Assuming it's a Kentucky claim, contact the Kentucky Department of Workers' Claims (502) 564-5550, and ask for open records. Give them your name and they should be able to pull up your claim and provide you the claim number. They may have you submit a written request (Open records request) for the documents. You'll want to request your Settlement Agreement (Form 110) or Opinion & Award. If you had an attorney help you, you want to request a copy of the Order Approving your Attorney's Fee.See question
Administrative Regulations regarding U.R. are summarized below. If the workers' compensation carrier is not adhering to these time frames, you need to contact an attorney.
Pursuant to 803 KAR 25:190 sec.(5)(2) UR Commences when the carrier has notice the claims selection criteria has been met. I take this to mean surgery / treatment has been recommended.
Pursuant to 803 KAR 25:190 sec.(5)(2)(a)(1-3)
1. an initial decision shall be communicated to the provider and employee within 2 working days of
initiation of UR. If additional information is required, tender of a single request shall be made
within two (2) additional working days.
2. The requested information shall be tendered by the medical provider within ten (10)
3. The initial utilization review decision shall be rendered within two (2) working days
following receipt of the requested information.
Pursuant to 803 KAR 25:190 sec. (7)(1)(a), following an initial review of a requested medical treatment / procedure, written notice of denial shall be issued no more than 10 days from the initiation of the UR process.See question
In Kentucky, we have claims for a traumatic event injury as well as a cumulative / repetitive trauma injury (i.e. performing an activity over and over causes a wear-and-tear type injury). It sounds like you have provided notice to your employer. If your employer will not turn the claim in to its workers' compensation carrier, you can do so directly if you are aware of the insurance carrier. If you are not, you can phone the KY Dept. of Workers' Claims, (502) 564-5550, and ask for the "coverage" section. You can give them the name of your company and your date of injury (the date you first went to the company nurse for treatment) and they will be able to tell you the carrier and provide contact information. Ultimately, you will probably need to consult an attorney to file a formal claim for benefits.See question
Th Statute of Limitations is two years. However, there are ways to extend it. If your husband was off work long enough (8 days) that he should have been paid temporary Total Disability benefits (TTD - workers' comp loss-of-time monetary benefits), but was not paid said benefits, you can argue the Statute of Limitations is tolled (i.e. did not run against him). As far as pursuing a claim - Yes it is worth it. There is a State fund (Uninsured Employer's Fund) which will step in and pay if the Employer did not have workers' comp insurance. You need to speak with an attorney ASAP.See question
The answer is "maybe." If a doctor provides an opinion that the work-activity is what led to the stroke, then you caould make a claim for a work-related injury. However, if the evidence shows your cosusin had a stroke, and just happened to be at work when it occurred, then, that would probably not be covered.See question
If, in the origina lsettlement, you did not waive "Right to Reopen" then you have four (4) years from the date of settlement to reopen the claim for increased impairment. You should contact an attorney as soon as possible to discuss reopening rights.See question
There are 4 types of benefits in workers' comp (assuming this is a Kentucky claim). You are entitled to (1) medical coverage for your injury - any thing reasonable and necessary for 15 years from the date of injury. (2) Temporary Total Disability benefits (TTD) - which pays at 2/3 of your pre-injury Average Weekly Wage so long as you are (a) not at MMI, and (b) restricted from work / under light duty restrictions which preclude a return to your customary pre-injury work or whcih the Employer will not accommodate. Once you reach MMI, however, TTD stops and you move to third type of benefit. (3) Permanent Total Disability (PTD) / Permanent Partial Disability (PPD) - Once at MMI, you can be evaluated for an impairment ratign and you will be entitled to either Permanent TotalDsiability (if you cannot perform any work) or permanent Paretial Disability based on your impairment rating if you have ongoing functional issues but are able tyo work in some capacity. The PTD / PPD benefits should start the day after TTD was terminated. (4) Vocational Rehab - you can ask the workers' comp. carrier to pay for voc. rehab.
In your case, because you are at MMI, you need to be rasted for an impairment and move forward to recover PTD / PPD.See question
Yes, you can move to another State. There is no requirement you remain employed with the Employer where you were injured. There are certain beenfits you are entitled to recover and certain provisions on medical coverage (for instance, you are only entitled to treatment done by your "designated treating physician", and if you move far away, you may need to select a new "designated treating physician" in your new locale.See question
Your Employer cannot make you quit after a work injury. I assume you have been given permanent light duty restrictions, which the Employer indicates it cannot accommodate. If that is the case, you could apply for unemployment benefits, as you are ready, willing and able to work within your light duty restrictions, and it is the Employer that is not allowing you to work. Alternatively, you could also apply for Long-term Disability benefits (LTD). I do not necessarily believe applying for such benefits requires you agree to leave your employment, however, I do not know what your specific policy states. Finally, if the employer were to terminate your employment, you would potneitally have a wrongful termination / retaliatory discharge claim (a civil lawsuit) against the Employer in addiiton to the workers' compensation claim. Regarding the Workers' Comp claim, nw that you are at MMI, you can be assigned an impairment rating and recover beenfits for your level of permanent disability.See question
Your question is more complicated than you might think. First, you need to look at the terms of your settlement, specifically, did you waive "Right to Reopen" or do you retain your reopening rights? Assuming you did not waive "Right to Reopen", then you may be entitled to (a) additional TTD and/or (b) additional PPD based on the facts of your case. Regarding TTD - these benefits are payable while you are restricted from work / under light duty restrictions the Employer will not accomodate, and paid until you either return to work or reach a level of recovery called Maximum Medical Improvement (MMI) which means you've reached a platea i nrecovery. In order to have been assigned an impairment rating as part of the original settlement, you must have been placed at MMI. So, just because you feel your condition worsens, does not necessarily mean you are no longer at MMI. If, however, you have to have an additional surgery, then you surele have departed fro mMMI status and would be entitled to addiitonal TTD. Please note, you can only receive additional TTD fro mthe date you file a Motion to Reopen the claim to request TTD, so, if you are having a surgery, it is best to file the Motion to reopen for TTD prior to undergoing the procedure to ensure your right to TTD. Regarding additional PPD, you have 4 years from your date of settlement to reopen the claim for additional PPD if your impairment rating increases. So, if you settled based on 5% impairment, and now, your doctor says you have 20% impairment, you could reopen the claim to request an award of benefits based on 20% for the remainder of the award period.See question