Workers Compensation Brochure

AN  OVERVIEW

In Kentucky, workers’ compensation is considered the “exclusive remedy” for injured workers.   Workers’ compensation benefits include partial wage replacement, payment of medical treatment and limited job training.  Many workers’ compensation disputes are resolved when the parties agree to a compromised settlement.  However, if such a settlement can not be reached, it is necessary for the parties to litigate the claim.  This process is begun when an application  is filed with the Department of Workers’ Claims by the employee or employer.    The Department issues an  order assigning the case to an Administrative Law Judge, and scheduling a Benefit Review Conference. This order also contains a time schedule to allow the parties to file medical documents and evidence in the case.  

The Benefit Review Conference is an informal proceeding held before the Administrative Law Judge.  It gives the parties  the opportunity to discuss the strengths and weaknesses of the case, with the goal of settling it at that time.  The Administrative Law Judge also has the opportunity to participate, and rule on any procedural disputes.

If the claim is not settled at this point, the Administrative Law Judge schedules a formal hearing, which is typically held two weeks later.  This hearing is the opportunity for the employee and employer to testify in  the presence of the Administrative Law Judge.  A court reporter is present, and makes a complete record of that testimony.   Within sixty days after that hearing, the Administrative Law Judge issues a decision in the case, awarding or denying income and medical benefits and possibly rehabilitation benefits.  That decision is based upon the evidence offered by all of the witnesses, the medical reports filed by the parties, and is controlled by the Workers’ Compensation statutes and case law.  

A WARNING ABOUT WORKERS'
COMPENSATION IN KENTUCKY

In 1996, the workers' compensation system in Kentucky was overhauled.  In my opinion, these reforms have degraded the rights of working people to reasonable compensation.   The system pays too little and oftentimes, pays too late.   Injured workers suffer when paychecks stop and medical bills go unpaid. 

WHAT YOU CAN DO       

Getting a lawyer is one answer.  A lawyer can make sure you are receiving maximum benefits and that the insurance company does not "set you up" for problems down the road or mishandle your claim.  A lawyer’s loyalty is only to you.   You can call your attorney as much as you want.   Your attorney will be there with you throughout your litigation.    Not getting a lawyer is the advice you may receive from the workers' compensation specialists hired by the State to handle claims.   A workers' compensation specialist is usually a college graduate with some experience in workers' compensation claims.   These specialists are paid by the State.   Some can be very helpful, but workers' compensation specialists handle matters over the telephone.  They do not handle litigation and have limited knowledge and experience.

HOW DOES OUR
OFFICE HANDLE YOUR CASE

We represent only you.  We submit your case to the carrier for payment or place your case into litigation, as necessary.   We handle all problems regarding your disability income benefits.  

WHO IS RESPONSIBLE FOR BENEFIT PAYMENTS

Employers are responsible for payment of benefits due under the Workers’ Compensation Act.  Usually, this liability is insured through workers’ compensation insurance.

RESPONSIBILITIES OF CARRIER

All carriers have certain duties and responsibilities once an injury has been reported.  These include:

1. To diligently investigate the claim.
2. Advise in writing the acceptance or denial of the claim.
3. Meet the time constraints for paying claims.
4. Attempt in good faith to promptly pay a claim where liability is clear
5. Make a prompt and appropriate reply to the employee and the Department of Workers’ Claims upon inquiry.
6. Maintain claim records that show the basis of claims management decisions.

YOUR RIGHTS!!

As an employee in Kentucky, you have the right to:

• Workers’  compensation insurance coverage. This coverage should be furnished by your employer at no cost to you.
• Know the identity of the workers’ compensation insurance carrier and the claim representative.
• Receive a courteous and reasonably prompt response from the  carrier upon communication regarding a claim.
• Receive temporary income benefits while recuperating from the injury.
• Receive all necessary medical treatment for the occupational injury or disease without making a co-payment.
• Select a physician to treat a work related injury or illness without interference from your employer.
• Change the treating physician one time with no questions asked.
• Receive a card, which identifies the designated physician, employer and carrier.
• Be reimbursed for expenses paid in the process of receiving medical treatment, including travel expenses and out of pocket payment of prescription medications.
• Receive retraining if unable to return to suitable work.
• File a claim for permanent disability benefits within two years of the injury or the termination of temporary income benefits, whichever is later.

YOUR RESPONSIBILITIES!

As an injured employee you must:

Notify Supervisors of Injuries and Diseases.  Employees must immediately (or “as soon as practicable”) notify their supervisors of any injury. Notification should include information about the work occurrence and the body part affected. Most employers have a written policy for reporting injuries;  compliance with that policy will facilitate the payment of benefits.

Obtain medical services.    As soon as possible after the work-related injury occurs, the employee should obtain necessary medical services.   If the employer has entered into an authorized managed care program, the employee must choose from among the participating medical providers.  Employees should ask treating physicians to promptly report their status to the employers and insurance carrier.  Prompt reporting speeds payments of benefits and helps employers and physicians in assisting employees to return to work.

Maintain open lines of communication.  In addition to promptly reporting injuries and medical status to employers, employees should keep lines of communication with the employer open.  Generally, the employer is interested in the well being of the employee and wants workers’ compensation benefits extended until the employee can return to work.