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Paperwork When Injured At Work

  • Dave Brown, Esquire
  • 11/23/2020

If you injure yourself at work, you will find out quickly that the workers’ compensation process requires the completion of a lot of forms. Your supervisor or a Human Resources representative from your employer is likely to ask you to complete an Incident Report, describing how you hurt yourself. You may be referred by your employer to an occupational medicine doctor to evaluate you for your injury. At your initial visit, you can expect to be asked to complete an intake form, explaining how your injury occurred, whether you have sustained previous injuries, and to what body parts you are experiencing pain.

It’s when the workers’ comp. insurance company for your employer gets involved in your case that you might get bombarded with forms. Twice a year, the insurance company is allowed to send you three different forms: Employee Report of Wages, Employee Report of Benefits for Offsets, and Employee Verification of Employment, Self-Employment or Change in Physical Condition. The insurance company’s purpose in sending these forms is to obtain the following information from you:

— Have you earned any wages since your work injury? If you have, what employer(s) have you worked for, and how much money have you earned? For example, if you injured yourself in April, started to receive workers’ comp. benefits, and then in July you tried to work for Wal-Mart part-time, earning $200.00 per week for four weeks, you are required to provide this information on the form. The insurance company will be entitled to take a credit on these earnings. So if you were earning $800.00 per week at the time of your injury, you would be entitled to 2/3, or $533.33, in weekly workers’ comp. benefits. For the weeks in which you were working part-time at Wal-Mart, the insurance company could reduce your benefits to partial disability benefits — $800.00-$200.00 equals $600.00 x 2/3 equals $400.00.

— Have you received any money that is not considered wages? You must indicate whether you have received unemployment benefits, pension benefits from your employer, Social Security retirement (old age) benefits, or Social Security disability benefits. If you have, you are required to state the amount per week or month that you have received these benefits and for what time period. Here is how the receipt of these monies will affect your workers’ comp. benefits.
If you have received unemployment benefits, the insurance company is entitled to a dollar-for-dollar credit. If you collected unemployment benefits of $500.00 per week for 26 weeks, the insurance company would be allowed a $13,000 credit on any workers’ comp. benefits that you are awarded. If the Judge awards you $30,000 in back workers’ comp. benefits, the $13,000 in unemployment benefits would be reduced so you would net $17,000. The law is designed to prevent “double-dipping” —an injured worker receiving workers’ comp. and unemployment benefits for the same period..
If you begin to receive a monthly pension from your time-of-injury employer, the insurance company may take a credit based on the percentage of your pension to which your employer contributed. To illustrate, if you are being paid $800.00 per month in a pension and your employer contributed 50 percent, the insurance company can reduce your workers’ comp. benefits by $400.00 per month.
If you have been receiving Social Security retirement benefits, the insurance company’s entitlement to a credit hinges on when you started to receive these benefits.
If you had been receiving your Social Security benefits before your work injury, they will not be entitled to a credit. However, if you injure yourself at work and then start to receive old age Social Security benefits, the insurance company is permitted to a credit on one-half of your monthly benefit. Therefore, if you are receiving a $1,200.00 monthly check from Social Security, your workers’ comp. benefits will be reduced by $600.00 per month.
If you are receiving Social Security disability benefits, your workers’ comp. benefits cannot be reduced, but Social Security may reduce the monthly amount they pay you because the sum of your disability and workers’ comp. benefits cannot exceed a certain number based on a formula that Social Security utilizes — this will result in a lower check each month from Social Security.
— Has your condition related to your work injury changed? You should indicate whether your condition has improved, stayed the same, or gotten worse.
It’s important that you complete these forms completely and honestly, sign and date the forms, and return them within 30 days. If you do not return the forms within 30 days, the insurance company could suspend your benefits and stop sending you a check until you complete, sign, and return these forms.

If you receive these forms and are not sure how to complete them, we at Pearson Koutcher Law can help. Workers’ comp. is all we do — we only represent injured workers in workers’ comp. cases. We can answer your questions about these forms — and any other issue involved in your case. Please call us for a free, comprehensive consultation — we would love to represent you in your workers’ comp. case.