Workers’ Compensation Claims in West Virginia

Pat Jacobs Answering Your Most Frequently Asked Questions

 

I’ve been representing workers for over 40 years in workers’ compensation cases. I want to emphasize that I only represent workers because I have never represented an employer or any insurance company trying to reduce benefits or reduce medical treatment for a worker. I’m always fighting on behalf of the workers when insurance companies or employers deny a request for treatment, say for instance, after you’ve been injured on the job or denies your request for wage replacement, which is called temporary total disability benefits. So, I’m there, I’ve got the knowledge, I’ve got all of the understanding on how the systems work, and if you have any questions, don’t ever hesitate, call me immediately. There’s absolutely no charge to talk to me and ask me questions about any issue involving a work-related injury.

What does workers’ compensation cover?

When you suffer a work-related injury, you’re covered under the Workers’ Compensation Statutory Laws of West Virginia and that provides your medical treatment. It’s 100% paid for unlike if you were to use your health insurance and go to the hospital for something, you have copays to deal with, you have deductibles to deal with, but not with worker’s comp. 100% of your medical treatment is paid for by the worker’s comp insurance company. 

 

In addition, if you’re off work and unable to work due to your work-related injury, you’ll have lost wages and you’ll get replacement wages. It’s called temporary total disability benefits paid to you by the worker’s comp insurance company. And then finally, if you’re unable to go back to your work, if your injury is very, very  severe, there are vocational rehabilitation programs. They are available to injured workers who cannot go back to their previous employment, their past relevant work. It could be anywhere from one week to six months. I’ve seen some incredibly poor administration and some of these workers’ comp insurance companies, particularly out of state, but if you get ones that are used to dealing with West Virginia, you will get your temporary total disability benefits started. I would give a ballpark figure within two weeks.

Can you go back to work and still receive workers’ compensation?

You can sustain an injury, be off work at first and say you have a surgery, then you go through a surgery to save a rotator cuff tear in one of your shoulders and then go through some physical therapy and you go back to work. Now, while you’re off work and you’re in for the surgery and the physical therapy, the worker’s comp insurance will pay 100% of your medical bills. While you’re off work, you’ll get temporary total disability benefits. But then if they say, “Well, we’ll release you to return to work,” your doctor releases return to work, you go back to work, your temporary total disability stops, but you still have some more medical treatment to get some additional work in physical therapy or some additional follow-ups with the orthopedic surgeon who did the surgery, for instance. That’ll still be paid for by the insurance company and those benefits will continue. Eventually at the end, you’ll get your evaluation for a permanent partial disability percentage.

 

Do you have to be treated by an employer-approved doctor?

No. When you’re injured, you need to seek medical treatment immediately or as fast and as soon as possible because that is what kicks in the start or the initiation of a worker’s compensation claim in West Virginia. You’re injured at work, now some injuries, obviously you’re going to be transported out of there by an ambulance. It’s not going to be any question about it, but some injuries you’re not immediately disabled and that you could maybe finish your shift or when your shift is over, you need to immediately go to a doctor. Employees find out who are injured on the job when they go to their family doctors, those doctors will immediately say, “Whoa, we don’t want any workers’ comp cases” they don’t want to fool with it. So, you’ll need to find a place and one of the places that does a lot of workers’ comp injuries for the general public is MedExpress or you can go to any emergency room like Charleston Area Medical Center (CAMC) emergency room. They’re all familiar and geared toward treating work-related injury.

What options do I have if my employer doesn’t have workers’ comp?

If that’s the case, you are definitely going to need to call me because there is a procedure, but hardly anybody knows about it and it’s a procedure. There’s a state-funded West Virginia workers’ compensation-like insurance company to deal with employers who fail and who violate the law and are guilty, criminally at violating that law who don’t provide workers’ compensation for their injured workers, so the worker will get taken care of, but the employer will suffer the consequences. In most cases, the claim will be denied or approved 15 days from the date the insurance company gets notified. Now, that doesn’t start until they receive a form called a WC-1, and that form comes from the initial medical provider. There is a provision in the statute that allows the insurance company to file a notice that they need additional time to do more investigation and that will give them usually another 30 days, but those cases are rare. Generally speaking, you will know within 15 days of that WC-1 getting filed with the insurance company.

What happens if I am permanently disabled?

If you have a very, very severe injury, you have to have what’s called a 50% permanent partial disability rating. That’s the writing you get at the end, or if that’s your first injury, or if you’ve had previous injuries, if you add up all your injuries and it comes to 50% or more current partial disability that you’ve gotten, you can make an application for permanent total disability under workers’ compensation. But I will say, that happens very, very rarely, both at a time. If people are unable to go back to work, it’s a very, very big battle. So, get  permanent total disability. It’s much easier to get social security disability.

Are there other legal actions I can take if a third party caused an accident? 

Yes. If you’re injured at work and just say your employer, you’re on a manufacturing plant or in a coal mine and your employer has independent contractors coming in, doing different parts of the job, if those people are negligent in any way and they’re negligence resulted in your injury at work, you get worker’s compensation from your employer, but you also have the option of pursuing and seeking damages against the negligent party, which was the independent contractor’s workers who were negligence injured you. There’s an additional aspect that gets you additional money. And I will say this, you can also sue your employer. Although employers, generally speaking, probably 85% of the work-related injuries, they have immunity. But if your injury is such that you get a 13% permanent partial disability or greater, it’s considered a serious injury. And then if you can prove your employer violated or failed to follow health or safety standards, whether it’s AMSA standards in the coal industry or OSHA standards in the manufacturing industry, or health department standards and restaurants, if they violated those rules, you can sue your employer in addition to getting worker’s compensation.