1. How long does an injured employee have to file a claim?
Prior to the filing of a claim, an injured employee must give notice of an accident or injury. Notice of an accident must be given to the employer “as soon as practicable after the happening thereof.” 342.185. A claim for benefits based on a traumatic injury must be filed within two years of the date of injury or death or the last voluntary temporary total disability benefits made by the Employer, whichever is later. KRS 342.185. When temporary total disability benefits have been paid, an IA-2 form must be filed electronically with the Office of Workers’ Claims in order to start the statute. The time limit for filing an occupational disease claim is typically three years. Other conditions require a careful review of the statute. KRS 342.316.
2. What kinds of injuries qualify for workers’ compensation benefits?
In order to be compensable, an injury must be received in the course of and arising out of the employee’s employment. Generally, this does not include injuries sustained going to and coming from work, injuries or disabilities caused primarily by the natural deterioration of some part of the body, injuries that are entirely psychological in nature without some physical component, pre-existing conditions not aggravated by the injury, or injuries caused by the employee being under the influence of drugs or alcohol. However, there will be situations where exceptions do apply.
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3. What types of benefits are available to an employee who files a worker’s compensation claim?
An employee is eligible to receive temporary total disability (TTD) benefits if the injury or disability prevents the employee from returning to his or her pre-injury position of employment. The amount of the TTD benefits is calculated as a percentage of the employee’s wages, with a maximum and a minimum amount. Prior approval does not have to be obtained from the Office of Workers’ Claims before terminating temporary total disability benefits. The employer must have reason to believe that the injured worker has (1) reached maximum medical improvement or (2) been released to return to work. KRS 342.0011 (11)(a). It is not reasonable to terminate TTD where an employee is released to perform minimal work but not the type of work customary or that the employee was performing at the time of injury.
If the employee’s injury or disability results in some type of permanent disability, the employee may be eligible for permanent partial disability (PPD) benefits. PPD benefits are calculated using a formula based, in part, upon the percentage of residual whole person impairment recommended by a physician. Weekly benefits are paid over a 420-week or 520-week period depending upon the extent of the disability.
An employee may also be entitled to vocational rehabilitation if unable to return to the type of work previously performed. These benefits usually do not extend past fifty-two weeks.
If the injury or disability renders the employee unable to engage in sustained remunerative employment utilizing the employment skills that he or she has or may reasonably be expected to develop, that employee may be eligible for permanent total disability benefits. These benefits, which are calculated in a manner similar to the TTD benefits, continue for the remainder of the claimant’s lifetime or until the employee qualifies for social security retirement benefits.
If an employee’s death is caused by his or her workplace injury or occupational disease, the spouse and/or dependants of that employee may also be entitled to death benefits. In the case of a dependant spouse, such death benefits are payable for life (or until social security retirement age) with a two-year dowry benefit upon remarriage.
Author: David D. Black, Partner. David Black is an attorney at Dinsmore & Shohl in Cincinnati, OH. He can be reached at [email protected] or 513-977-8143.
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My fiance fell at work,he needs a knee replacement and the wrkrs comp Dr said he is at MMI. I don’t understand how that is even possible. That lady had her mind made up before he was even at the appointment. He is unable to work and we are fixing to lose our house and everything else. The working man just gets screwed over so badly.