Burton Law Group P.C. Worker's Compensation attorney

OFF WORK BENEFITS

While you are off work and under the active care of a doctor you are entitled to a weekly check of temporary total disability (TTD) or “off work” benefits. The law establishes how much your employer or their insurance company must pay to you while you are off work and under the active care of a doctor. The amount of the check depends on your date of injury. The following is a schedule the maximum amounts that can be paid. Of course, your wages may not entitle you to the maximum; however, you can determine the amount of your weekly check by multiplying your average weekly gross wages by 70%.

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  • Injury between November 1, 2014 and October 31, 2015; The check should be 70 (seventy) percent of your average weekly wage up to a maximum of $571.55.
  • Injury between November 1, 2015 and October 31, 2016; The check should be 70 (seventy) percent of your average weekly wage up to a maximum of $589.33; no minimum.
  • Injury between November 1, 2016 and October 31, 2017; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $596.03; no minimum.
  • Injury between November 1, 2017 and December 31, 2018; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $590.63; no minimum.
  • Injury between January 1, 2019 and May 27, 2019; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $607.40; no minimum.
  • Injury between May 28, 2019 and December 31, 2019; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $867.71; no minimum.
  • Injury between January 1, 2020 and December 31, 2020; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $898.63; no minimum.
  • Injury between January 1, 2021 and December 31, 2021; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $923.53; no minimum.
  • Injury between January 1, 2022 and December 31, 2022; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $953.18; no minimum.
  • Injury between January 1, 2023 and December 31, 2023; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $986.86; no minimum.
  • Injury between January 1, 2024 and December 31, 2024; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $1,038.31; no minimum.

The benefits you receive from workers’ compensation are NOT subject to any state or federal withholding taxes. You do not need to report this money when filing a tax return. If this office’s efforts result in the insurance company starting these benefits, then the law entitles the attorney to a ten percent fee for those services. If you are already receiving these weekly “temporary” benefits then there is not an attorney fee on these off work “temporary” benefits.

Remember, to receive and continue to receive these “temporary” benefits you must remain under the active care of a physician, who is of the opinion you should be kept off work because of the on-the-job injury AND who is of the opinion that the treatment you are being provided is continuing to improve your condition. Once you have reached maximum medical improvement (MMI) the insurance company is allowed to stop these “temporary” off work checks.

A law now exists that limits TTD in cases of soft tissue injuries or injuries where no surgery has been recommended or performed. In the case of a soft tissue injury, only eight (8) weeks of TTD is payable unless there is an injection which entitles an injured worker to eight (8) more weeks of TTD (if they remain under the care of a doctor who is of the opinion they cannot work or restrictions exist which the employer cannot meet). If surgery is recommended, an injured worker can receive sixteen (16) more weeks of TTD and if surgery is performed, the soft tissue limitation is removed.

The law does not require payment for the first three calendar days missed from work for injuries occurring after February 1, 2014 and this waiting period is not compensated at any later time.  The entire time you are under the doctor’s care you are entitled to be reimbursed for mileage and prescriptions (see additional information below).

The employer or insurance company does not always voluntarily start paying your “temporary” off work benefits. They may believe they have a defense, for example they may be of the opinion you are able to work or that your injury did not happen on the job. Insurance companies are sometimes very quick to claim they have a defense, so they will not have to pay benefits immediately.

It is our experience that in most cases after the judge hears the testimony, the appropriate workers’ compensation benefits are awarded to the employee. If you are not already receiving off work benefits and they are in fact due please be advised that one of the first things we will do is begin work on getting these “temporary” off work benefits for you.

Sometimes the parties must still have a hearing on your right to receive these benefits. The hearing may not be set for up to 60-120 days from the day the request is filed. Once we get your medical records, we will file a request for a hearing. While we are awaiting the hearing date, we will make every effort to convince the insurance company to start your off-work benefits back to the first day they should have started so that a hearing can be avoided. This system is overcrowded and often insurance companies are understaffed; therefore, your patience in getting the initial off work benefits started remains appreciated.

MEDICAL TREATMENT

You are entitled to medical treatment that reasonably necessary in connection to your on-the-job injury. The judge can order your employer or their insurance company to pay for medical treatment directly related to your injury. There are various rules that the law has imposed as to what is “reasonably necessary in connection to your injury”. There are also very specific procedures to follow when changing physicians and they vary according to when your date of injury occurred. Most importantly, an injured worker cannot change doctors without prior approval by the insurance company or the judge. Please keep this office advised if you receive either a full or light duty release from any doctor, a referral to another doctor, or if you do not feel like you are responding well to the treatment you are being provided.

FOR INJURIES AFTER FEBRUARY 1, 2014, THE JUDGE HAS THE AUTHORITY TO STOP YOUR BENEFITS WHEN YOU MISS MEDICAL APPOINTMENTS. YOU MUST MAKE EVERY EFFORT TO ATTEND EACH AND EVERY APPOINTMENT AND/OR CALL THE PROVIDER’S OFFICE TO RESCHEDULE IF EXTRAORDINARY CIRCUMSTANCES EXIST.

MILEAGE REIMBURSEMENTS

The law provides that the insurance company must reimburse you at the statutory rate per mile whenever you travel in excess of twenty (20) miles round trip to see a doctor for treatment or a doctor for the insurance company. You will not be reimbursed for mileage below this threshold or for mileage incurred traveling to any doctors this office may send you to for a disability report or for any travel expenses you may incur in attending a deposition or hearing. The maximum mileage reimbursement allowed for any individual trip is six hundred (600) miles round trip.  If you travel over 100 miles, I would suggest that you include a request for a meal allowance, although it is not clear that current law allows for reimbursement of same.

We would ask that each time you go to see the doctor or physical therapist you get verification for the visit. You will find enclosed some forms for your use in submitting the mileage reimbursement requests. Even though the insurance company may be aware of the visit and ultimately receive records regarding the same, verification of the visit is very important. Verification can be as simple as the doctor’s staff initialing where indicated.

If you forget to have the medical provider’s office initial the form then go ahead and submit the same with your initialing in the space provided. Please be sure to include the date and round-trip mileage. You need not submit a receipt for the meal as we will seek the maximum allowable no matter what the meal actually cost.

The sheets (either completed or with as many mileage reimbursement requests as you want to submit at a time) should be sent to our office and we will forward them to the proper party. Please be advised it may take 30-60 days for the paying party to return the reimbursement to our office for forwarding on to you. For any prescriptions or other recommended aids you have purchased at your doctor’s direction, you can submit the receipt to our office with your mileage reimbursements or it can be done separately.

 ONCE RELEASED

We will need to be kept informed as to the progress of your medical treatment and how things are going with you personally. In some cases, medical providers do not automatically send progress notes to our attention. After you are released to return to work, or from the doctor’s care as having reached maximum medical improvement (MMI); you will need to let our office know. We will then make an appointment for you with a doctor in Oklahoma City or Tulsa for a permanent impairment evaluation. You will be notified by letter as to when and where the examination will be held.

IT IS IMPERATIVE THAT YOU LET OUR OFFICE KNOW ONCE YOU ARE RELEASED AT MMI. THE NEW LAW REQUIRES THAT WE FILE A REQUEST FOR A FINAL HEARING WITHIN SIX MONTHS OF LAST BENEFIT RECEIVED AND SOMETIMES THE ONLY WAY WE KNOW YOU HAVE REACHED MMI IS IF YOU INFORM US.

At this point, since your condition is no longer considered a “temporary” one (the doctor has reached a plateau in terms of what he can do to improve your condition) your weekly checks will stop. Normally you will know about this before we do; therefore, if at any time your doctor advises that your condition has stabilized, that you have improved as well as the doctor believes he can improve you or that there is no need to schedule a return appointment then please call our office so that we can discuss the matter in detail. At this point we would have you examined by a physician of our choice for his opinion as to your permanent partial impairment. Once that physician’s report is received by this office, we will file a request for a hearing before a judge. The hearing is our chance to prove the extent of your permanent partial impairment.

Approximately 2-5 months after filing our permanent partial disability report, a hearing will be held before a judge. Your employer’s insurance company may have you examined by a physician of their choice prior to that same hearing. We will notify you when the hearing date is set. The court gives approximately 30 days notice but as soon as we learn of the hearing date, we will notify you immediately.

It is possible that a settlement can be reached without the necessity of a hearing. Sometimes cases are sent to mediation where the parties work toward a settlement. Both parties have to agree in order for a settlement to occur, settlement cannot be ordered by the judge. Settlement involves closing the claim for good but the amount of permanent impairment settled upon is paid in a lump sum whereas impairment benefits are paid weekly if the claim proceeds to a hearing. If the claim proceeds to hearing and the judge issues an order awarding impairment, there is a statutory time available within which an injured worker is allowed to prove a change in condition and seek more benefits but that period of time is very short under current law.

If we have a hearing with the judge determining the extent of your partial disability benefits, then the judge will review the medical reports supplied by the parties, listen to your testimony regarding your present problem and will issue an order regarding how many more weeks of “partial” disability benefits you will receive beyond the “temporary” benefits you received while off work. The judge will issue an order normally one to two weeks following the hearing but the law does allow the judge thirty (30) days. We will provide you with a copy of the judge’s order when we receive it from the Commission. There will be an attached letter further explaining the order itself.

The Court will order a 20% attorney fee on the permanent partial disability benefits. Normally, this office may also have additional expenses that were incurred to get your case prepared for trial. This could include the charge submitted by the physician who examined you at the request of our office for the purpose of a disability report, any charges submitted by the doctors who have treated you for supplying the medical records from their office files, or any cost incurred if questioning of the insurance company’s physician becomes necessary. This office will pay all of these expenses initially and then you can reimburse these litigation expenses once we enter into a settlement of your claim.

 

RETURN TO WORK

The law provides that any person who is receiving the “off work” checks or TTD (temporary total disability) benefits from an employer or its insurance carrier has an obligation to promptly report in writing any change in material fact or change in the amount of income the person is receiving or any change in the person’s employment status which occurs during the period of receipt of such benefits. What this means is if while drawing these “temporary” benefits you return to any type of employment then you should notify our office, in writing, immediately. It is a crime to receive temporary total disability checks while you are working. These are the monetary amounts received while unable to work due to the injury. The other benefits or permanent partial disability that you receive after a court hearing can be received even though you are able to work. It is only a crime to receive “temporary total” disability benefits and work for wages.

Of course, once your physician has released you to return to work you are encouraged to attempt to do so. Once released, it will not hurt your compensation claim if you are able to find any type of work either from your same employer or a new employer. Even though the physicians may be of the opinion you have some “partial” disability that does not mean that you are totally prevented from seeking employment.

By all means, wait until your treating physician releases you or advises you that you can look for work before doing so. The physician may want to continue to see you even though he has released you to look for work or return to work in a limited capacity. This is permitted.

The law does provide for benefits concerning retraining into another field or job placement in the event you receive permanent restrictions that prevent a return to work in your previous occupation. Should you feel retraining may be necessary in your case then please advise this office immediately. You may want to get started on retraining while you are still drawing the weekly “temporary” checks. Once you advise this office as to the potential need for retraining, we will be glad to send you more information as to what the law provides or discuss the same with you by phone or in person. Please let me know if at any time your doctor thinks you are going to need some type of retraining.

The use of social media such as Facebook, Instagram, or Twitter is strongly discouraged during the pendency of your case. Our research has revealed that this type of activity can be readily used against you throughout your case by the insurance company and/or your employer even though your intentions are completely honest.

We realize that this is a brief statement outlining how an on-the-job injury claim progresses and the benefits that are available to the injured employee in a workers’ compensation case; however, if you will keep this letter, it may answer questions that arise in the future concerning your claim.

Of course, feel free to call our office at any time should you have questions. Brandon Burton or Melanee Kistler can answer any questions you have regarding workers’ compensation. If an attorney is not available, please feel free to consult with any legal assistant regarding your question and if they cannot assist you, they will relay your question to an attorney once they are available.

This office intends to represent and pursue your case with your best interests in mind. This office is of the opinion that your case is important as an individual case and not just another claim in the office. If at any time you do not feel that your needs are being addressed, please bring it to our attention so that we can discuss the problem.