FAQ'S - Workers' compensation

If you have been injured at work or if a workplace accident accelerates or aggravates a pre-existing condition you may be eligible for workers' compensation benefits. 

 Lost Wages The most common benefit which is provided through workers’  compensation is reimbursement for lost wages. These benefits can be paid  on a temporary basis, when the employee needs time off work to recover,  or a permanent basis if the employee will never fully recover from his  or her injuries. In a majority of cases employees will miss some work  and will have medical expenses but they will fully recover and will be  able to return to their old duties. These employees will be reimbursed  for the work that they missed. The amount of the reimbursement for lost  wages is usually equal to a percentage of what the employee would have  earned if they had been working. When a disability will have a permanent effect on the employee’s  ability to compete in the workforce and earn money then the employee may  get reimbursement for future lost wages. The amount of the benefits is  usually an estimate of the difference between what the individual could  earn without the disability and what their current earning potential is.  Again, every state can have its own scheme for calculating benefits. In extreme cases, where an employee cannot work at all, they are  entitled to total disability benefits. This is similar to future lost  wages except that it is not offset by any other amount. If an employee  has zero earning potential then workers’ compensation could be the only  income that they have. The amount of a total disability benefit could be  based on what the individual was earning at the time of the injury or  what their anticipated future earnings would be. 

Healthcare In addition to lost wages most states provide medical benefits.  Employees can get the treatments which are reasonable and necessary to cure  or relieve their injury. They can get reimbursement for medical bills  and for prescription medications. There may be certain limitations  however, like requiring the individual to see a particular doctor. In  some cases, workers’ compensation will also pay for transportation to  the hospital. The cost of future medical expenses may also be figured  into the amount of a monetary award. 

Rehabilitation There are two major types of rehabilitation; medical and vocational.  Many people think of physical therapy when they hear the word  “rehabilitation,” but it can also mean preparing for a new job. If an  employee is unable to return to his or her former position they may need  vocational training. Employees in vocational training will generally  get partial income too. They will be unable to work, both due to their  disability and the fact that they must attend training, and they may  require financial support. 

Conclusion These are just some of the benefits that are usually offered through  workers’ compensation. States can limit these benefits or offer much  more. Although the benefits vary from state to state, each state has a  schedule for calculating the appropriate benefit due. An employee can  get a good sense of what they may be entitled to by looking at their  states laws or talking to an attorney. 

 Many employees are aware of basic procedures they must follow when  they are injured on the job, such as notifying their employer and filing  a claim form. What they may not know is that their employer has  additional obligations under the workers’ compensation system. These  duties can range anywhere from providing employees with claim forms in a  timely manner to addressing harassment in the workplace. Failure to  comply with these obligations can lead to fines and even civil or  criminal liability. The first and most basic expectation of employers is that they  participate in the workers’ compensation system. Each state has their  own requirements about which businesses must participate, but usually,  only very small businesses are excluded. An employer that is required to  participate but fails to carry insurance for their employees is subject  to fines and civil or criminal liability. An employer who participates in workers’ compensation usually has  certain obligations towards employees and must submit reports related to  workers’ compensation. The obligations towards employees might include  posting a sign stating that the employer is in compliance with workers’  compensation and providing an injured employee with a claim form within a  certain period of time. The reporting requirements could include  providing a statement for every injury claim or providing more general  reports on the number of accidents which have occurred. Naturally, employers are expected to provide emergency medical care  for employees but they are usually also expected to provide ongoing  medical attention and to cooperate with rehabilitation plans. In some  states employers will even be required to provide rehabilitation  counseling for employees who will miss work for a certain period of  time. The term “rehabilitation” can be used to include more than just  medical needs- it could include vocational training. The idea is that  this is what the employee needs in order to become productive again-  whether it be in their old position or in a new one. An expectation that goes hand in hand with the obligation to  cooperate with the employee’s rehabilitation plan is the duty not to  retaliate against an employee just because they made a claim for  workers’ compensation benefits or because they require certain  accommodations. In order to keep employers from taking retaliatory  actions, states may allow the employee to take certain actions including  bringing a lawsuit, particularly if the employee is fired in  retaliation for bringing a claim. If an employee is fired they will  usually have the right to an administrative hearing or they will have  the opportunity to sue their employer for wrongful discharge. In general, employers don’t have a legal duty to make sure that no  one gets hurt in the workplace. If other employees are not properly  supervised or if there is not adequate security, this does not give rise  to a suit against the employer. These are the kind of negligence claims  which are generally barred by workers’ compensation. There can be  exceptions, however when an employer intentionally creates an unsafe  work environment. Also, employers have some responsibility to deal with  issues which create a hostile work environment like sexual harassment.  If an employer is aware of the conditions, or should be aware of them,  and fails to act, then they may be personally liable for an injury that  results. 

 If you are receiving benefits from workers’ compensation for a  disability, the effect of going back to work will depend on the type of  benefit involved and the laws in your state. Although the details of  each state’s workers’ compensation plans vary, there are characteristics  that most plans share in common. There are two major categories of disability benefits: temporary and  permanent. Temporary benefits are given when an employee needs to be  away from work for a short period of time for medical attention or  recovery. These benefits are intended to be temporary and expire when  the employee returns to work. Permanent disability benefits are given  when the employee will never fully recover from their injury and  therefore, their future earning potential is affected. The amount of the  benefit reflects future lost wages (the difference between what the  person would have earned and what they are able to earn with the  disability). In cases where the employee is unable to do any work as a  result of their injury, the individual would receive total disability  benefits (these can be temporary or permanent depending on how long the  disability prevents the person from working). This amount is generally  calculated considering what the employee was able to earn before his or  her injury. When a person returns to work, temporary disability benefits are  terminated, since there is no need to compensate the person for lost  wages since they are now able to work. In some states, the mere fact  that the person returns to their former position would be enough to end  the disability benefits, but other states require a letter from the  doctor saying that an employee is able to return to full duty. Total disability benefits are given when an employee is considered  unable to do any work. Therefore, if the employee returns to work or  finds a new job they will be unable to collect benefits. In general, if  the person resumes working their benefits will terminate. Different  states use different standards to determine when benefits will end. Some  states will ask whether the person is capable of finding sustained  gainful employment while other states will require that the person  actually has an opportunity to perform a gainful and suitable  occupation. The question is not just whether or not the person is  capable of performing at a job but whether the person actually has a  present opportunity for employment, such as a job offer. Individuals who receive permanent disability benefits generally  receive an amount that is based on their previous earnings and  compensates them for future lost wages. The idea is that the employee  may be able to find another job but they may not be able to earn the  same wage. If an employee is receiving benefits and ends up finding a  job that pays the same wage or more, their disability benefits will  generally not terminate. In general, fluctuations in the amount that the  employee earns will not cause his or her benefits to be reduced or  discontinued. This includes reductions in salary as well. If the  employee earns less than expected then the amount of disability benefits  is not increased. The amount of the benefit is calculated considering  the effect of the disability on employment so if the disabling condition  doesn’t change then the amount of the benefits generally shouldn’t  either. The effect of returning to work, whether in your former position or  to a new job, will vary from state to state. An employee who is being  paid workers compensation for future lost earnings or who is totally  disabled should use caution before making major changes in their  employment status. These changes could affect their benefits. These  individuals should also consider that they may have a duty to report  changes in their employment to the company through which they obtained  workers’ compensation or to the insurer who is paying the benefits. An  employee who fails to do this may find that they are responsible for  reimbursing workers’ compensation for any excessive payments made. The  financial stakes in these cases can be high so a worker in this  situation may want to consult an attorney before going back to work. An  attorney may also be able to inform the employee of other options  available to them such as applying for social security disability  benefits. 

 The short answer to that question is “Yes.” A lawyer can certainly  help you understand the workers’ compensation process and to help you  formulate your claim. What you probably really want to know is “Should I  have a lawyer help me with my workers’ compensation claim?” Is it going  to be worth the financial investment?" Well, that is a more difficult  question. It is going to depend on the situation. A vast majority of  workers’ compensation claims are easily handled between the employee and  the employer but some can get complicated and eventually end up in  court. The first step in making a claim for workers’ compensation benefits  is filing a claim with your employer. The advantage of having an  attorney when you first file your claim is that a lawyer can help you to  accurately and honestly describe the event which caused your injury  while still avoiding the pitfalls that may prevent you from receiving  benefits- like suggesting that you were intoxicated or engaging in  irresponsible behavior at the time of the incident. Generally, it is not necessary to have a lawyer when you first file a  claim. The need for a lawyer is more likely to arise after the claim  has been denied. Each state has its own appeals process for workers’  compensation claims that have been denied. When a claim is denied there  is usually an administrative appeal which is often followed by the  opportunity to appeal to a special board or commission. In some cases,  an appeal will be heard by a workers’ compensation court. Most people  would want a lawyer before going to court. Mostly because they are  uncomfortable in a courtroom setting but also because the other side  will probably have a lawyer. Some workers compensation cases are even  appealed to the highest court in the state (usually called the Supreme  Court). Whether or not you should have the assistance of an attorney probably  depends on the nature and severity of your injury. If you have a  serious injury, a work-related disease, or the permanent aggravation of a  preexisting condition you may be entitled to a monetary award for  future medical expenses and lost wages. If you are unable to do the same  work or if you are unable to work at all, then the stakes of a workers  compensation claim will be high. The type of benefits that you will  receive through the program (monetary benefits, vocational training  etc.) could be critical to your well-being and financial outlook. If you  have the type of injury that has permanent or long term debilitating  effects then you probably want the assistance of an attorney. Finally, another benefit to having an attorney is that sometimes,  workers’ compensation is not your only option. Although in a majority of  cases you do not have the right to sue your employer, there are a few  narrow exceptions. If the injury was the result of an intentional act  then you may have the right to sue. If the injury results from a  defective product or machine then you could have a claim against the  manufacturer of that item. An attorney can help you consider these  options as well as other options that may be unique to your situation. 

 Workers’ compensation is a system created by state law. Most  employers are required to participate in the system. Employers  contribute money to a fund that then provides benefits to workers who  are injured on the job. In theory, this system for workplace injuries  works to the benefit of employees and employers. Employees benefit  because they do not have to prove that their employer was at fault in  order to be compensated for their injury. The employer benefits because  the employee gives up the right to sue the employer. The employer’s  liability insurance goes down and they have more certainty about future  expenses. Both parties get to avoid the time, hassle and uncertainty  associated with a lawsuit. Each state has its own set of workers’ compensation statutes but most  systems operate in a similar fashion. When an injury occurs, the  employee notifies his or her employer and fills out a claim sheet. Both  have certain obligations – the employee must report the incident in a  timely fashion and the employer must provide them with a claim form, and  often other information, in a timely fashion. The time-period to comply  with these rules varies between states. If the claim is initially denied, there is an appeals process. The  particular process will depend on state law. There is usually an  administrative process where the issue is reviewed and then an appeal to  a special court or board if necessary. Sometimes these decisions are  reviewed by the highest court in the state. The benefits of workers’ compensation go beyond reimbursing medical  bills or paying for lost wages while unable to work. The benefits may  include compensation for future benefits lost and for vocational  training. If an injury is so severe that it will permanently affect the  employee’s ability to engage in certain employment and earn a certain  wage they may be eligible for a monetary award. If the employee is  unable to return to his or old position but can still work, workers’  compensation can provide vocational training so that the employee can  find gainful employment in a new job. The downside to workers’ compensation is that employees do not have  the right to sue their employers for most workplace injuries or  illnesses. The amount an employee will receive in compensation may be  less than what they could have received with a successful lawsuit. On  the other hand, an employee that could not have proven that the employer  was negligent would have received nothing. There are certain instances when an employee may still have the right  to sue. One example is if the employer or their agent does something to  harm to the worker intentionally. Even when workers’ compensation is  the exclusive remedy for the employee, they retain the right to sue  people other than their employer. If an employee is injured at work  using a product made by third party they can go after the third party.  If they succeed, however, then the employer may be able to go after them  for any workers’ compensation benefits already paid out. Overall, most are content with this system of dealing with workplace  injuries. There are no major efforts to reform the system. Although some  of the payouts may be small they are easier to obtain and accessible to  more people. Quick assistance for injured employees means that they can  recover more quickly and thus return to work. 

 It is well known that workers’ compensation is available for people  who are injured on the job. What may not be so clear is what constitutes  an injury. If you have to pull your co-workers bloody hand from a piece  of machinery, causing you emotional distress, is that a compensable  injury? A court in Illinois said yes. Ultimately, whether certain  emotional or mental affects of workplace events will be covered by  workers’ compensation depends on state law and how the courts rule in  similar matters. Therefore, the answer can vary tremendously from state  to state. As in all workers’ compensation claims, an employee making a claim  for emotional distress or mental stress must show that there has been an  injury and that the injury was work-related. Many states include mental  and emotional conditions in their definitions of injury, but most  states have definitions that are more ambiguous. It is often necessary  to look at decisions of the workers’ compensation courts and the civil  courts in order to understand how the law has been interpreted. Some state laws include the requirement that an injury manifest  itself with physical symptoms. What the courts consider a physical  symptom is also something that will vary. Some courts require objective  physical evidence of an emotional response like fainting, sickly  appearance, pale face, or nervousness. Other courts will use a more  subjective standard and may accept evidence of changed emotional state. If an employee can show that they have suffered an injury, then they  must still show that the injury was the result of a work-related event.  Usually a claim is considered work-related if it occurs while the  employee is performing their usual duties, while they are on breaks, and  when they are running errands for the benefit of their employer.  Company social events are usually covered by workers’ compensation too.  The work-related activities definition would be the same for a person  making a claim for a mental or emotional problem as someone making a  claim for a broken leg. The difference is it may be harder for the  former to prove the connection between their injury and the workplace. When a traumatizing event occurs, such as pulling an injured hand out  of a machine, the connection between the emotional response and the  event is clear. If the emotional distress is the result of harassment or  the stress of work duties, then it may be more difficult to show a  connection between the symptoms and the cause. This is the challenge of  bringing claims for mental and emotional conditions that do not result  from a physical injury. Since this area of law is still developing, it can be difficult to  predict when a condition will be covered. Courts have gone both ways,  for example, about whether or not distress caused by workplace  discrimination or harassment is compensable. When it comes to stress  caused by an employee doing his or her regular duties or because his or  her duties have changed, most courts have found that the employee should  not be compensated. This area of law continues to change as society is  more willing to acknowledge the affects of nonphysical injuries. Finally, there is the issue of emotional distress that is the result  of an intentional act by the employer. If the employer, or one of its  agents, does something with the intent to cause distress then it may  take the case out of the realm of workers’ compensation and allow the  employee to bring a private lawsuit. A careful reading of state law is  needed to determine if workers’ compensation remains the exclusive  remedy in that situation so an experienced workers’ compensation  attorney should be consulted. Often, an employee will have the  additional option of going to court under these or similar  circumstances. 

   The  Social Security Administration (SSA) is burdened with a large number of  Social Security Disability Insurance (SSDI) and Supplemental Security  Income (SSI) applications. Their application review process can be  lengthy, and results in the majority of applications being denied the  first time around. Individuals struggling with a disability or illness do not have time  to waste when they are unable to work and earn income. They need results  as quickly as possible. Our job at Sullivan Sullivan and McGuire is to  simplify the Social Security Disability process and improve our clients’ chances for:   

• Having an SSDI claim accepted as soon as possible, whether in initial filing or in a denied claim appeal
• Having a favorable disability onset date that results in the most generous benefits payment possible

SSDI Claims Filed Alone Versus Those Filed With Legal Counsel

Individuals  who have legal representation are more likely to have their claims  accepted during the initial application phase. This is because their  applications are typically more well-documented and grounded in  substantial evidence that supports their claims. By working with us, you can be certain your claim will be filed  properly in accordance with all important deadlines. It will be  substantiated by medical records, an analysis of your occupational  limitations and an understanding of your financial hardships. We can  inform you of the various regulations that govern how disability  benefits are determined, the Social Security rulings that may relate to  your claim and the medical vocational grid rules that pertain in your  case. Our attorneys work with clients personally,  responding to inquiries and keeping our clients involved. This is your  case. You should know how it can affect your livelihood and your ability  to meet the demands of daily life. Once you have retained counsel from our firm, you will not have to  deal with complicated correspondence with the Social Security  Administration. We can do the heavy lifting for you, and ultimately  provide you with a better chance at success.     

   There  is a great deal of confusion between the Social Security  Administration’s two disability benefits programs: Social Security  Disability Insurance (SSDI) and Supplemental Security Income (SSI). If  you have questions about the difference between SSDI and SSI and which  one makes the most sense in your case, you are not alone. At Sullivan Sullivan and McGuire, our lawyers have more than 30 years of experience providing Social Security Disability guidance to people in the greater Denver area. We can answer your  questions and help you pursue benefits through the program that is right  for you.  

A Question Of Eligibility

The  key distinction between SSDI and SSI is eligibility. The first criteria  that must be met for both programs is that you must be disabled and  unable to work. To qualify for SSDI benefits, however, you must also  meet criteria related to your work history. To get SSDI benefits, you must have earned sufficient work credits  prior to becoming disabled. In other words, you must have worked for a  certain period of time and contributed a portion of your income to  Social Security. Only after earning the required amount of work credits  are you considered insured under SSDI and eligible for benefits. SSI, on the other hand, is considered a low-income program. You are  not required to have worked for any length of time prior to becoming  disabled. You will only be eligible for these benefits if you have  limited income and assets.  

Different Benefits

The  amount of benefits offered through SSDI and SSI also differs. The  amount of money you could receive in SSDI benefits is based on your  lifetime earnings. For most people, this is substantially more than is  offered in SSI benefits. The amount of money you could receive in SSI  benefits is set by law and could be impacted by other income you  receive.     

      The  Denver SSDI attorneys of Sullivan Sullivan and McGuire are committed to  getting people the SSDI or SSI benefits they need. We have more than 25  years of experience in helping people in Denver and the surrounding  parts of Colorado. We will put forth every effort to see that you get  the benefits you need to maintain your quality of life despite an injury  or illness that prevents you from working. Our success rate in SSDI means that we know what to do to get  results. We have helped countless people through the system. Our team  knows how to navigate through the seemingly endless amounts of red tape  and bureaucracy that stand between you and the benefits you need. Having handled these cases many times before, we understand what the  judges are looking for when we appeal an SSDI denial. We know their  specific habits, and we know the guidelines that they follow. At the  outset of your case, we will design a legal strategy with these things  in mind. We will gather medical records and testimony to strengthen your  case. TheDenver SSDI attorneys of Sullivan Sullivan and McGuire  will present a strong case in an administrative law hearing. If we are  unable to get results there, we can stand by your side to pursue  additional steps. We are here to see that your rights under SSDI law are  observed.  

Tom  and Darla both work in the same field. They know each other through a  community organization. Recently, they both suffered serious injuries.  Darla’s was the result of being hit by a car while on a walk. Tom’s was  the result of falling from his roof while putting on new shingles. Darla  was surprised to find that her SSDI claim was denied while Tom’s was  accepted, despite the fact that the only real difference in their  situations is that Tom is 15 years older. Does Darla have any options? At Sullivan Sullivan and McGuire, we will not only help Darla  understand why she was initially denied, we will also help her  understand the additional action she can take.  

Our  attorneys are committed to SSDI law. We frequently lecture on the  topic, sharing our knowledge with a wide range of other professionals.  That is the level of understanding we bring to every case.     

   Countless  Social Security Disability claims result in denials. That does not mean  a denied SSD claim is not legitimate. You do not have to simply accept a  denial. The attorneys of Sullivan Sullivan and McGuire can stand by  your side to appeal the decision and help you get the benefits you need.  If you or a loved one has had a Social Security Disability claim  denied, we are here for you. Since 1982, the law firm of Sullivan Sullivan and McGuire has helped people who are unable to work due to injury or illness of  any sort. We are available to stand beside people in Denver and the  surrounding parts of Colorado. When you choose us, you can be assured  that you will have an experienced attorney by your side from start to  finish. Your case will not be passed around the office. We will be here  for you when you need us. The Social Security Administration (SSA) may give a wide range of reasons for denial of an SSDI or SSI claim, including:   

• Injury or illness does not meet their criteria for a disability
• Not enough work credits
• Insufficient medical evidence of disability

No  matter what reason was given to you for your denied SSD claim, we can  help. We will put forth every effort to see that your rights are  observed and you get what you deserve.  

How Do I Appeal A Denied Claim?

Understanding  why your claim was denied is the first step to appealing the SSA’s  decision. The next step involves making sure the information presented  to the SSA is as thorough and detailed as possible. Our attorneys have in-depth research and writing skills: key elements  in any appeal process. We make sure our clients’ paperwork is complete  and accurate and the evidence they used to support the claim does  exactly that. We review the filing process to make sure deadlines were  met and will be met during the appeal. Perhaps most importantly, we  investigate the details surrounding our clients’ medical conditions by  speaking with medical professionals, occupational experts and financial  analysts who can provide insight into the full scope of our clients’  needs. In many cases, compounding factors like one disability that coincides  another impairment are what make the difference between an accepted and  denied claim. We can make sure no key information goes overlooked.  Due  to an injury sustained in a serious truck accident, Harlan was no  longer able to continue working at his job as a roofer. He sent in a  Social Security Disability claim and was denied. A few months later, he  found out he could appeal the decision. He was told that the 60 days he  had to appeal had expired, and he now needed to start all over again. In  the meantime, he is having difficulty paying his bills. What should he  do now? The attorneys of Sullivan Sullivan and McGuire take great care to  ensure that important deadlines are met in cases like Harlan’s. We know  what to do after SSDI claims denials.  Our  team’s hard work in Social Security Disability claims cases has earned  us a 90 percent success rate for our clients. We want to make you one of  our successes.     

      Many  misunderstandings exist about Colorado Social Security law and the  rights they provide. At Sullivan Sullivan and McGuire, our attorneys are  committed to cutting through those misunderstandings. We are here to  educate you about how SSDI or SSI can benefit you. If you or a loved one  is unable to work due to a serious illness or injury, we are ready to  help. Since our establishment in 1982, Sullivan Sullivan and McGuire has made a commitment to helping people get the benefits they need to  maintain their quality of life. Our experienced lawyers are available to  help people in Denver and the surrounding parts of Colorado. The help we provide starts by providing you the information you need  to understand Colorado Social Security law. We will clarify common  misunderstandings, including those related to:   

• What the Social Security Administration considers a disability
• The difference between SSDI and SSI
• The relationship between a person’s age and their ability to get SSDI or SSI
• What documentation the Social Security Administration needs to see in order to provide SSDI or SSI
• How Medicare and Medicaid relate to SSDI and SSI
• Whether SSDI or SSI is based on a person’s  ability to continue in the current line of work or on the ability to  obtain an alternate form of employment

We will provide you with the knowledge you need to make educated decisions as we move forward with your case.  Tina  used to work as an electrician. Recently, she lost the use of her legs  in a car accident. She is no longer able to pursue the line of work she  has done for the last decade. Her application for benefits was denied.  She was told that the information provided does not indicate that she is  unable to pursue a job in an alternate field. Can she still obtain  benefits under Colorado Social Security law? The lawyers of Sullivan Sullivan and McGuire are dedicated to helping  people like Tina get the answers they need to understand SSDI and SSI.  You  deserve personal attention. We are prepared to provide it. At the  outset of your case, we will learn about how your injury or illness has  had an impact on your life and your ability to work. We will learn about  your goals. As we move forward, we will only move in the direction that  is right for you.