An Overview of Workers’ Compensation Benefits

 

Workers’ compensation (workers’ comp) helps people who get hurt or sick from the work they do. Sick or injured workers can get medical care, wage loss benefits, and vocational rehabilitation (VR).

 

Most employers pay for workers’ comp insurance or are authorized to be self-insured.

 

Michigan Workers Compensation Act

 

The Michigan Workers’ Disability Compensation Act (Act) established protections for workers who get sick or injured from the work they do. It makes benefits available to most workers regardless of who is at fault for the injury or illness.

 

The Michigan Department of Labor and Economic Opportunity, Workers’ Disability Compensation Agency (Agency) is in charge of administering those claims.

 

Covered Employers

 

All public (government) employers are subject to the Act. Private (non-government) employers who regularly have three or more workers are also subject to it. If a private employer only has one worker, but that worker worked at least 35 hours a week for 13 of the last 52 weeks, that employer is subject to the Act.

 

Exceptions

 

There are exceptions for employers who don’t meet this standard but are part of certain industries. Some examples of industries where employers may still be subject to the Act are agriculture, housekeeping, and real estate. Employers not subject to the Act can still get workers’ comp insurance.

 

Covered Workers

 

The Act covers all workers regardless of whether they are full-time or part-time. It also covers workers regardless of length of time they have worked for the employer.

 

Independent Contractors

 

If you get sick or hurt from the work you do and you are an independent contractor, you will not be able to get workers’ comp. However, it is possible that your employer wrongly classified you as an independent contractor. Independent contractor status is not controlled only by what your employer calls you. Many factors are used to decide if you are an independent contractor or an employee. You may want to talk to a lawyer if you feel your worker classification is wrong. Contact the Michigan workers compensation attorneys at The Lockwood Legal Group, LLC for a free consultation.

 

Covered Injuries and Illnesses

 

The Act covers a worker who gets hurt or sick from the work they do. If the work they do causes, contributes, or aggravates the condition, the worker should get workers’ comp. The worker has to prove a connection between their work and their condition. They may need medical evidence that shows the condition is linked to their work. Some conditions may be hard to connect to the work someone does.

 

The Act applies to work-related injuries or illnesses that occur in Michigan. It doesn’t matter if the employer or worker aren’t residents of Michigan, or the employment contract was signed out of state.

 

The Act can also apply when the injury or illness occurs outside of Michigan. The Act will apply if the worker is a resident of Michigan at the time of the injury or illness, or the employment contract was made in Michigan.

 

For more information about what injuries are covered by workers’ comp, read this list of questions about Eligibility for Workers’ Comp on the Michigan Department of Labor and Economic Opportunity (LEO) website or further posts on Michigan workers compensation located on our blog.

 

Worker Responsible for Their Injury

 

Workers who are hurt because of their “intentional and willful” misconduct cannot get workers’ comp benefits. Intentional and willful misconduct means an employer regularly enforced a safety rule that a worker ignored and was hurt as a result.

 

However, judges have recognized that a certain amount of horseplay is expected at most jobs. If horseplay causes an injury or illness, that doesn’t mean a worker can’t get workers’ comp.

 

The Different Workers’ Comp Benefits Available in Michigan

 

Medical Benefits: Medical benefits should be made available to you starting the day you get hurt or sick. If you need extended medical care, your employer gets to select the doctor you see for the first 28 days. After that, you can switch doctors if you would like. If you do, let your employer and their insurance company know by writing them a letter or an email. They can dispute who you choose. To learn more about what happens if your employer disputes the doctor you choose, read the section “Disputed Claims” below.

 

Wage Loss Benefits

 

After you report your injury, there is a seven-day waiting period before you can get wage loss benefits. The seven days include weekends and holidays. You are eligible for benefits on the eighth day.

 

This means if your injury does not last that long, you will not get wage loss benefits. If you stay out of work for at least 14 days, you can get benefits for the first seven days you were out of work. Weekly benefits are about 80% of your wages after taxes. To learn more about wage loss benefits, read Michigan Workers’ Compensation Wage Loss Benefits.

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Vocational Rehabilitation (VR)

 

You have a right to VR if you cannot do the same work you did before your injury or illness. VR can include services to help you return to the workforce. Some examples include new job training and education. To learn more, read this pamphlet about VR from the Agency.

 

If you and your employer cannot agree on a VR program, you have the right to a hearing in front of the Agency. Learn more by reading the section “Disputed Claims” below.

 

 

Injury or Illness Resulting in Disability

 

In order to get wage loss and VR benefits for an extended period, a worker must show their injury or illness caused a disability. A worker has a disability if the injury or illness limits their ability to earn wages. The worker needs to share information about their qualifications at the time they got injured or sick. This can include education, training, work experience, and other skills. These things don’t necessarily have to be related to the work they were doing at the time they were sick or injured.

 

To learn more, read the section “Getting Your Benefits” in Workers’ Compensation Wage Loss Benefits.

 

Report an Injury and File a Claim

 

If you get hurt or sick from the work you do, report it right away to your employer. Reporting an injury or illness is different than filing a claim. You need to report getting sick or injured within 90 days of the injury or learning you are sick.

 

You have two years from the date you are hurt or the date your disability starts to file a claim for medical benefits. You must file a claim for wage loss benefits within one year of the date you get hurt or sick. However, the sooner you report it, the sooner you might get access to benefits.

 

Your employer will either start covering benefits themselves, or they will file a claim with their insurance company. If your employer does not do either of these things, you can file a claim with the Agency using form WC-117.

 

If you don’t know whether your employer has workers’ comp insurance, you can use the Current Workers’ Compensation Insurance Coverage Lookup on the Agency’s website. You could also contact the Agency to find out.  If they do not have insurance, they may be self-insured. This means that they plan to pay any required workers’ comp benefits through a claim administrator. themselves.

 

If your employer doesn’t have workers’ comp insurance to cover your benefits, you can sue them in court to cover the damages caused by your injury or illness. These types of cases are complex. If you want to sue your employer, you may want to consider speaking with an experienced workers compensation attorney from The Lockwood Legal Group, LLC. All initial consultations are free. 

 

It’s possible that you and your employer may not agree about what benefits you should get. To learn more about this, read “Disputed Claims” below.

 

Getting Your Benefits

 

Your responsibilities for getting workers’ comp begin by promptly reporting your injury or sickness to your employer. Once you are getting benefits, you must let your employer, or their insurance company know if you are getting income from work. You cannot get workers’ comp benefits if you are working and earning the same amount or more than you did before you were injured. The two exceptions to this are if your disability is total and permanent, or if you lost a body part as a result of the injury (specific loss). To learn more about specific loss, review the “schedule of disabilities” section of the Act, or talk to a highly skilled Michigan workers compensation attorney at The Lockwood Legal Group, LLC.

 

To continue getting your benefits, you must do all of these:

1. Look for jobs that you are able to do with your disability.
2. Agree to reasonable periodic medical exams if your employer or their insurance company asks for them.

3.   Continue rehab that will help you return to work.

4.   Accept employment offers if you are physically able to

5.   do the work.

 

Disputed Claims

 

Many benefit claims are undisputed. However, when there is a dispute, the Workers’ Compensation Board of Magistrates hears them. In most cases, neither the worker nor employer can take a workers’ comp issue directly to court.

 

If your claim is disputed by your employer or their insurance company, you will need to file form WC-104A, Application for Mediation or Hearing with the Agency. Depending on the facts of your case, the Agency will schedule your case for a mediation or a magistrate hearing.

 

The Agency will schedule your case for mediation if any of these are true:  

• Your employer does not have workers’ comp insurance.
• Your claim is only for vocational rehabilitation services or only for medical benefits.
• You do not have a lawyer.
• The Agency believes the dispute could be resolved by mediation.

 

If none of those situations apply to your case, the Agency will schedule your claim for a hearing in front of a magistrate. If your case starts with mediation but is not resolved, the Agency will schedule it for a hearing in front of a magistrates.

 

Contact The Lockwood Legal Group, LLC today!

 

If you think you might have a case, it is crucial you contact a qualified attorney right away. We understand litigation is often daunting to those who are not attorneys. but rest assured, we will be here for you all throughout the process. No one fights harder for their clients then attorneys of The Lockwood Legal Group, LLC.

 

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