Most Frequently Asked Questions by Workers.

Most Frequently Asked Questions by Workers.

The answers provided are not meant to be a substitute for legal advice. 

 

 

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How much will I be paid while on workers' compensation, and when can I expect a check

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My employer isn't making a claim for me, how do I do it myself

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My adjuster wants me to look for work even though I still have restrictions and can't return to my regular job. Do I have to do this?  

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I was recently sent for an "Independent Medical Evaluation" (IME) by my insurance adjuster. The IME doctor's restrictions are much different than the ones I have from my own doctor. Which ones do I follow? How can I get a copy of the IME report?  

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How long do I have to turn in a claim? Who do I report my claim to? What if I work a late shift?  

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I don't like the doctor my company sent me to. When and how can I choose my own doctor?  

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I am off work with a work injury, but my employer is also counting this against my Family Medical Leave Act (FMLA) time. Can they do this?  

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Can I find out if my employer has workers' compensation insurance?  

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My employer told me not to file a claim, and that they would pay for all the bills. This isn't happening and now the bills are coming to my home. What do I do?  

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I asked my insurance adjuster for vocational rehabilitation assistance, but they don't want to provide it. What do I do?  

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What is a "Wage Earning Capacity Evaluation"?

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My nurse case manager doesn't seem to have my best interests in mind. Can I request a new one, or deny their assistance altogether?  

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Do I have to pay income tax on my workers' compensation earnings?  

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Does my employer have to bring me back to work after an injury?

 

 

 

 

Q.

How much will I be paid while on workers' compensation, and when can I expect a check? 

A.

In most cases, wage loss benefits are calculated by taking the average of the highest 39 weeks of the last 52 weeks of gross wages prior to injury. This is your Average Weekly Wage (AWW). Generally you should receive 80% of the after-tax value of your AWW. In certain circumstances, the value of discontinued "fringe benefits" such as the cost of health insurance, employer contributions to a pension plan, and vacation and holiday pay may be included in determining the AWW. Your first check is due and payable on the 14th day of disability. However, a benefit check is not considered "late" until 30 days after the due date. After receiving your first check, you should be paid your benefit on a weekly basis.
 

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Q.

My employer isn't making a claim for me, how do I do it myself? 

A.

You can simply go to our website at www.michigan.gov/wca and print form WC-117, "Employee's Report of Claim." Or you can contact the agency via phone and request the form be mailed to you. The agency will process the form upon receipt, and notify the employer and their insurance company that a claim has been filed.
 

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Q.

My adjuster wants me to look for work even though I still have restrictions and can't return to my regular job. Do I have to do this?

A.

Yes, you should always remember that your main objective is to return to work as quickly and safely as possible. Essentially, if you have the ability to do some type of work after your injury, you have a duty to look for available work, and make a "good faith effort" at obtaining those jobs.

 

If you need assistance with your job search, you may be entitled to vocational rehabilitation services.
 

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Q.

I was recently sent for an "Independent Medical Evaluation" (IME) by my insurance adjuster. The IME doctor's restrictions are much different than the ones I have from my own doctor. Which ones do I follow? How can I get a copy of the IME report?

A.

You have a right to follow the advice of your personal physician. However, your employer or insurance carrier also has a right to follow the IME recommendations. The options in this case would be to:

 

1.     Follow your doctor's restrictions. The consequence of this may be a suspension of benefits.

2.     Show the IME report to your physician for feedback and an opinion that can be sent to the insurance company.

3.     If safely possible, try to report to work utilizing the IME restrictions.

 

If you desire a copy of the IME report, you may make a written request to the insurance carrier. You should receive a complete and correct copy of the report within 15 days of your request.

 

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Q.

How long do I have to turn in a claim? Who do I report my claim to? What if I work a late shift? 

A.

Your company should have a process for you to follow for reporting injuries. Once an injury occurs however, you should report the incident within 90-days, usually to your supervisor or human resources department. Again, follow your company's reporting procedure. If you have a repetitive-type injury, the date of injury would be the date of diagnosis.

 

You have up to 2 years after the occurrence of the injury to make a claim with your employer or through the agency.

 

If you work 2nd or 3rd shift, your company should have a procedure in place for reporting injuries if the business office is closed.
 

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Q.

I don't like the doctor my company sent me to. When and how can I choose my own doctor? 

A.

Your employer has the right to choose the doctor for the first 28 days following the start of medical care. After that, you are free to change doctors if you wish. It is strongly recommended that you notify the insurance company and employer of your physician choice in writing.

 

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Q.

I am off work with a work injury, but my employer is also counting this against my Family Medical Leave Act (FMLA) time. Can they do this? 

A.

Yes, FMLA can be applied concurrently with a workers' compensation leave. The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave. Eligible employees are entitled to up to twelve work weeks of leave in a 12-month period for certain circumstances, including a serious health condition that makes the employee unable to perform the essential functions of his or her job.

 

For more information, visit www.dol.gov.

 

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Q.

Can I find out if my employer has workers' compensation insurance?

A.

There are two ways to find this information:

 

1.   Visit the agency website (www.michigan.gov/wca) and click on "Insurance Coverage Lookup" located in the menu on the right side of the home page.

2.   Call the Workers' Compensation Agency's main number at 1-888-396-5041 and choose the option for locating insurance coverage.

 

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Q.

My employer told me not to file a claim, and that they would pay for all the bills. This isn't happening and now the bills are coming to my home. What do I do?

A.

In cases like these, there are several reasons why the employer may be faltering on their commitment to pay for your claim, or to initiate a claim with their insurance company. We advise employees to file form WC-104A with the agency to initiate a formal mediation hearing in order to determine whether all parties are fulfilling their responsibilities under the Workers' Compensation Act.

 

The medical service provider can also file for a hearing using form WC-104B. In this process, the mediation hearing is between the provider and the employer.

 

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Q.

I asked my insurance adjuster for vocational rehabilitation assistance, but they don't want to provide it. What do I do? 

A.

If If you have a work-related injury or illness which prevents you from returning to your job and you are currently receiving workers' compensation benefits, you are entitled to a maximum of 104 weeks of vocational assistance in returning to work. Vocational rehabilitation can help you return to your current job or a new one by identifying interests, skills and abilities, evaluating accommodations, providing job readiness assistance, outlining career objectives, and arranging retraining opportunities. Vocational rehabilitation services create a "win-win" scenario for employers, carriers, and injured employees, especially when utilized as an early intervention tool.

 

If your request for vocational assistance is denied by the employer or insurance carrier, you can file form WC-104A to request a mediation hearing to try to resolve the dispute.

 

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Q.

What is a "Wage Earning Capacity Evaluation"?

A.

This is a different type of evaluation than one that is done for vocational rehabilitation purposes. Although this type evaluation is generally performed by a vocational rehabilitation professional, and is a one-time assessment of your previous work history, qualifications, and training, it is performed in order to determine your current wage earning capacity at reasonably available jobs in your area.
 

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Q.

 

My nurse case manager doesn't seem to have my best interests in mind. Can I request a new one, or deny their assistance altogether?

A.

Nurse case managers are advocates of proper medical care and treatment, and are tasked with coordinating the activities of medical professionals, community agents, funding sources, client and family for the goal of achieving maximum functional outcomes. Bottom line: their job is to help you return to work as quickly and safely as possible. They can be tremendous advocates for your safe return to work.

 

However, the Workers' Disability Compensation Act does not address nurse case management services. If you feel that the nurse case manager is not managing the process as outlined above, you should first attempt to discuss your concerns with the case manager directly. If this is not helpful, you have the right to request a new case manager, or deny further case management assistance entirely.
 

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Q.

Do I have to pay income tax on my workers' compensation earnings?

A.

No, workers' compensation payments are tax free. However, if you should need a history of payments, you can contact your insurance carrier or the Workers' Compensation Agency for assistance.

 

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Q.

Does my employer have to bring me back to work after an injury?

A.

The law does not require the employer to hold your job for you until your return, or even to offer you a different job. However, most enlightened employers try to make work available for their injured employees whenever they can because it is better in many ways for both employers and employees.

 

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