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Who can receive Workers' Compensation Benefits? Most full-time and part-time employees who suffer from any injury or disease, which results from work or working conditions, are covered. Under the law, certain kinds of employees are not covered. What should I do if I am injured?
Do I have to file any papers to make a claim? Upon notifying your employer of your work-related injury, they will be filing an "Employer's Report of Industrial Injury/Illness" (WC-1) with us. If they have not filed this report, you may contact our claims manager, Cory T. Okamoto at 526-1619 for administrative intervention. What do I tell my physician if I am injured? If you are injured as a result of your work, you should tell the person treating you that this is an industrial injury. Ask the physician to send the medical reports and bills to us at: Fairmont SpecialtySM
- WC Claims From whom can I obtain treatment? You may obtain treatment from a physician of your choice. However, you may be under the care of only one (1) attending physician. Your attending physician may refer you to other specialist(s) with our prior approval. Can I change attending physicians? You may change your attending physician once, but you must notify us before making the change. Any other changes in physician require our approval before making the change. If I'm injured, for what medical benefits will workers' compensation pay? If your claim is accepted, workers' compensation should pay for the following:
Am I entitled to loss wage benefits (TTD)? If your physician certifies that you are unable to work because of an industrial injury, you may receive Temporary Total Disability (TTD) benefits as wage replacement after a three-day waiting period. You may receive 2/3 of your weekly wages up to a specified maximum. Again, TTD is paid for periods a physician certifies you are unable to work. Are the benefits paid to me taxable? Benefits paid to you for workers' compensation are not taxable/reportable. Accordingly, you will not receive a W2 for these benefits. When does the three-day waiting period begin and will I ever be paid for it? The three-day waiting period begins on the first day of disability which is certified by your attending physician. There are no retro-active periods or thresholds for the waiting period; the first three days of certified disability are simply not paid. What is the maximum weekly benefit? The maximum weekly benefit is determined by the state in accordance with the year in which your industrial accident occurred. If you were injured in 2004, the maximum weekly benefit amount is $596.00. What if my workers' compensation claim is denied pending investigation; how will I get paid for lost wages? If your workers' compensation claim is disputed and you are not paid benefits, you may file a temporary disability insurance (TDI) claim with your employer's TDI insurance carrier (*note: Fairmont SpecialtySM does not handle TDI insurance). If you are eligible for TDI benefits, you will be paid benefits at rates allowed by the TDI law. If your workers' compensation claim is later found to be compensable (accepted), the TDI carrier may recover the amount they paid from your workers' compensation benefits. What if my workers' compensation claim is denied pending investigation; how will my medical treatment get paid? If your workers' compensation claim is disputed and you have sought medical treatment, your medical provider will normally continue to bill us directly for your treatments. We will hold the bills in our file until a final (acceptance/denial) determination is made. If the claim is accepted, we will notify you and process the bills for payment. If the claim is denied, you and your medical provider will be notified. Medical providers will usually then forward the billing to your private health care insurance carrier for payment. What is Permanent Partial Disability (PPD)? After you reach the point of stability or maximum medical recovery, you may be sent to an independent physician to be evaluated, depending on your type of injury. The evaluation will be used to determine the extent of your permanent impairment. In some cases, PPD benefits may result from the evaluation. What is disfigurement? If an injury results in noticeable permanent disfigurement, you may be entitled to a disfigurement award. Disfigurement includes scars, deformity, and discoloration. Laceration scars and surgical scars are reviewed six months from the date of the occurrence. Burn scars are evaluated after one year. Who is eligible to receive death benefits and what are they? Where an industrial injury results in death, the surviving spouse and dependent minor children are entitled to weekly benefits as provided in the workers' compensation law. Funeral and burial expenses are also covered, up to a specified maximum amount. What if I have a dispute? If we are unable to reach an agreement on certain issues, you do have a few options. You may:
How do I contact the Disability Compensation Division (DCD)? To reach the DCD, address all inquiries to:
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