What to Do After a Utah Work-Related Injury or Illness
The Utah workers’ compensation program exists to help injured workers in need of financial benefits. Utah is a no-fault state, meaning proof that the injury was the employers fault is not necessary to get benefits. You only need to show that your injury happened at work because of a work-related activity. Unfortunately, some injured employees don’t get the recovery they need because they make a few critical mistakes during the claims filing process. Follow these steps to get workers’ compensation after a Utah workplace injury.
REPORT THE INJURY
The first thing you should do is report your injury to your employer, either verbally or in writing. In Utah, if you wait more than 180 days to notify your employer, you may not be able to receive any compensation for your injury. Additionally, employers and insurance companies are often skeptical of delayed claims because it can be an indicator of workers’ compensation fraud. They are more likely to deny your claim if you wait to report your injury. When you report the injury, you must provide the following details:
- When the accident happened
- How you hurt yourself
- When you discovered that the condition was related to work
- What symptoms you are experiencing
After the employer has received notification of your injury, they have seven days to file a First Report of Injury form. They send the form to the workers’ compensation insurance carrier, who then send it to the Labor Commission. Once each organization has received the form, you will get a notification that the process has started.
SEEK OUT A MEDICAL PROVIDER
Most employers will have a list of medical providers that you can use when you are seeking workers’ compensation. If the employer does not have chosen medical providers, you can see your personal provider. Tell the doctor that your injury is work-related. They will report the first visit by completing a Physician’s Initial Report of Injury form and giving you a copy before sending it to the Labor Commission and insurance carrier.
INSURANCE CARRIER CLAIM
Once the insurance carrier receives either the doctor’s or your employer’s form, they will open a claim for your injury. The insurance carrier has to make a decision about whether to award compensation within 21 days of receiving the form. They can file for an extension of up to 45 days, if needed. Insurance carriers will be extremely thorough when deciding about a workers’ compensation claim. When they are determining whether you are eligible for workers’ compensation, they may:
- Review your medical records
- Analyze your work experience, education, and wages
- Order a medical examination to further assess your condition
- Send you for an evaluation about your ability to fulfill your normal work duties
If the insurance carrier accepts your request for workers’ compensation, they will contact you and your employer to determine what your weekly pay should be while you are off of work. The workers’ compensation insurance carrier will pay all your medical bills. In most situations, the process plays out smoothly and they will pay you until you are able to return to work.
APPLY FOR A HEARING IF DENIED
If the insurance company denies your claim for workers’ compensation and you want to challenge the decision, you can file an application for hearing with the Labor Commission. It is a good idea to hire a workers’ compensation attorney if you are appealing the claim. A workers’ compensation judge will look over your case and issue a written decision. If the judge agrees with the insurance carrier and you still want to appeal, you have 30 days to file an appeal that the Labor Commissioner or Appeals Board will hear.
TYPES OF BENEFITS
If you are deemed eligible for workers’ compensation in Utah, there are various types of benefits that the insurance company could award you. The most basic coverage they will award is any of your medical expenses, including hospital bills, doctor visits, prescriptions, and other various medical necessities that have arisen from your injury. Along with reimbursement, you may be eligible for temporary or permanent disability benefits.
TEMPORARY DISABILITY
For temporary disability, you can receive compensation for any wages that you lose from days off of work that you needed to recover. Payments for temporary total disability are two-thirds of your average weekly wages your employer usually pays every two weeks. Utah lawmakers set different maximums for temporary total disability each year. You can receive temporary disability benefits up until your physician determines that you are at maximum medical improvement, which occurs when the doctor believes that you have recovered as much as possible and your condition is plateauing. You can receive temporary disability benefits for a maximum of 312 weeks.
If you are physically able to go back to part-time work but only in a position where you will earn less than before your injury, you may still be able to receive temporary partial disability benefits. They amount to two-thirds of the difference in your weekly wages before and after the injury, plus an added $5 for each spouse or child.
PERMANENT DISABILITY
The second type of benefits that you could receive are permanent disability benefits. If a doctor determines that your accident has left you totally and permanently disabled, you can receive two-thirds of your average weekly wages up to a certain maximum. You can get permanent total disability benefits for as long as you have a debilitating injury that prevents you from returning to work or getting another job.
Permanent partial disability benefits are two-thirds of your average weekly wages, as well, but with a lower maximum than with permanent total disability. Your doctor will assign a certain rating to you, depending on the severity of your injury, and the rating will determine how long you are eligible to receive benefits. If you injured a body part that is on a state list, you can receive benefits for up to 218 weeks, depending on the severity of the injury. If you injured a body part not on the list, you can get benefits for a maximum of 312 weeks.
Sources:
https://www.nolo.com/legal-encyclopedia/file-workers-compensation-claim-utah.html
https://laborcommission.utah.gov/divisions/IndustrialAccidents/WCClaimsProcess.html
https://www.disabilitysecrets.com/resources/utah-workers-compensation-claims-eligibility-filing-and-
