The filing of a workers comp claim typically gets initiated, uh, in the first instance by the employer and/or their insurance company. Employers are obligated to report all workplace injuries; they should be communicating that to their workers comp carrier, and that carrier should be opening up a claim—a claim number, assigning you an adjuster, and sending you certain information. That’s the typical way that the claim is, uh, opened up or initiated. But if we’re talking about your right officially to be on workers comp, then the—the first step or the necessary step, oftentimes if the employer doesn’t do it or the insurer doesn’t do it the right way, is to file a petition in the Workers Compensation Court called an Original Petition, seeking to establish that you did officially have a work-related injury and that you are disabled, whether it’s for a limited period of time or into the future. That’s something that’s an important step in the process—namely, memorializing your claim and getting your right to workers compensation benefits etched in stone, essentially legally. And that’s something—it’s the first thing, uh, we look to do when we, uh, take on a new client.

Uh, if you are requested to come back light duty, then refusal to do that, uh, can have consequences if the light duty position, quote unquote, is offered to you under what’s called Suitable Alternative Employment. The Suitable Alternative Employment provisions of the Act are very specific in terms of how it has to be done and offered, but it can sound a lot like a light duty position. Now, if you refuse an offer of Suitable Alternative Employment, then there can be consequences to your workers compensation weekly check and your benefits. But oftentimes, uh, you do not have to, or you’re not required to, go back light duty as a condition of being able to stay out and receive your weekly check.

Um, light duty is, um, not a required thing for you to submit to, but it—it can be something that is good for both sides if it’s done through a process in the Workers’ Compensation Act known as Suitable Alternative Employment. That’s—that’s different than light duty, but sometimes it is confused with light duty. You want to make sure, if you’re going to go back to work for the same employer but it’s something different than you were doing at the time of your injury, that you’re protected, and the Suitable Alternative Employment provisions of the Workers Compensation Act do offer protections to you that you otherwise wouldn’t have if you simply went back light duty. Sometimes employers will tell employees, “We’re sorry, we don’t have any light duty employment for you,” in which case, um, you don’t go back. But there’s many cases where your employer may say, “Well, we want you to come back light duty,” and depending on the circumstances, legally you’re not obligated to do that and you can remain out on workers comp until you resume your full duty capabilities. Um, so the mere fact that your employer wants to assign you to light duty or wants you to do light duty doesn’t mean necessarily that you have to do that or sacrifice your rights. Um, it can depend on the circumstances, of course, and you’re well advised to consult with your lawyer about the implications of working in, um, a light duty capacity. But, um, generally speaking, you don’t have to, um, submit to light duty and you can continue to remain out until you’re better and go back to full duty, and you can collect your weekly checks until that point.

If your employer does not report your claim, um, you can again figure out through your lawyer, typically, who their insurance company—their workers comp insurance company—is as of the date of your injury and make your claim directly, uh, that way or by filing a petition in the Rhode Island Workers Compensation Court to document your case and your claim. Uh, and, um, despite your employer not reporting it like they should, your rights will still be protected.

There are no company-required medical appointments with one exception. Uh, first of all, your employer, uh, shouldn’t be telling you who to use as your doctor to treat you for your work injury. However, if you’re on workers comp or claiming workers comp, the employer—or more often their insurance company—can have you examined by a doctor of their choice to get an opinion on your injuries, uh, or what treatment you need. That’s called—well, they will call it—an independent medical examination. It’s not independent. This is an insurance company paying a doctor to see you and give them an opinion in some regard, and they tend to often favor the insurance company’s interest over you, the injured worker’s interest. But as I tell all my clients, you are obligated to go to these appointments, to be cooperative, and to, and to have, uh, this doctor examine you on a one-time basis. Uh, but, uh, it’s another example or another situation where it’s important to be represented and to know what to do to prepare for this, uh, examination that you do have to go to. Uh, your lawyer can talk to you about that, can talk to you about why the insurance company might be getting this examination done at this point in your case, where they’re going with it, what the best-case scenario is, what the worst-case scenario is, and what will likely happen after you get that examination and after you get that report back, depending on what it says.

No, if you have a, uh, bona fide workers compensation injury and claim, and you are out of work because of it, the—you shouldn’t be using or forfeiting your sick time or vacation time. Rather, you are out on workers comp, you’re not out on family medical leave or anything else. You should be paid your weekly benefits while you’re out, and you are entitled to be out, um, for up to a year and get your job back, um, under the right to reinstatement. So no, you shouldn’t be docked vacation, uh, time or sick time or anything like that.

When there’s a workplace injury, an employer is obligated under the law to report it and report it on a specific form to the Department of Labor. That’s a form we often don’t see, but it is a requirement as part of the system and a requirement in terms of documentation that has to occur in all cases of workplace injury. Um, additionally, your employer should put their workers compensation insurance company on notice promptly that there’s been an injury. Um, regardless of whether or not you’re going to be missing time or not, they—they should report and open up a claim, um, so that if you are disabled and if you are going to be missing time, it can be dealt with promptly.

Workers compensation settlements, uh, uh, take primarily two different forms. The first type of settlement is, uh, called a denial and dismissal. These typically occur in cases that are highly contested, cases where, um, both sides, uh, agree that rather than have the injury officially recognized and memorialized, um, you’re going to settle the case for some amount of money to have it dismissed, to have it denied and have it not considered workers comp. So that typically occurs, uh, in a case where if we have a, a client that perhaps it’s a close call as to whether or not they were even an employee or not, or it’s a close call in terms of, um, whether the medical evidence really does show that they’re disabled, or perhaps there’s some other dispute about whether or not this case qualifies for benefits. Uh, it becomes a situation where going forward with a petition and having a judge decide it, uh, and all the risk that involves—namely, you could lose and, and get nothing out of your claim—or, um, you could settle for an amount you agree to, and in exchange your case is denied, dismissed. It’s—it was—it is not workers comp, but you’re accepting and, and receiving a lump sum of money out of it. That’s the first type of case, called denial and dismissal benefits. They tend generally to be smaller amounts of money—not always, but generally they’re not as, um, valuable as, uh, cases that settle for people that are officially on workers comp and have been on for, you know, some time. That doesn’t mean they’re not important, um, parts of the workers compensation system. In an important, uh, way you, you might receive compensation, uh, for something that you otherwise may get nothing for. So, um, that’s the first type of settlement, a denial and dismissal. The second type, uh, is, uh, called a commutation or a lump sum settlement or a lump sum commutation of your case, and that’s, um, typically a settlement that has more value to it. It’s someone who is already entitled to—officially entitled to—workers comp benefits, has been receiving them for some time, has been getting medical treatment, and for whatever reason both sides determine that it’s in everyone’s best interest to settle the case. That can be for a number of reasons, um, because, you know, uh, you can’t stay on comp for more than 6 years if you’re only partially disabled, which is most people. You can’t predict the future often, and you don’t know if you’ll be able to collect that weekly benefit check up until the gate or the six-year mark, uh, and this is a lump sum of money that’s paid to end your case forever and all time. And if you settle this way via commutation, you will receive that lump sum of money. However, you will sign something that releases your employer and their insurance company forever from the case going forward. Your weekly checks will stop, and your right to have medical treatment—even medical treatment, uh, that’s related to your injury—to have that paid for by the insurance company, that will end as well. And any future medical treatment you need, uh, will become your responsibility. So it’s something that, of course, needs to be weighed out in terms of the, uh, benefit, uh, to you of settling your case in that manner. Sometimes, uh, it makes sense, sometimes it does not. But when it is, uh, something that makes sense and is, uh, the best option you have and is in your best interest, uh, these are settlements that have to be heard and approved by the Workers Compensation Court. There’s a considerable amount of paperwork that you sign to get a settlement like that, and, um, typically it means the end of your case forever. Some—with some exceptions—sometimes people settle their case by a commutation but will, quote-unquote, leave the medicals open, meaning your weekly check will stop in exchange for the lump sum of money, but the insurance company’s obligation to pay for your medical benefits, uh, going forward remains open.

Pre-existing conditions in and of themselves, uh, do not preclude you or prevent you from workers compensation benefits. What we look at is if your work-related activities or your work injury, uh, exacerbated your underlying pre-existing condition that you had, uh, for reasons that are not related to work. You still can qualify for workers compensation benefits provided you can show through medical evidence or otherwise that your work did, in fact, exacerbate your pre-existing condition, and not only that, that it exacerbated it to a point where you are no longer able, um, to work or that you’re disabled. If you can show that, you’re qualified again for workers compensation, uh, benefits just like someone who’s hurt, uh, without, uh, having a pre-existing condition.

Yes, part-time employees, uh, just like any employees, are entitled and are, do qualify for workers compensation benefits in the same way that full-time workers are. Um, if you’re hurt at your part-time job, you will qualify for workers compensation provided you meet all the requirements. The difference would be, of course, if you’re working part-time, you’re making less money at that job than someone who’s working full-time. That will amount to, um, a benefit, a weekly benefit check that’s based on your average weekly wage. So the lower your average weekly wage is, the lower your weekly benefit is. Um, this gets a little more complicated if you have more than one job. Then we look at, are you missing time from both jobs, all jobs, or just the part-time job you were injured at? And the, um, effect that can have in terms of how much you’re entitled to on a weekly basis and what your average weekly wage is, um, is, is important for us to look at and, and can mean, and can have a difference in the amount of your benefits.