Tag Archives: deductibles

Higher out of pocket costs in disputed comp. claims other COVID workers comp(lications)

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I had an awful realization summarizing medical bills in preparation for a workers’ compensation trial; injured workers who aren’t exposed to COVID-19 are in for a nasty surprise due to the resurgent pandemic: having to pay deductible in denied or disputes workers’ compensation.

Due to the COVID-19, many hospitals in Nebraska are delaying non-urgent surgeries because of lack of space in hospitals. Often times orthopedic injuries which are the most common workers’ compensation injuries are deemed to be non-urgent.

Of course, if workers’ compensation cases are accepted a worker doesn’t have to worry about medical expenses. However, many workers compensation case are disputed. In disputed case, many workers fortunate enough to still have health insurance pay for surgeries with private health insurance.

But private insurance requires you to burn through a deductible in order to have insurance start paying benefits. Your typical white-collar weekend warrior or Crossfit mom typically waits until the year to have surgeries as they don’t have to pay the deductible because it was spent down through out the year

But because of delays in non-urgent surgeries, more injured workers paying for surgeries in disputed workers compensation cases with private insurance will need to pay deductibles for procedures delayed into 2021.

So what options do workers have in this situation?

The first option is to get a lawyer and file a workers’ compensation lawsuit if you haven’t done so already. This may seem self-serving, but under Nebraska law, if a medical bill is related to a workers’ compensation claim a provider must delay collections efforts until the case resolves. (Of course, if you need a surgery and] your employer or their workers compensation insurer is denying medical care, you should get a lawyer even if you don’t have to pay a deductible)

Other problems with COVID delays

Higher out of pocket medical costs aren’t the only hitch for injured workers due to surgical delays to due to COVID-19. Workers who need to miss work due to a medical condition only have 12 weeks of job protected leave under the Family Medical Leave Act. (FMLA) Delays in surgery due to COVID may prolong treatment and return to work beyond 12 weeks.

Earlier in the pandemic, I thought the silver lining of medical delays could mean more temporary total disability (TTD) for injured workers waiting for medical treatment. I still think that could be true, but I can also see employers being more aggressive in return to work or voluntold community service light duty work to get around paying lost income benefits. Voluntold light duty assignments are full of pitfalls for injured workers

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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No, you don’t need to burn your PTO to get workers’ compensation benefits.

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Employees do not need to exhaust paid time off (PTO) to receive workers’ compensation benefits in Nebraska. Employers in Nebraska must carry workers’ compensation insurance. But in Nebraska, employers aren’t required to pay PTO. Workers compensation pays out benefits whether you have paid leave or whether you have health insurance.

If you injure yourself at work and someone in management or HR tells you that you need to exhaust your paid leave before you collect workers’ compensation benefits, one of three things might be happening.

1. Someone at your company is misinformed about workers’ compensation.

2. Your employer is misleading you about how workers’ compensation works.

3. Maybe you misunderstood what you were told.

So why do some people think you need to exhaust paid leave before you receive workers’ compensation?

Short-term disability and exhaustion of leave

Many short-term disability policies require that employees exhaust paid leave before claiming short-term disability. My wife was required to burn her paid time off in order claim short-term disability during her maternity leave. White collar employers tend to have more short-term disability claims than workers compensation claims. (They tend to shift work injuries on to short and long-term disability, but that’s another story.) So a white collar HR department that lacks knowledge of workers compensation may, wrongly, assume that injured workers need to exhaust paid leave before receiving workers’ compensation.

The stigma of workers’ compensation

Employers who believe that employees need to burn paid time off before workers’ compensation benefits, may also believe this is necessary because they believe it should be necessary. Burning your paid time off before receiving workers’ compensation would be the same as paying a deductible before health insurance pays. Employers who think PTO should serve as a workers’ compensation deductible may believe that workers’ compensation and workers’ compensation claimants are illegitimate. Forcing employees to burn PTO before receiving workers’ compensation is one way to “hold employees accountable.”

Paying a quasi-deductible to receive workers’ compensation benefits is the cornerstone of a portable benefits scheme dreamed up by Obamacare architect Jonathan Gruber. (Portable benefits are touted as a replacement for workers’ compensation —- particularly for gig economy workers. Bad portable plans shift the cost of work injuries onto injured workers.)

Misinformed or mislead: A distinction without a difference

I know some high-injury employers actively misinform employees about workers’ compensation. These employers may tell injured workers they need to use paid time off before they can collect workers’ compensation to discourage injured employees from taking time away from work. Employees may work through pain to avoid missing work and losing out on paid family leave and or paid vacation time.

Employee misunderstanding

Nebraska law requires a one-week delay period before an injured worker who is off work can collect temporary disability. If disability lasts longer than six weeks, the employer must pay that first week. . Some employees may take this statement to mean that they need to exhaust their paid leave or PTO to receive workers’ compensation. Many employees don’t want to take the chance of missing out on a week of pay Bluntly many employees may need to draw paid leave or PTO while they are waiting for workers’ compensation benefits to start.

Can you collect workers’ compensation for times you took PTO in Nebraska? Yes you can.

The Nebraska Court of Appeals ruled in Godsey v. Casey’s General Stores that an employee can collect temporary total disability for periods when they took PTO. The court reasoned that since paid leave was a benefit ready earned by the injured worker that an injured worker could collect workers compensation and PTO.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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