Michigan Workers Compensation Benefits Overview
Most workers have heard of workers comp – but don’t fully understand what benefits they’re entitled to receive if they are injured on the job. This article provides details of each workers comp benefit available to Michigan workers and what do to when a claim is denied by the employer or insurance company.
Michigan lawmakers adopted a workers compensation act where employees give up the right to sue in civil court in exchange for a no-fault system. This benefits the employee by offering compensation regardless of whether they were at fault for the injury or not. The employee just has to prove that he or she was injured on the job. With a no fault system though, the employee is limited in what benefits he or she can collect.
What are my rights under workers compensation in Michigan?
If you are injured on the job in Michigan, you are entitled to Michigan workers comp benefits. You must file a claim for workers comp with your employer and their insurance company.
You are enti tled to be paid wage loss benefits for as long as you are disabled and cannot work. You have the right to reasonable and necessary medical treatment for your injury. You may also qualify for retraining or tuition reimbursement to help you get back into the work force.
Below are the four types of benefits Michigan workers are entitled to receive when injured on the job:
Workers comp lawyers frequently tell people that one of the most important benefits under workers comp is medical treatment. You are entitled to unlimited medical treatment for your work injury. Medical treatment includes surgical and hospital services as well as prescription medications.
You can also get dental care, artificial limbs, eyeglasses, hearing aids, wheelchairs and other appliances necessary to cure or relieve the effects of your work injury.
Your employer or its workers compensation insurance carrier will be responsible for paying all reasonable and necessary medical treatment. This holds true even if your treatment continues after you have returned to work. Medical treatment can be paid for life.
Disputes frequently occur as to what is reasonable and necessary medical treatment. Your employer or its insurance company cannot force you to use a specific doctor or pursue a specific course of treatment. You have the right to decide for yourself.
Your employer or the insurance company can recommend a doctor, but you have the right to select your own doctor. To do this, notify your employer or the insurance company by providing the name and address of the doctor and your intent to treat for your injury.
Be careful treating with doctors recommended by your employer or the insurance company because of a potential conflict of interest. If your workers comp benefits are ever disputed, you need a doctor who will be on your side. If you were injured on the job and your company or their workers’ comp insurance company denies your claim, you should contact an experienced workers’ compensation attorney to assist you with getting the benefits you deserve under Michigan law.
Your employer or its insurance company must pay the cost of a professional nurse or a semiskilled attendant if required. This is a workers comp benefit called attendant care. You will usually need to have a prescription for attendant care written by your doctor. Attendant care includes activities of daily living. Some examples are wound care, help with mobility, bathing, using the bathroom, eating, dressing, and taking medications.
Family members can get paid up to 56 hours per week for providing attendant care. Your spouse, brother, sister, child, parent or any combination of these persons can receive payment from workers comp.
Don’t let the insurance company tell you that the maximum is 56 hours per week for attendant care after an at-work injury If you need more attendant care than 56 hours per week, the insurance company must pay a professional. The 56 hour maximum only applies to family members.
Many Michigan workers have no idea how much they’re supposed to be collecting in wage loss benefits if they’ve been injured at work. Many times, an injured worker just assumes that they are receiving the correct workers’ compensation rate from the insurance company and employers. But insurance companies often make mistakes – and those mistakes are never in your favor.
Your average weekly wage is calculated by taking the highest 39 weeks of the 52 weeks before your work injury. Your comp rate is generally 80 percent of your after-tax average weekly wage. Wage loss benefits are not subject to state or federal income taxes because your workers’ compensation rate is already based upon the after-tax value of your average weekly wage.
Insurance companies in Michigan often fail to include overtime, premium pay, tips, bonus payments and the value of fringe benefits in your average weekly wage. Health insurance is considered a fringe benefit. Other errors that insurance companies make are failing to include all of your dependents and using the wrong tax filing status. These errors can dramatically affect the amount of wage loss benefits that you receive.
Your workers’ compensation rate is fixed at the time of your injury. It stays the same even if the economy changes, your job is eliminated or your employer files bankruptcy. You are entitled to wage loss benefits for as long as you are disabled from work.
If you want to calculate your own workers’ compensation rate, you must obtain a copy of your wage records. You have a right to these records - don’t let the insurance company or your employer tell you otherwise. The state of Michigan provides 2011 weekly workers compensation benefit tables on their website for residents to calculate their average weekly wage and 80% after-tax average weekly wage.
Many times the insurance company or your employer will fight you on the correct workers’ compensation rate. It is in their best interest to pay you as little as possible. Because of a recent Michigan Supreme Court decision called Stokes v. Chrysler, some insurance companies and employers are reducing the workers’ compensation rate based upon a hypothetical ability to earn wages in other employment. You should speak with an experienced workers’ compensation attorney immediately if this occurs.
Workers tend to have better outcomes if they can return to work after an injury. This is because wages earned over a lifetime will be more than what workers compensation will ultimately pay. A successful return to work also helps reduce stress and restores a normal life. You may find yourself incapable of doing your past work because of permanent medical restrictions. Your employer is required to provide vocational rehabilitation to help you get back to gainful employment. You are allowed a maximum of two years of vocational rehabilitation under workers comp. Vocational rehabilitation could include tuition reimbursement or retraining for another job.
Your employer and its insurance company have an incentive to help you with retraining and job placement because it reduces the total amount of wage loss benefits paid. If you find a lesser paying job, workers comp must pay the difference. Don’t let the insurance company tell you otherwise!
Disputes often arise as to what vocational rehabilitation is needed.
You may want to go to college and begin a new career. The insurance company may want you to just accept any job so that wage loss benefits can be stopped. Talk to an experienced workers comp lawyer to learn about all of your options under workers comp.
A vocational rehabilitation counselor may be hired to help with retraining and job placement. A vocational rehabilitation counselor can make your situation worse by ignoring medical restrictions and by suggesting demeaning jobs. If it is found that you did not cooperate with a vocational rehabilitation counselor, you can lose wage loss benefits.
Vocational rehabilitation counselors are sometimes hired by insurance companies for the sole purpose of cutting your workers comp benefits. You can have a lawyer present during any meeting with a vocational rehabilitation counselor. Don’t let your employer or the insurance company trample on your legal rights. An experienced Michigan workers comp attorney can intervene if a vocational rehabilitation counselor does not have your best interest at heart.
You can also trade away the value of vocational rehabilitation as part of a workers comp settlement. This allows you to get a lump sum payment and do your own retraining or rehabilitation.
What if I am turned down for workers compensation benefits in Michigan?
Some employers and insurance companies will routinely deny benefit claims for workers comp regardless of the facts. They will tell you that your medical condition is not work related or that you can work when you cannot.
If your employer or the insurance company has disputed your claim for workers comp, you must seek benefits through a formal process at the Michigan Workers' Compensation Agency. You must demonstrate that you suffered an injury on the job and that you are disabled from work or need medical treatment. You always have the burden of proof when your claim has been denied.
ABOUT THE AUTHOR: Alex Berman
Alex Berman is an attorney with Michigan Workers Comp Lawyers - a Michigan based law firm exclusively representing injured and disabled workers for more than 30 years. Alex has helped countless people get workers compensation benefits and never charges a fee to review a case.
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.