Compensable Workers Comp Claims FAQs

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Compensable Workers’ Compensation Claims

A compensable claim is a claim covered under the Workers’ Compensation Act that an injured employee can request compensation for. For a claim to be covered by Workers’ Compensation benefits, the employee’s injury must be a compensable injury.

To protect your rights, ask an experienced Indiananapolis workers’ compensation lawyer how long you have to report your accident.

What is a Compensable Injury Under the Workers’ Compensation Act?

A compensable injury is an injury caused by an accident that happens during the course of employment. However, it is important to note that just because an injury occurs at work, that does not mean the injury is covered under the Act. Furthermore, just because the injury occurs during work hours does not mean the claim is automatically covered.

Let’s look at some examples:

  1. Slip and Fall – Alan is at work, and during the course of his normal work, he slips on a wet floor and hits his head. This scenario would be covered under the Act. However, if Alan comes to work feeling light-headed and faints while at work and hits his head, the employer would not be responsible for any injuries sustained as a result of the fall.
  2. Parking Lot – Barbara is walking into work and injures herself in the parking lot. If the injury is within a reasonable time period of the work shift and the parking lot is associated with the place of employment, the injury is likely covered. However, if Barbara voluntarily returned to the work parking lot to watch the 4th of July fireworks and sustained injuries, those injuries would not be covered.
  3. Lunch – If Chris is on his employer’s property during his lunch hour, an injury may be covered. However,  the injury would have to result from reasonable activity during the course of his employment to be covered.
  4. Ingress and Egress – The time required to enter and exit the employment premises is generally covered by the act. This is closely related to parking lot injuries. If Diane is walking into work and slips on a sidewalk, this may be covered under the Act because entering the building using the employer’s sidewalk is reasonably within the course of business.

More questions about what’s covered and what’s not covered by Workers’ Compensation law.

  • What happens if I don’t report the accident on the same day of the occurrence?

While it is a good idea to report your injury to the appropriate supervisor as soon as possible, reporting your injury a few days later does not keep you from recovering. Don’t wait too long, or your claim could be denied because you didn’t report it soon enough.

  • Are heart attacks covered by the Act?

Heart attacks are covered under the Act if the employee can prove that there was some kind of unusual stress or exertion during the course of employment that triggered the heart attack.

  • How long do I have to work for my employer to be covered under Workers’ Compensation Insurance?

There is no minimum time requirement for coverage under workers’ compensation. If you are injured on the job your very first day, you receive the same coverage as an employee working for 25 years.

  • If I receive injuries during a work-sponsored retreat, party, or recreational activity, do they qualify as work-related injuries?

The key word here is work-sponsored. If the retreat, party, or recreational activity is sponsored by, encouraged by, or mandatory by order of the employer, any injury resulting from the activity is likely covered under the Act. For example, a company requires all employees to attend a teambuilding work retreat. During the course of the retreat, employees are required to participate in a trust fall exercise. If an employee is injured during the exercise, the injury sustained is likely compensable under the Act. However, if employees engage in an activity voluntarily (such as a pick-up basketball game on a weekend), injuries sustained are not compensable under the Act.

  • What is PPI, and what is a PPI Examination? What if I disagree with my PPI rating?

PPI stands for Permanent Partial Impairment. A PPI rating is a percentage ranging from 0-100 that describes your permanent loss of physical function. At the end of treatment, when an injured employee reaches maximum medical improvement, the treating physician will issue a PPI rating. This rating will then be used to determine a dollar amount award based on the impairment suffered by the injured employee.

If you disagree with your PPI rating, you are entitled to a second opinion from a different doctor. However, a second PPI examination and report will be your personal expense and not covered by the Act.

  • What is MMI? How does it related to IME?

The acronym MMI stands for Maximum Medical Improvement. You reach your MMI when your treating physician says you do not require any more medical treatment.

IME stands for Independent Medical Examination. If your temporary total disability (TTD) benefits are terminated because you have reached your maximum medical improvement, you are entitled to an IME. The IME is a second opinion with a doctor appointed by the Indiana Workers’ Compensation Board.

  • Are Workers’ Compensation benefits taxable?

No, but any questions pertaining to tax reporting should be directed to the IRS or a tax professional.

  • What if my employer does not have Workers’ Compensation Insurance?

Employers are required to have workers’ compensation insurance under Indiana law. Failing to do so can result in employers being penalized. Contact the Indiana Workers’ Compensation Board (1-800-824-COMP) to verify whether your employer has insurance.

  • I live in another state, but I was injured while on the job in Indiana. In which state should I file a claim?

If you work in Indiana or your employer is based in Indiana, you should file a workers comp claim in Indiana.

  • Can I collect Workers’ Compensation benefits for pain and suffering?

No. Under the Indiana Workers Compensation Act, injured employees cannot recover money for pain and suffering from their employer. However, if you can bring a third-party lawsuit, which is a civil action against an at-fault party other than your employer, you could sue for damages such as pain and suffering.

For example, Amy works for a flower store. While Amy is delivering flowers in a company vehicle, another vehicle runs a red light and hits Amy, injuring her. Because the injuries occurred within the course of her employment, Amy may recover workers’ compensation insurance benefits and also sue the other driver in a separate lawsuit. The other driver is the third party who is responsible for Amy’s losses.

  • Can I get a settlement for my Workers’ Compensation claim?

If you are injured on the job and suffer some kind of permanent disability, you are entitled to a settlement, usually paid in a lump sum. However, if you fully recover from your injury after treatment or therapy, you may not be entitled to a settlement.

  • My spouse died as a result of a workplace accident. Can I collect Workers’ Compensation?

If a family member dies from a work-related accident, the Workers’ Compensation Act provides benefits for the surviving family members throughout the life of the surviving spouse. A seasoned Indiana workers’ compensation lawyer can explain these provisions in more detail.

  • I received a bill from the Workers’ Compensation doctor. Do I have to pay the bill?

If your claim is approved, you do not have to pay for medical treatment that resulted from a work-related injury. If your claim was denied, you might still elect to not pay for medical treatment and indicate you are in the process of having your claim approved.

  • My restrictions prevent me from returning to my job. What should I do?

If you were injured on the job, you are entitled to Vocational Rehabilitation services from the State of Indiana. However, these services do not qualify for workers’ compensation coverage and will be your out-of-pocket expense.

As an injured worker, you need to understand the workers’ compensation insurance process and whether you have compensable injuries under Indiana’s Workers’ Compensation law.

If you have questions that were not answered above, talk to a workers’ compensation attorney at Klezmer Maudlin PC as soon as possible. During a free consultation with our experienced workers’ compensation lawyers, we can discuss your unique circumstances and explain your legal rights.