Here is some important information that you must know in order to have reasonable expectations during the Workers’ Compensation claim’s process:
HOW MUCH YOU CAN COLLECT:
Your level of disability can fall under one of four categories:
Mild = on average 25% disabled (includes any disability greater than 0% and up to 49.99%).
Moderate = on average 50% (includes 50-74.99 % disabled).
Marked = on average 75% (includes 75-99.99 % disabled).
Total = 100% disabled.
Your wage benefits are based on your percentage disability, your gross average weekly wage during the year leading up to the date of accident, and the statutory maximum allowed at the time of your accident.
On or After Maximum
How your wage benefits are calculated:
Mild disability = 1/6 of your gross average weekly wage up to the statutory maximum.
Moderate disability = 1/3 of your gross average weekly wage up to the statutory maximum.
Marked disability = 1/2 of your gross average weekly wage up to the statutory maximum.
Total disability = 2/3 of your gross average weekly wage up to the statutory maximum.
DETERMINING YOUR DEGREE OF DISABILITY
Your doctor is the one who determines your degree of disability as a result of the work accident. In order for you to be able to collect wage benefits, your doctor’s reports MUST indicate the exact percentage of disability that you have and explain how it related to the work accident. Without an exact percentage (for example, if your doctor simply states that you are partially disabled but does not indicate how much percentage of partial disability you have) you may only be able to receive the minimum amount available in the partial category. Therefore it is CRUCIAL that you MAKE SURE your doctor’s reports indicate the exact percentage disability you have AND that your disability is causally related to your work accident.
You should also keep in mind that your doctor's opinion can be contested by the Insurance Carrier if the Carrier has a controverting IME (Independent Medical Examiner's) opinion indicating a lower degree of disability than that which your doctor is stating in his/her report. By law, the Carrier has the right to rely on his Doctor's opinion and pay you only the rate correspondent to that degree of disability. Sometimes your attorney can work out a rate in between what your doctor is saying and what the Carrier's doctor is saying, called a temporary rate, or "TR". These rates can be retroactively adjusted at a later time during the course of your claim. However, if a rate cannot be worked out, or if the IME says you do not have any disability, your attorney will likely ask the judge to direct depositions of both your doctor and the IME doctor. During depositions, your attorney will ask questions that will undermine the credibility of the IME doctor and boost the credibility of your doctor. After depositions are conducted, your attorney and the Carrier's attorney will deliver either oral or written summations, where they each ask the Judge to honor their respective doctor's position.
The judge will then make a decision regarding your degree of disability by either siding with your doctor or the IME.