Category: Workers’ Compensation

What if I had two jobs when I got hurt?

Workers' Compensation

This is fairly common. You’re average weekly wage is based on what your earned on the job where you got hurt. This is true even if you’re disabled from the other job. While that is difficult for you as a practical matter it’s only fair that your employer’s liability be limited to taking care of you on this job. The good thing is that you are entitled to make money on the other job without workers’ compensation taking a credit for it unless you expand your hours or are making more money on the other job now that you’ve got more time for it. This is always a tricky situation and really requires a good conversation with an attorney.

My employer is sending me to the company doctor. It’s an accepted claim, right?

Workers' Compensation

No! It’s very common for an employer and/or an insurance company to send you to their handpicked doctor in hopes of getting a report from him saying you weren’t really hurt, or that you can work, or some other opinion which is favorable to them. If the doctor says something that they don’t like – expensive evaluations like an MRI or taking you out of work – the defendants turn around and deny your claim. Your employer’s only responsibility is to pay for the authorized visits with this doctor. They have NOT accepted your claim.

If your company or their adjuster is telling you to go to a specific doctor you should ask them if they’ve accepted the claim. This is done on a Form 60 or, if the claim is accepted while they investigate, a Form 63.

What’s the difference between a Form 60 and a Form 63?

Workers' Compensation

These are the two forms which defendants use to accept a claim before the Industrial Commission. A Form 60 is an outright acceptance of the claim. It’s difficult for an insurance company to get off the hook if they’ve filed this. As a result you are more likely to see an adjuster file a Form 63.

Technically, a Form 63 is supposed to be used if an adjuster isn’t sure if a claim is compensable. She has 90 days to investigate the claim and then deny it if she needs to. If she takes no action within 90 days the claim is accepted. There are two things to look out for. If you have a Form 60 it may be very limited – they are only accepting your low back, not your hips, legs, or upper back for instance.

Additionally, a Form 63 is often misused as a 90-day trial. If your case looks like it’s going to be expensive the claim is going to be denied without regard to the actual facts of how you got hurt. We’ve actually had an adjuster testify to that tactic, under oath, before the Industrial Commission.

What am I supposed to do with a Form 19?

Just hang onto the Form 19. The Form 19 is the acknowledgement from your employer and/or their insurance company that you’ve reported a claim. If you haven’t set up a file at home for all your workers comp stuff, now is a good time to do so. If you haven’t received a Form 60 or a Form 63, follow up with your employer or the adjuster and ask for one.

What’s so important about a Form 18?

Workers' Compensation

A Form 18 is the form you use to formally open a file at the Industrial Commission. Just because your employer or the adjuster is sending you to a doctor doesn’t mean they’ve accepted the claim. And it doesn’t mean you have a claim on file with the Industrial Commission. More often than you’d think an injured worker reports his claim to his employer, gets some medical treatment, and returns to work. After a while the injury is acting up and bothering him but when he tries to go back to the doctor his adjuster denies the claim saying that a Form 18 was not timely filed with the Industrial Commission. The fact that everyone “knew” about the claim doesn’t always make a difference. The Industrial Commission needs that Form 18. This is the only irrefutable way to have a claim established.