuana intoxication has taken place.
With the introduction of legislation covering intoxication standards, it will be hard to tell if intoxication is taking place and how an impact could take place for workers’ compensation benefits when an employee was considered as being impaired while getting injured on the job. There is even some legislation that if an individual is refusing a drug test or fails a required drug test, then it can be assumed that impairment had taken place. Some states have exclusions for this type of legislation which covers medical marijuana.
Current law in North Dakota allows for a rebuttal that presumes marijuana caused an injury if the limit is a certain amount during a drug test. A refusal to take a drug test automatically denies a workers’ compensation claim. In Nevada, a law exists that covers the standards of under the influence of any controlled substance as well as marijuana for the purposes of workers’ compensation. An exception exists for those who have a medical marijuana prescription that is legal and current.
While medical marijuana has been a huge debate for being covered by workers’ compensation, the fact remains that the ultimate decision for coverage is left to the courts. If you feel like you should be covered by workers’ compensation for your medical marijuana, then you need to get a hold of our office today.
Posted on: May 24 2022
Many jobs still do not have a way to allow remote work. If this is the case for you, then you could be at a higher risk of becoming infected by the Coronavirus the minute you step into your workspace.
The thing to know is if you will be covered by workers’ compensation if you become sick or gravely ill? The bad part is that the answer to this is based on what your state describes the sickness as and which will determine if compensation is warranted. In fact, many of the state policies in place are constantly changing. However, there needs to be some guidance in this matter.
The need to prove the Infections Source
Many workers’ compensation insurers are continuously arguing the fact that an exposure did not take place at the worksite. In fact, the state may even require the need for a burden of proof that can show infection took place while working.
Being a worker that is considered essential will allow a claim to become much easier to be proven that it took place while working. The reason is due to their direct contact with infected individuals. These essential workers are considered to be first responders, health care workers, and law enforcement.
If you are considered a nonessential worker, then the likelihood of proving exposure took place at work will become difficult while submitting a claim for workers’ compensation. You need to check with your state to see what the policies say if any.
Hopefully, if a state is not able to assume the exposure took place at work, then an assumption must be made while claiming for benefits. By assuming exposure took place at work, the insurer will need to show proof that it did not take place at work. If unable to show proof, then it assumed that exposure did take place.
Frequently, a rebuttable presumption is accepted by the fact that they are made by decrees on the state level or actions taken place through policies or legislation.
Get In Contact With An Experienced Workers Compensation Attorney
With a pandemic in full swing still, there still seems to be no way of telling how workers’ compensation truly works to cover a sick worker. Each state has their own initiatives in place relating to COVID-19. However, changes can occur quickly, and if an infection has taken place while working and you need to prove it, then your attorney will be able to assist. You should get a hold of an experienced attorney today so that you can go over the options you have. We will sit down with you and provide the most up-to-date information concerning policies covering the COVID-19 and how it is covered by workers’ compensation.
Posted on: May 15 2022
Many times, the question of how workers comp pays a doctor is asked by a client involved with a workers comp claim. Many times a doctor who sees a workers’ compensation patient will be hesitant to see them. The reason is that getting the payment for providing treatment will not be easy. Often, a call to the insurance company may not be answered. The doctor will likely not have any claim documents available to submit.
Not being able to contact the insurance may even make matters worse, such as the bills remaining unpaid and the patient requiring follow-up. Often, a doctor will not blame the patient and continue to provide necessary treatment. For the doctor to be paid by workers comp, there are a few things to be aware of first.
Being Familiar with the Workers Comp Fee Schedule
Many states may have a workers comp fee schedule that doctors must follow regarding procedures they conduct. The fee schedule represents the max amount chargeable to the patient. If the cost is higher than a fee schedule amount, it will likely be cut in half. When a doctor makes a claim for payment, it must be made using form UB-92 or CMS 1500. If a dispute arises, they must have it settled with their state agency covering Workers’ Disability Compensation.
Requesting Payment from Private Insurance
If your workers’ comp patient uses their private insurance for treatment, then submitting a payment claim directly to the insurance carrier can be made. Ensure that the dispute form is obtained by the doctor conducting the treatment. When a settlement is received, the patient will be responsible for the payment.
Getting Ahold of the Attorney for the Plaintiff
As you give the patient’s attorney a call, it must be understood that you should cooperate with them as much as possible. Make sure that the claim forms are completed fully and have appropriate medical documents along with them. By submitting the claim forms in full, the doctor is able to be fully paid what they are owed. Refrain from charging for administrative processes, which may slow the process. Forgo making any collection effort against the patient. This will only lead to a recovery amount that will be significantly less. It is essential to have the medical bills protected as part of the case.
Discounts should be sought by the doctor seeking payment and have the payment sent to them out of any settlement amount. A lot of times, when a discount is negotiated, it will be a higher amount than what the fee schedule will state. Frequently, a doctor will need to provide an opinion concerning disability. When these opinions are obtained, the doctor will be compensated. Despite this, it is essential that the fees are not in excess because it may delay obtaining an opinion.
When a doctor needs to see a workers comp patient, there may be several stressful situations for the doctor as they try to get paid. By getting ahold of us today, we will explain the entire process of getting paid from workers comp.
Posted on: Apr 29 2022
Following the contact of your employer concerning your injury, you should also be in contact with an experienced workers comp attorney. As you talk to the attorney, they will be able to review your case and advise you of your options. You should understand that both the workers’ comp insurance and your employer are not obligated to assist in your case or ensure that you are protected.
Experiencing an injury at work can cause the employee more stress than they should be experiencing. Plus, having this stress on top of the pain that is present will only make matters worse. When an employee is waiting to hear back concerning their workers’ comp claim, they will not be earning a paycheck due to being out of work. Often, a claim will get denied when it should have been approved. This is due to the insurance provider not wanting to pay a claim. Also, if the injury claim is not as simple as others, then you need to have representation that has your interest in mind.
An employer and claim adjuster does not have your interest in mind. This is why you should contact an experienced workers comp attorney to handle your case. A lot of times, an adjuster will manipulate the case by using their in-depth knowledge of the law surrounding workers comp. When you have an attorney evaluating claims on a daily level, they will be able to ensure that the compensation you obtain is fair.
Regardless of having an adjuster’s word of being fair, you need to have great legal representation to have a truly fair case. You should explain to your attorney all of the details surrounding your accident and injury. The attorney will be able to decide if legal representation will be warranted. Your appointment with your attorney needs to be done so that you have a basic understanding of the rights you have. Although you may not always need an attorney to help with your claim, you should find out what certain rights are available.
Getting ahold of an attorney specializing in workers comp will make your entire claim process much easier to understand. It can even help the claim get approved quicker. You will also have an idea of what to expect shortly after submitting your claim.
When you have a work-related injury, you need to get ahold of an attorney to advise you and a doctor in regards to your injury. As soon as you do, you can get your claim process started. By getting ahold of us now, we will also quickly go over your injury to ensure that you are treated so that you can heal and return to work.
Posted on: Apr 15 2022
If you are injured on the job, then your employer will require you to be treated by a doctor who accepts workers’ compensation patients so that you can get back to work as quickly as possible. While many workers´ comp insurance providers also want you to return to work, they could seek opinions that are very conservative in nature and which may not have your interests in mind.
It would be best if you remembered that everything that is said to the doctor might have an effect on the benefits you receive from workers’ compensation. This means you need to be careful with what you say during your appointment. Consulting an attorney specializing in workers’ compensation would be a great idea so that you can expect what will take place and what questions the doctor may ask you concerning your injury.
During Your Exam
As you have your exam, the doctor will attempt to determine your workability based on the injury you have sustained. The doctor will then send this evaluation to the insurer to determine benefits.
You will be evaluated on how you move and how you appear, such as your ability to stand and sit, are you limping and showing signs of discomfort, and if you appear to be having any type of difficulty.
You can expect the doctor to look for any type of pain or none for that matter. The doctor will want to know your medical history and if you have conditions that are pre-existing, as well as any previous treatments in the past.
Make sure that you explain your work injury in detail and how the injury currently affects you negatively. By being as detailed as possible, the doctor will not be able to say that the condition is not as bad as you say it is.
Things That You Should Avoid Telling the Doctor
Below are a few of the things that you need to avoid saying when a workers’ compensation doctor is evaluating you:
- Remember that you should complete all of the treatment you are provided with until you are cleared to return to work.
- Never delay the treatment that you are prescribed. This delay will cause your injury to become worse and extend recovery.
- Do not bend the truth about the circumstances of your injury
- Do not leave out any history concerning previous injuries
Lying about an injury or making it sound worse than it really is will never result in receiving benefits from workers´ comp. This is because your medical records could be easily obtained by the insurer to verify everything in order to prevent fraud.
You will then appear untrusting by your employer once they find out the results of the claim. Not only that, but your doctor may be unable to provide proper care based on what you are lying about.
Ultimately, you need to be able to return to work after being fully recovered from the injury. By avoiding the above, you will have a better chance of receiving benefits and the medical care that you are in need of. However, if you have questions concerning what you should tell the doctor about, then you should contact us now so that you are prepared.
Posted on: Mar 29 2022
Regardless of where you work, you will likely be covered by workers compensation insurance that your employer provides. The purpose is to cover any lost wages that result from a work-related injury. Although the laws concerning workers compensation vary, the fact of the matter is that you will need to be seen by a doctor in order to receive any benefits.
When it comes to the doctor, what they say and report to the insurer will have a lot to do with the amount of your benefit you obtain and determine if your claim will be approved or denied. With this in mind, many employees may be wondering whose side the doctor is really on when it comes to a claim.
Is the Doctor on your Side or the Insurer´s Side?
To put it bluntly, the doctor has a contract with the workers compensation insurer, so they are working for them and not you. However, no matter who the doctor is working for, they must stand by their oath to practice medicine fairly and with the utmost integrity and have their patient´s health in mind.
Often, an injured employee may not agree with the doctor and request a second opinion.
Can Personal Physicians Provide Care for Workers´ Compensation Claims?
This may depend on the state in which you reside and what the law says about it. When you are employed, you usually choose a healthcare provider from a network of providers that your employer works with. The good thing is that a second opinion is usually granted after you change doctors. However, if the permission is denied and you seek treatment from a new provider, their payment may not happen.
For a doctor change to occur, you may need to prove the circumstances, which may need evidence to support the change. When you get ahold of an experienced workers compensation doctor, they will be able to guide you through this change process as smoothly as possible.
Be prepared for roadblocks along the way, though, because the law will determine whether a change can occur or not. This includes the policies that your employer may have in place concerning which doctors you can see. You may experience some stress knowing that you don´t have complete liberty to see your doctor of choice, especially when the doctor tries to make the condition seem pre-existing.
Get In Touch with an Experienced Workers Compensation Doctor
It is never a good feeling to get a second opinion. This will only result in extra waiting for your claim to be approved. However, it can also determine that you get the right amount of medical care your injury needs. By getting ahold of us today, we will work hard to get you to the right doctor that your claim deserves.
Posted on: Mar 15 2022
When a company is operated within a state, there will be quite a few expenses involved. Regardless of the size or business of the company, the owners of these businesses love when they are able to find short cuts in order to save themselves money. Many companies will also try to save costs by eliminating costs that seem unnecessary, such as workers comp. However, the fact of the matter is that there are more risks involved for the company and if an injury occurs, then the financial liability could be in the hundreds of thousands.
States Governing Workers Comp
While each state has their own requirement when it comes to workers comp, all companies are required to have a certain type of insurance. The only exception is Texas, which only makes the requirement voluntary. When it comes to the rules and coverage of each state, that is determined by the state itself. For example, Georgia requires the workers comp insurance be determined by the number of staff members they have. While another state may have the company carry insurance based on company type. It is important that a business owner fully understands their state laws regarding workers comp as well as the coverages they must provide.
Fines Instilled For Non-Coverage of Workers Comp
Similar to what we saw with regulations regarding workers comp and their state requirements, there are also laws covering the fines instilled for non-coverage of workers comp. Besides fines, states may also pursue felony charges against a company if they willingly forgo workers comp coverage, which may put the company owner behind bars. A few of the states that could add jail time are Michigan, California, Massachusetts, Illinois, and Pennsylvania.
Staying Away From Any Type of Risks
Having a huge expense such as workers comp may not be what many companies will be willing to pay for. In fact, many companies experience an operating cost of 2% just for workers comp insurance. With the rise of costs increasing, the amount of companies deciding to forgo this coverage will also rise. It is crucial that the insurance not be dropped by the company.
The purpose of workers comp is to provide coverage to all employees of a company who sustain injuries while on the job and covering the medical bills sustained by the injury. It also includes covering legal fees and wages lost while recovering. It is believed by many that having the costs paid out of pocket may save money. However, it is also believed that the premiums a company pays will be cheaper in the long run.
With the high risks involving workers comp, many companies decide to get away from offering it in order to save money. If you currently work at a company that does not provide workers comp and you have been injured on the job, then you need to get a hold of us today to get your injury case started.
Posted on: Feb 22 2022
While many jobs provide workers compensation, there are also many who do not provide coverage due to the job type not being one in which workers compensation covers. The following categories that are never covered by workers compensation involve owners of a business, volunteers, federal employees, independent contractors.
Owners of a Business
In a lot of states, the owners of a business will not be a covered individual of their insurance. However, in other states, the owners may elect to have the coverage for themselves as long as the premiums are regularly paid.
Working as a Volunteer
Working as a volunteer means you are not a paid employee and as such are not covered by workers compensation. Although coverage is not normally provided, the business still has the option to cover them. Many exceptions also exist which workers compensation covers and these include volunteer police and volunteer firefighters. When a volunteer is requested by a police officer or firefighter, they too become covered by workers compensation while assisting in emergency situations.
Employees of the Federal Government
Regardless of your job title or department your job falls under within the federal government, the workers´ compensation is a different type of system that is covered by the federal government.
Federal staff are covered through FECA, which covers any and all diseases and injuries happening by no fault of their own. With railroad workers, the Federal Employer´s Liability Act covers them and permits an employee to bring suit to their employer because of the injury sustained. Benefits provided may include earning lost wages, receiving medical treatment, and other damages such as pain and suffering.
Having a worker as an independent contractor means they will not be covered by a company’s workers´ compensation insurance. However, they will be covered directly by workers´ compensation. This will be determined by the fact that the company will have the person listed as an employee or an independent contractor. This will matter the most when and if an injury takes place. When an employee is injured, a company may try to have them classified as an independent contractor so that they will not have to pay the insurance benefits that would be provided.
Separate Instances Where Workers Compensation Is Not Provided
Your state may have a list of job statuses that are listed as not being covered by workers compensation. A few of these involve workers who work on a part-time basis, Taxi-drivers, workers in the agricultural field, and those who work intermittently.
When you have become injured on the job but are listed as not being covered by workers compensation, then you need to be on the phone with us today! We´ll get your case started so that you get the benefits you deserve.
Posted on: Feb 1 2022
During the evaluation of injury claims made through workers comp, one must keep in mind that the worker’s comp insurance is purchased by the employer through a variety of insurance providers. After a claim is approved by the insurance company, they then begin to pay benefits to the employee.
Although this is the case most of the time, states create individual plans for worker´s comp that are used for regulating purposes, employee safety, and dispute resolution. It is for this reason that a lot of information concerning injuries takes place over a multitude of institutions.
In a 2020 report by the IJERPH, it was discovered that there were 5 main injuries that were reported to worker´s comp. These involved:
- A strain
- A Contusion
- A laceration
- A sprain
- A puncture
Below, we explain the top injuries reported to worker´s comp.
When an individual experiences a strain, it is due to the muscle or tendon being overly stretched or tears. The majority of strain injury is caused by performing repetitive motions while working such as pulling, pushing, or lifting objects that weight a lot.
A contusion is the medical term for a bruise that results from any body part getting hit hard. Although a bruise is not considered to be a major injury or having much significance, it does have the possibility to cause a substantial amount of pain- For a bruise that becomes associated with swelling may be a sign of an issue that is more severe in nature.
When a laceration happens while working, it is usually caused by an employee handling the wrong type of tool or having no knowledge of how to handle the use of the tool. Any machine tools that have exposed blades or protective parts may also cause a laceration. By ensuring that lighting is good, you will decrease your chances for lacerations.
Equal to a strain injury, the sprain also happens due to overstretching or tearing of a ligament. Sprains are also the result of repetition and manipulating objects of significant weight. The individual may also experience a sprain if they become uncoordinated in their actions.
Employees can experience a puncture injury as they handle tools that are sharp. Some examples include scissors, knives, working on surfaces that are splintered, nails, or glass. Dull items or even shards made from glass or metal can put an employee at risk for a puncture would to occur.
Having an idea of what injuries are reported the most to worker´s comp can help an employer instill ways to make a work environment safer. To get a better idea of what you can expect from reporting an injury to worker´s comp, contact us today and we will be happy to assist.
Posted on: Dec 23 2021
When it comes to reporting injuries in the workplace, it is preferred that they get reported shortly after occurring. The deadline to submit a worker´s comp claim will differ among each state. However, the normal timeframe seems to be ASAP, which is not a bad thing.
Having a flexible timeframe such as this can be justified by having some factors involved.
- Injury being deemed as work-related by a doctor
- Circumstances of the injury
- When the injury occurred
As far as the state that you live in is concerned, when an employee takes too long to report their injury, they may become ineligible for benefits or worse their benefit amount may be much less than it should be. A good example of this is in Colorado. For every day that reporting is late, you will be deducted an equal day.
Besides having the injury reported after the occurrence, an employee will need to file a claim for benefits if they choose to be compensated. All documents from a doctor will need to accompany the claim form when the employee makes the claim.
For filing a benefits claim for worker´s compensation, the timeframe can vary by state, but normally the variance can be more than 3 years. With that, it is also advisable to file a claim ASAP due to the amount of time the claim may need to be closed.
For instances where the employer declines to have the injury reported, then the employee has the right to make direct contact with the insurance provider to file their claim for benefits. If the insurance provider information is unknown, then the worker´s compensation for the state may be contacted to obtain the insurance provider information.
Timeframe For An Employer To Report Worker´s Comp Injuries
As an employer is notified of a work-related injury, they should work as a guide for their employee so that the insurance provider can be notified. As part of the process, the employer needs to furnish the following:
- Correct worker´s comp forms to the employee to get the claim process started
- Details concerning going back to work
Once an employer has been officially notified, the employee can begin their benefits claim. It is advised that all forms necessary should be provided to the employee within one day after the injury. As part of the claim forms packet, the employee should have one that covers the details of the injury and the circumstances surrounding it. The name of the form may be similarly known as an “Initial Report”. This form will request information regarding the following:
- Type of injury sutained
- Location of the injury
- Any injury treatment needed
- Any supplemental information
After filling out this form, it needs to be received by the insurance provider asap and in accordance with the insurer and state timeframes, they have set. Other than the forms for the claim, an employer may be required to submit additional forms to the insurance company. On top of all of that, the doctor treating the injured employee may have to submit all treatment documents to the worker´s compensation provider.
Each state may regulate how the specific process will take place and how forms will be submitted and the order in which they are submitted. Ultimately, the state has the final say in the entire process and could affect the way a worker´s comp claim is handled regardless of benefits being paid out.
Under normal circumstances, an evaluation of the claim will only take place after the necessary forms and documentation have been received by the insurance. Both employee and employer will then be notified later on if the claim for benefits will be paid or not. The timeframe for the payout of benefits will be determined by the rapidness of filing the claim, which could be more than a year. For injuries that are claimed quickly, the payout may also be quickly made, thus closing the case much quicker, too.
Keep in mind that not all worker´s compensation cases will be the same. Each of the state laws governing worker´s compensation will differ, which is why it is important to have all of the current information as soon as an injury takes place.
Submitting a claim for worker´s comp benefits should not feel like a chore, and it should not take a long time. When the claim is known and filed with the insurer, the benefits will be paid on a timely basis. If you see yourself in an uncomfortable situation with your employer concerning the worker´s compensation process, you should get ahold of us today. We will give you the exact information needed for your state and advise you on the options available to you.
Posted on: Dec 15 2021