What is Workers’ Compensation?
To better understand Workers’ Compensation, it is important to understand who is considered an employee in the State of Indiana. The Indiana WC statute defines an employee as follows:
“Employee means every person, including a minor, in the service of another, under any contract of hire or apprenticeship, written or implied, except one whose employment is both casual and not in the usual course of the trade, business, occupation, or profession of the employer.” Reference IC 22-3-6-1
Workers’ Compensation is a type of insurance that benefits both employers and employees. Its purpose is to compensate people who have been injured or disabled while at work, including those who have developed occupational diseases. The Indiana Workers’ Compensation Act was passed in 1915 and is run by the 7 member Workers’ Compensation Board, all of whom are attorneys appointed to 4-year terms by the governor.
Employers benefit from having workers’ comp insurance for their employees because it removes the possibility of lawsuits. Without the insurance, workers could sue their employers for lost wages and medical benefits, but with the insurance, these benefits are paid.
Employees benefit because they don’t have to prove fault on the part of their employers or go without money while waiting for lawsuits to be resolved. Instead, their claims usually result in payments within 15 days. It doesn’t always run like clockwork, and the rules are intricate, which is why an experienced workers’ compensation attorney may be necessary to make sure that you receive the benefits that you deserve.
Some employers are exempt from buying workers’ compensation insurance in Indiana:
- Independent contractors:
The statute defines an independent contractor: ”A person is an independent contractor and not an employee under IC 22-3-2 through IC 22-3-6 if the person is an independent contractor under the guidelines of the United States Internal Revenue Service.” Reference IC 22-3-6-1 and IC 22-3-7-9
- Railroad employees covered under the Federal Employees Liability Act
- Employees engaged in interstate or foreign commerce who have access to federal alternatives to state-based workers’ compensation (seamen, longshoremen, etc.)
- Real estate employees (i.e., real estate agents who work as independent contractors for real estate brokers)
- Athletes on scholarship
- Prison inmates
- Most Volunteers
- Coaches for youth sports teams
In general, workers’ comp covers medical expenses, a portion of lost wages, rehabilitation costs, and death benefits. This will be covered in more detail below.
Do You Have a Workers’ Compensation Case?
- Your employer is required by Indiana Codes to post a notice in a conspicuous location to inform all employeesthat they are covered by workers’ comp. The notice must also contain the name, address, and telephone number of your employer’s insurance carrier or the person responsible for administering your employer’s workers’ compensation claims if the employer is self-insured.
- Know that even if you are injured on your first day on the job, you are still covered, as long as you were performing your job at the time. For example, if you trip over your dog on the way to your kitchen before going to work, you are not covered. However, if you trip on your way into the building where you work, you are.
- Your employer is not allowed to fire you for filing for workers’ compensation.
- If you need to see a doctor immediately for an emergency, you are covered. If you have a nonemergency injury (like carpal tunnel syndrome caused by repetitive motions at work), you may need to have a doctor assigned to you, but you are also covered.
- If you have a heart attack as a result of your work (perhaps you were told to overexert yourself), you have a case. If you have a heart attack at work that could have happened at any point of any day and isn’t related to work, you do not have a case.
- If you were violating company policy when you were injured, you may not be compensated. For instance, if you were racing your office chair down the hallway during lunch and broke your foot, this is considered horseplay. On the other hand, if you simply stepped into the hallway and were injured by a colleague who was playing around, you are covered.
- Under IC §22-3-2-8, compensation is not allowed if your injury happened because:
- You knowingly injured yourself (did it on purpose)
- You were intoxicated
- You were committing a crime
- You knowingly failed to use a safety appliance
- You knowingly failed to obey a reasonable written or printed rule of your employer which has been posted in a conspicuous position in your place of work
- You knowingly failed to perform a statutory duty
Common On the Job Injuries
Workers’ comp covers any injuries you suffered at work or occupational diseases caused by your work as long as they require medical attention and prevent you from continuing to perform your job. The good news is that Indiana’s nonfatal workplace injuries and illnesses have decreased by 71% since 1992. Of course, that good news is not significant if you are the one who has been injured. Some examples of injuries occurring at work include:
- Motor vehicle accidents (if driving is in the scope of your job)
- Exposure to hazardous chemicals (common in the cleaning industry)
- Falls from equipment, scaffolding, or roofs
- Slips and falls due to slippery or wet floors
- Getting caught in machinery
- Overexertion caused by carrying or pushing something heavy
- Hernias or back injuries caused by lifting or twisting
- Repetitive stress injuries like carpal tunnel syndrome
- PTSD caused by witnessing or experiencing traumatic events
- Hearing loss caused by dangerous decibel levels
- Fire or explosions
The 10 Indiana industries with the most non-fatal work-related injuries (as of 2019) are:
- Prefabricated wood building manufacturing
- Health care and social assistance
- Industrial machinery manufacturing
- Ferrous metal foundries
- Couriers and messengers
- Wood product manufacturing
- Veneer, plywood, and engineered wood product manufacturing
- Motor vehicle body and trailer manufacturing
- Nursing care facilities (skilled nursing facilities)
Workers’ Compensation Process in Indiana
If you are injured on the job, there are certain steps to take.
- Report the accident to your employer. The accident must be reported within a reasonable time period, but it is best to do it as soon as possible.
- Your employer should file an accident report within ten (10) days. Make sure to get a copy of this. Be truthful on this report, and don’t leave anything out.
- For future reference, document everything that happened for yourself. Include exactly what happened and where. Also, get the names and contact information of any witnesses.
- If your employer does not file the accident report and get the ball rolling, you can contact the Workers’ Compensation Board yourself. The contact information should be on the poster that your employer is legally obligated to post. If there is no poster about workers’ compensation, you can contact the board yourself at this number: 1-800-824-COMP. This would be a good time to contact a workers’ comp attorney.
- Unless you ended up in the emergency room or hospital, you will have a doctor assigned to you.
- When you see the medical provider, inform him or her of all pains. Don’t just focus on the body part that hurts the most. You never know when an injury could end up being more severe than you expected — it’s best to have everything documented as soon as possible.
- Follow all medical advice.
Workers’ Compensation Benefits
All medical costs:
Ambulance, emergency room, hospitalization, prescriptions, physical rehabilitation, travel expenses for necessary medical care outside of the county, etc
Temporary partial disability benefits (TPD):
If you are able to return to work, but unable to perform the same job at the same rate of pay, you can be paid up to ⅔ of the difference between the two rates. These benefits continue for a maximum of 300 weeks.
Temporary total disability benefits (TTD):
According to IC 22-3-3-7, you are entitled to these benefits if there is a wage loss because of your injury. If you miss more than 7 consecutive days of work, you will be paid from the 8th day. If you miss more than 21 days of work, you are then eligible to be paid for the first 7 days you missed. Your payment will be calculated but is generally ⅔ of your regular weekly wage up to a maximum of $780 per week.
You are eligible to be paid at this TTD rate if you are either impaired from performing any and all occupations or are unable to perform the same or similar job held while injured. An employer may mitigate his liability for TTD benefits by providing light duty work within the restrictions placed upon by the employee by the treating physician. You will receive these benefits for up to a maximum of 500 weeks, until you take another job, or until you reach maximum medical improvement (MMI).
Permanent partial impairment benefits (PPI):
Once you have reached maximum medical improvement (in other words, your medical provider says that this is as good as it’s going to get), you will be given a PPI rating, which is expressed as a percentage of the loss or lost use of a body part or function. This amount may be paid in installments or in a lump sum.
Permanent total disability benefits (PTD):
According to IC 22-3-3-10, if you are unable to return to work in any capacity, you will be paid the TTD rate for up to 500 weeks or your PPI benefit, whichever is greater.
If your injury or illness prevents you from continuing to do the work for which you are trained, you are entitled to vocational rehabilitation training to prepare you for a job that you can do. Indiana vocational rehabilitation can provide help with the following:
- Exploring your employment interests and skills
- Providing assistive technology or other services to help you keep your job
- Re-entering employment in the same or different type of employment
- Providing services necessary for career advancement
Indiana workers’ comp pays up to $7,500 for funeral and burial expenses. In addition, any dependents of the deceased worker are entitled to receive up to 500 weeks at the same rate as TTD benefits (⅔ of the worker’s weekly wage). If the surviving spouse remarries, the payments stop.
Appealing a Workers’ Compensation Denial
Remember that your benefits do not come from your employer, but your employer’s insurance company. Insurance companies are notorious for protecting their bottom line. You may need the help of an experienced workers’ compensation attorney to help you appeal if you are denied compensation or if your compensation is delayed.
Reasons you may be denied:
- Your employer may not carry the required workers’ compensation insurance.
- The insurance company may allege that you deliberately tried to harm yourself or that you were intoxicated at the time of the injury (see #7 in the Do You Have a Workers’ Compensation Case? section above for more examples).
- The insurer may claim that you are an independent contractor and therefore not covered by WC
- The insurance agency may say that you had a pre-existing condition. If the job exacerbated or triggered the preexisting condition, you are still eligible for workers’ comp. Make sure to tell the truth at all times so that you aren’t counted as untrustworthy. Your medical records will show that you had a pre-existing condition, but they will also show that you were able to perform your job perfectly well until the triggering event that injured you.
- You may not have reported the injury within the required amount of time (30 days).
- You may not have followed the directives of your medical provider.
- Important paperwork may not have been filed by your employer.
- The doctor or insurance agency may dispute the fact that your injury was work-related.
- You may not have attended the medical appointments that were scheduled for you, or you may have seen a provider who was not assigned to you.
What can you do?
- Make sure to follow up on any missing paperwork. You may be able to resolve the problem by fixing an oversight.
- The state of Indiana recommends contacting their ombudsman division to explore Alternative Dispute Resolution options.
- If these measures do not resolve the issue, the state says that you must file an Application for Adjustment of your claim with the Workers’ Compensation Board. This form is available for download here.
- Contact Flores Law Group to help you navigate the maze of regulations so that you can receive the benefits you are entitled to. The workers’ compensation system is so massive and complicated that anyone who doesn’t deal with its labyrinthian rules consistently is at a disadvantage. Even the National Institute of Healthsays, “The modern system of workers’ compensation is so complex and arcane it produces considerable grief to those who must deal with it on a daily basis.”
How Flores Law Group Can Help You
You may not need an attorney if your case is relatively simple. For example, if all of these things are true, you are in a good position:
- Your injury is minor.
- Your employer admits that the injury happened at work.
- Your employer filed everything on time and your benefits are approved.
- You didn’t miss much work.
- You do not have a pre-existing condition.
However, you should hire an attorney if any of the following conditions are met:
- Your claim is denied. Don’t despair. Many claims that are initially denied are subsequently approved with legal guidance.
- Your employer’s settlement doesn’t cover all of your medical bills or seems insufficient. Don’t sign any settlements until you have spoken to an attorney. Flores Law Group provides free initial consultations.
- You were seriously injured and are unable to return to work at all — or at least unable to return in the capacity that you had before the incident. In these cases, insurance companies will often offer a lump sum, but you need representation to make sure that you are being fairly compensated.
- You are currently receiving or planning to receive social security disability benefits. Workers’ comp and social security can affect each other, and you don’t want to receive less than you should because of an offset happening that is more than it should be. Flores Law Group can draft your settlement agreement in a way that doesn’t put you at a disadvantage.
- Your boss has retaliated against you in any way for filing for workers’ compensation. This is illegal. Your boss is not allowed to demote you, fire you, or retaliate against you in any way simply because you were injured on the job. Your attorney can stand up for your legal rights. The Indiana Workers’ Compensation Board has this caution on their website: “Indiana is an at-will employment state, meaning that an employee can be fired at any time except for a handful of reasons. If you feel you have been wrongly discharged please contact a lawyer.”
- If you do not like or agree with the doctor that was assigned to you and feel that you are receiving inadequate care, you can file an Application for Adjustment of Claim with the Workers’ Compensation Board. Make sure that you always communicate with your employer regarding medical care. Your attorney can help you with this.
- If your injury is PTSD that was caused by something that happened at work. Mental health injuries are extremely difficult to prove, so an attorney’s help could be crucial.
- If you were injured as a result of a third party’s negligence. For example, if a drunk driver crashed into you while you were driving as part of your job, you can sue that driver. The CDC reports that 24% of all work-related deaths happened to workers driving or riding in a motor vehicle on a public road.
Flores Law Group can help you gather evidence to support your claim, make sure you file all forms on time, negotiate with the insurance company, and (if necessary) represent you at a hearing or trial.
The insurance agencies are represented by lawyers; you should be too.
Statute of Limitations
The statute of limitations runs two years after the last date of compensation paid or in the alternative two years from the date of injury.
Contact Us Today
Injured individuals are often at a loss when dealing with insurance companies, especially when their lives have been changed permanently. Our office fights for the rights of those affected by workplace accidents or accidents caused by the negligence of others. We will help you navigate your workers’ compensation claim and help you understand your rights from the first phone call.