Delaware law requires your employer to obtain Workers’ Compensation insurance to protect workers who suffer work-related injuries or illnesses.
The insurance coverage pays for your medical costs, lost wages, and other harms caused by a work-related injury or illness. In exchange for accepting Workers’ Compensation benefits, you give up the right to sue your employer for any liability in the matter.
You will need to report your injury or illness to your employer and request to file a Worker’s Compensation claim. Your employer should give you the information that will enable you to start the claims process.
Obtain Medical Treatment From an Approved Provider
You likely will need to see a doctor that is approved by the insurer that underwrites the Workers’ Compensation insurance policy. All insurers that underwrite Workers’ Compensation have lists of approved doctors that they trust to give them honest medical diagnoses regarding work-related injuries or illnesses suffered by workers.
You can see your family doctor, too, but will have to use your health insurance to cover those visits and pay any deductibles out of your own pocket.
The approved doctor gives the Workers’ Compensation insurer and your employer their opinion on your medical condition and possible causes. The insurer will pay all costs for medical treatment obtained through an approved service provider.
The insurer will assign the matter to an insurance adjuster who likely will try to contact you and possibly interview you over the phone or in person. If you have retained a Delaware Workers’ Compensation lawyer, the insurance adjuster would have to communicate through your attorney and respective law firm.
What Kind of Benefits You Might Anticipate Getting?
Your benefits should pay for all medical costs that arise from the work-related injury or illness. The insurer should pay for any physical therapy, rehabilitation, or vocational training that you might need to resume working. Your transportation costs related to getting medical treatment also should be covered. =
Temporary total disability benefits commonly are paid for those who miss work due to a work-related injury or illness. If you miss more than three days of work, the benefits should pay for two-thirds of your average daily and weekly pay while you are away from work. In Delaware, you could possibly collect benefit for temporary total dis up to 300 days.
When a Settlement Might Be Offered?
More serious injuries, illnesses, or permanent impairments might cause the insurer to offer you a settlement. For example, if you were to lose a pinky finger due to a work accident, a settlement likely would be paid for the loss because it is a permanent impairment.
Workers’ Compensation schedules often standardize payments for permanent impairment to appendages, limbs, and other body parts. The type of disability and its extent would determine the settlement amount that the insurer offers to you.
You also might suffer injuries that do not have a standardized settlement amount. A serious back injury or injuries to your heart, lungs, or kidneys do not have a standardized settlement. Instead, settlements are offered on a case-by-case basis for such injuries.
Benefits also apply for disfigurement, which includes scars, burns, and amputations. The extent of the disfigurement sets a daily benefit amount that is multiplied by up to 150 days for a maximum financial benefit.
Death benefits also apply and are based on the deceased worker’s average weekly pay. The death benefit is multiplied by the number of dependents up to the maximum number allowed by state law. The insurer also might pay up to $3,500 toward funeral expenses.
Factors That Could Affect a Settlement
Many kinds of work-related injuries and illnesses could affect a settlement amount. The insurer should consider each injury on its own when attributing the cause to the workplace accident.
An illness can be more problematic to consider. The insurer might question its origin and effect on your health or ability to work. If the insurer says your illness is not work-related, it could deny that portion of your claim.
You will need to show that the illness was caused by your exposure to your work conditions. A medical specialist can confirm your illness and its most probably cause, which will help to support your insurance claim for benefits.
Two Ways to Pay Workers’ Compensation Settlements
Any settlement will require negotiating with the insurer. You might want to retain an experienced Workers’ Compensation attorney to negotiate on your behalf. An attorney would show you are taking the matter very seriously and are more likely to fully understand and affirm your rights.
The insurer might offer a lump-sum settlement instead of paying you a monthly benefit amount. It is important to have documentation of your injuries, illnesses, and costs to get the best settlement.
Reasons Why an Insurer Might Deny Your Claim
Workers’ Compensation insurers may deny claims if they have reason to believe the injuries or an illness is not work-related. The insurer might suspect that activities outside of work caused your injuries if there is no direct evidence to support your claims of an accident or work-related injury or illness.
An insurer also might suspect that you are in better health than you claim and can return to full duties much sooner. The insurer-approved medical doctor could provide the insurer and your employer with a diagnosis that suggests your injuries or illness are not as serious as you claim.
A second opinion from your medical doctor or a specialist could help you to show that your health is as you claim. Doctors do not always agree on the extent of injuries, illnesses, or their causes. So the opinion of your doctor might give you the leverage needed to obtain a better settlement.
Wilmington Workers’ Compensation Lawyers at Rhoades & Morrow Uphold Your Rights
If you have issues with your claim or settlement, the Wilmington Workers’ Compensation lawyers at Rhoades & Morrow can help. You can call (302) 427-9500 or complete our online form to schedule a free consultation at our law office in Wilmington, Delaware. With offices in all three counties of Delaware, we serve clients throughout the state.