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Workers Comp Claims and Settlements

When to File a Workers Compensation Claim

Whenever a worker is injured on the job, he or she should immediately report the injury to the immediate supervisor. If a problem does not result from a single event but instead results from an exposure over a long period of time, the worker should report the injury as soon as he or she knows there is a problem that may be related to the work.

The law does not require that either notice or claim be in writing. However, most employers provide forms upon which to report an accident or injury. Workers should use such forms. The failure to report an injury in writing will not in itself mean that the worker is not entitled to compensation. However, if there is any doubt about the situation, it will be much easier for the worker to prove that he or she reported the injury, and that the injury happened, if a written report is made and the worker keeps a copy of the report.

Section 381 of the Workers Disability Act requires that the employee give his or her employer notice of an injury within 90 days after the injury or within 90 days after the employee knew or should known of the injury. If the worker fails to give such notice, however, the employer does not escape responsibility unless it can show that it was somehow harmed by the worker’s failure to give notice.

Section 381 also requires that a worker must make a claim for compensation benefits within two years after the injury. The claim to the employer need not be in writing, but as discussed above, there are good reasons why it should be. In the vast majority of cases, the claim is made with the employer. The law, however, does provide the alternative that a worker can make a claim by filing it in writing with the bureau on a form available from the bureau.

What other time limitations apply?

Circumstances can arise under which a worker has given the proper notice and made a proper claim but for various reasons benefits were not paid. Sometimes many years go by before a worker files an application for hearing. Section 381(2) provides that in those cases the worker cannot receive past due benefits for more than two years back from the date he or she filed an application for hearing.

Section 833(1) deals with the situation in which a worker receives benefits, which are then stopped and the worker later files an application for hearing to have benefits started again. Ordinarily a worker would do this shortly after benefits were stopped. Sometimes, however, this is delayed for a long period of time. Section 833(1) provides that under these circumstances the employer cannot be ordered to pay benefits for more than one year back from the date the application is filed with the bureau.

Sometimes, for various reasons, an employer pays a worker more benefits then he or she is entitled to. Under these circumstances the employer has a right to recover that overpayment from the worker. Usually this is done by reducing future benefits by a specified amount until the overpayment is recovered.

Section 833 provides that the employer cannot recover for an overpayment which was made more than one year prior to the date it takes action to recover that overpayment.

Workers’ Compensation Settlements

How are claims paid?

Workers’ compensation benefits are ordinarily paid on a weekly basis. There are a number of circumstances, however, under which workers can receive a payment of benefits in a single lump sum.

When an employer has denied benefits and a case is eventually decided in favor of the worker, the worker is usually entitled to receive a large payment for past due benefits. Under these circumstances the worker receives a large lump sum payment but it is not in any way a “settlement” of the case.

Under the circumstances described above, the worker keeps his or her right to file a new claim if he or she has additional trouble in the future. In other words, if the worker has more medical bills or another period of disability involving that same injury, the claim can be reopened.

Sometimes cases are settled by a redemption. If a case is redeemed, the worker receives a single, lump sum payment from the employer and in return gives up all of his or her future rights to workers’ compensation benefits. Redemptions are valid only if they are approved by a magistrate after a formal hearing. At such a hearing papers are prepared that show exactly how much the settlement will be, where the monies will go and how much the worker will receive. The case and reasons for the settlement are then explained to the magistrate by the parties. The magistrate makes certain that the worker understands his or her rights. Only then will a magistrate approve such a redemption settlement.

If an employer is represented by an insurance company, it must be notified of any proposed redemption at least ten days before the hearing. It has a right to come to the hearing and object to the settlement.

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