All medical expenses that your doctor says are related to the industrial injury are to be paid, with no co-pay from the injured worker. I medical expenses are denied, make sure the bills are sent to the workers compensation insurance adjuster. As long as the bills are submitted to the adjuster within one year of service, legal action can be taken to get the bills paid.
Mileage to and from the doctor, hospital or clinic is to be paid. The rate changes every July 1st. It was 51.5 cents a mile in 2012-2013. A list of the date of visit, doctor's name and miles round trip can be submitted to the adjuster quarterly for reimbursement. Mileage is lost if not submitted within a year of the medical visit.
Temporary Total Disability (TTD)
TTD pays for time off work when a doctor's written report states that the injured worker has medical restrictions and the employer has no work meeting those restrictions. TTD is paid at 2/3 of the wage at the time of the injury up to the maximum of the state average weekly wage. This maximum changes every July 1st. It was $762 for 2012-2013. TTD ends at return to work, full work release or maximum medical improvement, whichever comes first.
Temporary Partial Disability (TPD)
TPD pays for reduced hours of work when a doctor's written report states that the injured worker has medical restrictions and the employer cannot provide full time employment that meets the restrictions. TPD is paid with the following formula: (Week's wage at the time of the injury) - (Week's wage on light duty) X 2/3 Up to the maximum of the state average weekly wage. This maximum changes every July 1st. It was $762 for 2012-2013. TPD ends when the injured worker can return to work at the wage at the time of the injury, full work release or maximum medical improvement, whichever comes first.
Permanent Partial Disability (PPD)
PPD pays for the impairment rating provided by the doctor. An impairment rating is a number from a chart from the AMA Guides to Evaluating Permanent Impairment or the Utah Guides to Permanent Impairment. PPD starts at maximum medical improvement. Te impairment rating allows us to calculate how may weeks of PPD benefits are to be paid using the following formula: 312 X (impairment rating) = (Number of weeks of PPD.) For example, a 10% rating would result in 31.2 weeks of benefits.
Adjusters often require a Permanent Partial Disability Agreement to be signed before they pay PPD benefits. They have no right to do this, but injured workers have little recourse. Most Utah workers compensation attorneys review PPD Agreements free of charge, so make sure there is no problem with the agreement before you sign.
Permanent Total Disability (PTD)
PTD in Utah is only available to the most seriously injured workers. The injured worker must prove that due to the written medical restrictions from the accident, he is unable to work in any job held in the past or any other work "reasonably available to him" unless provided with vocational rehabilitation. Although this is slightly more stringent than Social Security Disability, seek legal counsel for detailed analysis if you this you fall into this category.
If the court finds that an injured worker is PTD, the workers compensation carrier will be allowed to attempt retraining through schooling and on the job training options, but payment for time off work and all related expenses must be made by the carrier.
Death and Dependents Benefits
In the case of death from an on the job injury, weekly benefits are paid to the spouse and children of the decedent for six years, Thereafter, benefits continue to be paid if they are dependent on that source of income. Burial expenses, up to the annually adjusted maximum are also paid.
When benefits are not paid in a timely manner, they accrue 8% simple interest from the date they should have been paid until the date the check is issued.
Additional resources provided by the author
Find more information at the Utah Labor Commission website or the online help pages at Atkinlaw.com.
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