No one asks to be injured on the job. Unfortunately, though, workplace accidents and injuries are all too common and can occur at any time. Understand your workers compensation rights and responsibilities in Vermont. Injured workers are covered by the Vermont workers’ compensation system. This post will introduce you to your rights within that system, so you can take the steps you need to ensure you receive the compensation to which you are entitled.
Workers’ compensation is a unique type of personal injury law. It does not specifically require an employer to be negligent (unreasonably careless) in order for an injured employee to receive compensation for a workplace injury. Rather, the only requirements are that the injury (1) “arise out of,” and (2) occur “in the course of” one’s employment. If both of those requirements hold true, an injured worker is covered – even when an employer does not act negligently or otherwise cause or contribute to the workplace injury.
The most important first steps in obtaining workers’ compensation benefits are to immediately inform your employer that you have been injured and to begin medical treatment for your injuries. Under Vermont law, you have six months from the date of your injury to report it to your employer. Do not assume that your employer automatically knows about your injury. The best practice is to report your injuries as soon as possible and begin treating.
Once you inform your employer of your injuries, two important time periods come into play. Under most circumstances, within seventy-two (72) hours of first learning of an employee’s injuries, the employer must contact its insurance carrier. The insurance carrier then has twenty-one (21) days to either accept or deny the injured worker’s claim. A claim may be denied for any number of reasons, but often the insurance company will argue that an injury is not work-related or that the employee was not injured to the extent he or she claims. If your claim is denied, don’t panic. Remember that the primary goal of an insurance company is to pay out as little as possible toward an injured worker’s claim. The less money an insurance company pays out in claims, the more money it keeps in its deep pockets.
If the insurance company accepts your claim, then wage replacement benefits (also known as temporary disability benefits) come into play. These benefits, the most common of which are “temporary total disability payments” or “temporary partial disability payments,” are based upon your average weekly wage. In addition to wage replacement benefits, the insurance company should also begin to pay an injured worker’s reasonable and necessary medical expenses, including compensation for medical services, supplies, physical therapy, medication, and chiropractic treatment, as examples.
If the insurance company denies your claim or discontinues coverage of certain types of medical treatments or benefits, the next step in the process is to appeal that decision. Upon appeal, a workers’ compensation specialist of the Vermont Department of Labor will schedule a telephone conference. During the telephone conference, the hearing officer will speak with both sides and their attorneys and make a decision about the disputed issue(s). The decision is typically formalized in an “interim order” that is issued by the specialist. If you disagree with the specialist’s decision, you and your Windham County workers’ compensation attorney must request a formal hearing.
The Discovery Process
Leading up to the formal hearing is a period of fact-finding, known as “discovery.” During this phase of the dispute process, each side is entitled to uncover factual information about the other side’s version of the case. As part of the discovery process, the parties will typically engage in depositions – out of court “meetings” during which the employer/insured’s attorney has the opportunity to ask you (the “claimant”) about the workplace accident, your injuries, and treatment. The employer/insured’s attorney also has the opportunity to depose your medical providers about the nature and extent of your treatment, and depose any witnesses. In addition, the insurance company may require you to undergo an independent medical examination (IME), where you will be evaluated by a doctor of the insurance company’s choosing.
Also prior to the formal hearing, the parties may be required to participate in mediation, which is a form of settlement negotiations. A mediation session is conducted by a neutral, third-party evaluator, or mediator, who meets with each side and attempts to facilitate an amicable resolution of the disputed issues, without the need for a formal hearing.
Formal Hearing and Appeal
Assuming the dispute is not resolved during mediation, the formal hearing goes forward on the scheduled date. Within thirty (30) days of the hearing, the attorneys must submit a document called “Proposed Findings of Fact and Conclusions of Law.” The hearing officer will review these submissions, consider all of the evidence that was presented at the hearing, and then issue a decision in your case. If you are dissatisfied with the hearing officer’s decision, you may appeal your case to the Vermont Superior Court for a jury trial.
If you have questions about your rights within the workers’ compensation system, or concerns about the way your workers’ compensation claim is being handled, a skilled Windham County workers’ compensation attorney can help. Contact us today. Use the email form on this page to tell us about your situation, or call 1-855-357-3309 to schedule a free initial consultation.