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Did you know that 3.3 million people were injured on the job in 2009 but most don't know much about how workers' compensation is involved in their job injury?
Don't let a workers' compensation claim leave you guessing what's next. The following are frequently asked questions heard at Vail Valley Medical Center's Occupation Health Clinics:
Why does a work-related illness/injury seem so different from a personal illness/injury?
Work-related illnesses/injuries are regulated by statutes set by the Colorado Division of Workers' Compensation and, in some cases, other federal entities. The statutes not only regulate administrative issues, but medical treatment protocols, returning employees to work, authorization for services and other issues. Every entity involved with the injury has to follow specific rules: you, your employer, employer's workers' compensation insurance and the various treating medical facilities.
I hurt myself at work, but I was told it was not workers' compensation. How can that be?
Just because it happens at work does not automatically make it workers' compensation. A work-related illness/injury is one that occurs “during the scope of performing your job.” Certain illnesses/injuries do not fall into that category. Examples of this include walking down the hall and tripping on a shoe string or getting burnt when getting popcorn out of the microwave (if your job isn't to make popcorn.)
What if I chose to see my own medical provider and/or a specialist and the occupational health provider did not make the referral?
You do have the right to see whatever provider you chose. However, charges will not be paid through workers compensation nor your private insurance since it is a work-related injury. Outside treatments will not be covered if you don't receive a referral from a workers' comp provider.
Why can't I get an MRI done right away? Why do I have to wait to hear from occupational health about an authorization?
Your employer's workers' compensation insurance will not pay for procedures they did not authorize. Again, your private insurance will not pay since it is a work related injury so follow the timeline provided to avoid extra out-of-pocket expenses.
I've seen the insurance approved specialist (ex: an orthopedist) for my injury, why do I have to also continue to see occupational health?
The occupational health clinic's role in your care is to:
— Assess you for fitness for duty.
— Set your work restrictions.
— Evaluate the recommendations by the specialist and ensure that they follow the workers' compensation guidelines.
— Address your pain issues, physical therapy and make sure your activities of daily living needs are being met.
— Facilitate communication between your specialist, employer and insurer.
If the specialist deems your injury “non-surgical,” the occupational health provider will manage your injury/illness until you have reached maximum medical improvement (MMI).
What is this “maximum medical improvement/MMI” I got on my last appointment to occupational health?
It is a point in time when your illness/injury has become stable and when no further treatment is reasonably expected to improve your condition.
My lost-time pay was reduced by 50 percent for a safety violation. Is that legal?
Yes, this is mandated by statute, if your illness/injury occurred during or because of a safety violation like not using safety devices provided by the employer (ex: safety glasses, seat belts, etc.) or not following company's reasonable safety rule (ex: only trained personnel are to handle hazardous spills).
If the injury resulted from your use of alcohol or controlled substances, your worker's compensation benefits could also be reduced by 50 percent. For more information on workers' compensation, call Vail Valley Medical Center's Occupation Health Clinic at 970-479-5085.
Ginger Hatton is an employee at Vail Valley Medical Center's Occupational Health Clinic. She has been with VVMC for five years. Email comments to cschnell@vaildaily.com.
Don't let a workers' compensation claim leave you guessing what's next. The following are frequently asked questions heard at Vail Valley Medical Center's Occupation Health Clinics:
Why does a work-related illness/injury seem so different from a personal illness/injury?
Work-related illnesses/injuries are regulated by statutes set by the Colorado Division of Workers' Compensation and, in some cases, other federal entities. The statutes not only regulate administrative issues, but medical treatment protocols, returning employees to work, authorization for services and other issues. Every entity involved with the injury has to follow specific rules: you, your employer, employer's workers' compensation insurance and the various treating medical facilities.
I hurt myself at work, but I was told it was not workers' compensation. How can that be?
Just because it happens at work does not automatically make it workers' compensation. A work-related illness/injury is one that occurs “during the scope of performing your job.” Certain illnesses/injuries do not fall into that category. Examples of this include walking down the hall and tripping on a shoe string or getting burnt when getting popcorn out of the microwave (if your job isn't to make popcorn.)
What if I chose to see my own medical provider and/or a specialist and the occupational health provider did not make the referral?
You do have the right to see whatever provider you chose. However, charges will not be paid through workers compensation nor your private insurance since it is a work-related injury. Outside treatments will not be covered if you don't receive a referral from a workers' comp provider.
Why can't I get an MRI done right away? Why do I have to wait to hear from occupational health about an authorization?
Your employer's workers' compensation insurance will not pay for procedures they did not authorize. Again, your private insurance will not pay since it is a work related injury so follow the timeline provided to avoid extra out-of-pocket expenses.
I've seen the insurance approved specialist (ex: an orthopedist) for my injury, why do I have to also continue to see occupational health?
The occupational health clinic's role in your care is to:
— Assess you for fitness for duty.
— Set your work restrictions.
— Evaluate the recommendations by the specialist and ensure that they follow the workers' compensation guidelines.
— Address your pain issues, physical therapy and make sure your activities of daily living needs are being met.
— Facilitate communication between your specialist, employer and insurer.
If the specialist deems your injury “non-surgical,” the occupational health provider will manage your injury/illness until you have reached maximum medical improvement (MMI).
What is this “maximum medical improvement/MMI” I got on my last appointment to occupational health?
It is a point in time when your illness/injury has become stable and when no further treatment is reasonably expected to improve your condition.
My lost-time pay was reduced by 50 percent for a safety violation. Is that legal?
Yes, this is mandated by statute, if your illness/injury occurred during or because of a safety violation like not using safety devices provided by the employer (ex: safety glasses, seat belts, etc.) or not following company's reasonable safety rule (ex: only trained personnel are to handle hazardous spills).
If the injury resulted from your use of alcohol or controlled substances, your worker's compensation benefits could also be reduced by 50 percent. For more information on workers' compensation, call Vail Valley Medical Center's Occupation Health Clinic at 970-479-5085.
Ginger Hatton is an employee at Vail Valley Medical Center's Occupational Health Clinic. She has been with VVMC for five years. Email comments to cschnell@vaildaily.com.
