Kentucky Workers’ Compensation
By Zac Pingle, Staff Writer
What is Workers’ Compensation?
Workers’ compensation allows injured workers to receive financial compensation for their injuries without filing a personal injury lawsuit against their employers. Nearly every employee is covered by workers’ compensation by Kentucky State Law, with the exception of certain farmers and domestic servants. Workers’ compensation is a no-fault means of compensation, meaning that you will be compensated for your injuries regardless of who was responsible for them. Although, keep in mind that Kentucky workers’ compensation benefits are only available for work-related injuries and will not pay for any injuries that happen outside of the workplace or work hours.
What Kinds of Benefits does Kentucky Workers’ Compensation Provide?
There are many different forms of coverage or “benefits” that workers’ compensation provides. These benefits are intended to make an employee “whole again,” meaning that the goal of compensation is only to offset the damages done to you. This is why workers’ compensation will requires your employer’s insurance company to pay for all relevant medical costs that relate to your injury. You are also entitled to 52 weeks of vocational rehabilitation if your injury stops you from returning to your job. Although, workers’ compensation is used primarily for income benefits, which are:
Temporary Total Disability (TTD)
If your injury stops you from returning to work, then the first income benefit that you are likely to receive is Temporary Total Disability (TTD) benefits. TTD benefits are equal to two-thirds of your average weekly wage. Average weekly wage is calculated by using the highest paying 13 weeks of the last year you worked before you were injured. The amount of compensation for TTD benefits is limited to the state average weekly wage maximum. TTD benefits will be paid until you are healthy enough to return to work, or until your injury has reached Maximum Medical Improvement (MMI). You will not be compensated for the first seven days after you injury, unless your injury lasts two weeks or longer.
Permanent Total Disability (PTD)
If your injury does not heal completely once it has reached MMI, you may qualify for Permanent Total Disability (PTD) benefits. Like TTD benefits, PTD benefits will compensate you for two-thirds of your average weekly wage. The difference is that these benefits could last for the rest of your life and have to be paid a minimum of 20 percent of the state average weekly wage. In general, injuries that are presumed to be total and permanent are:
Complete and permanent blindness in both eyes.
Loss or paralysis of both feet at or above the ankle.
Loss or paralysis of both hands at or above the wrist.
Loss or paralysis of a hand and a foot.
Incurable insanity or imbecility.
Total loss of hearing.
Permanent Partial Disability (PPD)
If you suffer from a permanent disability, but you can still return to work, you may qualify for Permanent Partial Disability (PPD) benefits. You may only receive PPD benefits once your injury has reached MMI and your doctor has confirmed that you have a permanent impairment. Doctors are required to asses the amount of impairment you have by using the American Medical Association’s Guides to the Evaluation of Permanent Impairment, the Fifth Edition. Based on your doctor’s evaluation, you will be assigned an impairment rating which will be used to determine the amount of compensation you are paid. Calculating the amount of PPD benefits can be a little complicated because there are a few different multipliers involved. To calculated PPD, multiply two-thirds of your average weekly wage by your impairment rating. Next, multiply the factor that your impairment rating is assigned to (though this will vary depending on the amount of income you earn after your injury). If your impairment rating is less than 50 percent, you can only be paid for up to 425 weeks. However, if your impairment rating is greater than 50 percent, you may be paid up to a maximum of 520 weeks. To make the calculation of PPD benefits easier, the Kentucky Department of Workers’ Claims has created a PPD Calculator on their website.
What Should I do if I’m Hurt at Work?
It is very important to inform your employer if you are hurt on the job as soon as possible. There cases where it is more reasonable to wait to tell your employer of an injury, such as needing emergency treatment. Although, you will still need to give your employer notice of your injury as soon as reasonably possible. You notice should be in written format and include the date of your injury, your name, and a brief description of what happened when you were injured. You may also want to consider keeping a journal that records the effect of your injuries on you, as well as hold on to any information regarding your injury (medical bills, police reports, etc.).
Once you have given notice to your employer, he will inform his insurer and start the process of filing a workers’ compensation claim on your behalf. So, the next step that you should take is to seek medical treatment. You are allowed to chose your own physician in the state of Kentucky. Although, you may have to chose your physician from an approved list if your employer has a medical compensation plan. This doctor will examine your injuries and provide you with initial treatment. Do not forget to tell your doctor that you sustained your injury while on the job so that he will know who to bill for your treatment.
If My Claim is Denied, What Should I do?
In most cases of workers’ compensation claims there is no question as to the entitlement of an injured worker, thus claims are not denied often. However, if your claim is denied, then it is likely that your case was simply misfiled or your case lacked sufficient evidence that your injury was work-related. You should consider contacting your employer’s insurance carrier if you believe there was any misunderstanding with your case.
On the other hand, if your employer’s workers' compensation provider still challenges your claim after you have attempted to resolve the matter, your next best step would be to retain a Kentucky workers’ compensation attorney. You should receive a notice of a denied claim by mail within two months after your claim has been denied. At this point (assuming that you have called the insurer to discuss why your claim was denied), you and your attorney will appeal the denial and attend a Benefit Review Conference. The simple act of having your attorney with you may lead to the insurer dropping its challenge to your claim at this hearing to avoid going through the appeals process. However, if your case still is not settled after the Benefit Review Conference, you may then attend a formal hearing of your case by an Administrative Law Judge (ALJ).
It is important to retain an experienced workers’ compensation attorney, as the claims and appeals process can be very complicated and required in depth knowledge of law. It is your right to retain a workers’ compensation attorney at any point in the claims process. Additionally, workers’ compensation attorneys are paid on contingency, so you won’t be charged up front.