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Who pays workers’ compensation benefits?
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Can the insurance company stop my checks
whenever they want?
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What happens to my claim if my employer
goes out of business?
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What happens to my claim if I return to
work for another employer?
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What if I have a new injury with my new
employer or my work there aggravates my old injury?
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I think I’m being followed. Is this legal?
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Can I move out of state while I’m receiving
benefits?
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Do I have to meet with a nurse case manager that was assigned to
me by the insurance company?
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Does my employer have to cover my health insurance while I’m on
comp?
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Can I be fired while I’m collecting
workers’ compensation?
- Am I entitled to return to work for my employer?
1. Who pays workers’ compensation benefits?
Most employers are subject to workers’ compensation laws
and are required to purchase workers’ compensation insurance to cover
employees for work related injuries. Benefits are paid by the employer’s
insurance company. Some employers are allowed to be self-insured for
workers’ compensation.
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2. Can the insurance company stop my checks whenever they want?
It depends. When an insurance company pays benefits,
they are required to file either a Non-Prejudicial Agreement or
Memorandum of Agreement with the Department of Labor (they choose which
form to file) and send a copy to the injured worker. The Non-Prejudicial
Agreement allows the insurance company to pay benefits without accepting
liability for the injury and also allows payments to be stopped at any
time during the first thirteen weeks of disability. The Memorandum of
Agreement, on the other hand, signifies the insurance company’s legal
acceptance of the claim and
prohibits payments from being stopped without the injured worker’s
written consent (on a Suspension Agreement) or court order. Injured
workers who have not had their claims accepted through a Memorandum of
Agreement have the right to petition the Workers’ Compensation Court for
acceptance of their claims. The court order will have the same force and
effect as a Memorandum of Agreement in prohibiting payments from
stopping without your written consent or court order.
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3. What happens to my claim if my employer goes out of business?
Workers’ compensation remains the responsibility of the
insurance company regardless of whether your employer remains in
business.
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4. What happens to my claim if I return to work for another employer?
In general, the insurance company that paid your
benefits remains responsible for your injury even if you return to work
for a different employer. The insurance company remains responsible to
pay for any medical care that you need for your injury and to pay
disability benefits if your injury again becomes disabling, provided
that you did not have a new injury with your current employer that
aggravated your old injury.
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5. What if I have a new injury with my new employer or my work there
aggravates my old injury?
Your new employer’s insurance company may become
responsible for your old injury if you have another injury with your new
employer that aggravates your old injury or if the nature of the work
that you are doing aggravates your old injury. This is often the subject
of dispute between the insurance companies for your old employer and
your new employer – whether your medical condition is due to the effects
of the old injury or whether it’s due to the old injury becoming
aggravated by your current job or a new injury in your current job.
Either way, you’re covered.
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6. I think I’m being followed. Is this legal?
Insurance companies have the right to have an
investigator perform surveillance activities on you. This may include
following you, taking photographs and video, and talking to your
neighbors. Insurance companies hire investigators to see if you’re doing
any physical activity that might suggest that you’re not disabled or if
you’re working somewhere and not reporting your wages. It’s a nuisance
but perfectly legal as long as the investigator does not violate any
laws such as trespassing.
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7. Can I move out of state while I’m receiving benefits?
Yes. You can live anywhere in the world and the
insurance company will send your check to your new address. The
insurance company must also continue to pay for medical treatment near
your new residence.
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8. Do I have to meet with a nurse case manager that was assigned to
me by the insurance company?
People have different opinions on nurse case managers.
Some find them helpful with coordinating medical care for complex
injuries. Others find them an unnecessary interference with their
patient-doctor relationship. Nurse case managers report directly to the
insurance adjustor that is handling your claim. The bottom line is that
it’s your decision whether to allow a nurse case manager to assist you
with your medical care.
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9. Does my employer have to cover my health insurance while I’m on
comp?
Only in very rare cases is an employer responsible
for paying your health insurance. In most cases, you are required to
continue to pay whatever you were paying before your injury to keep your
health insurance in effect. If your health insurance is terminated, you
probably have a right to continue coverage under COBRA.
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10. Can I be fired while I’m collecting workers’ compensation?
If you’re out of work because of an injury, you may be eligible
for up to 12 weeks of leave under the Family and Medical Leave Act
(FMLA) during which time you cannot be fired. After that, or if you’re
not eligible for FMLA leave, you can be terminated from your job even if
you are collecting workers’ compensation. However, subject to certain
limitations, Rhode Island law does provide injured workers with a right
to be reinstated to their job for a period of one year following the
injury. This right to reinstatement exists even if you’ve been fired.
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11. Am I entitled to return to work
for my employer?
Yes. You are entitled to be reinstated to your regular
job if your employer had more than 9 employees and your job is still
available. If it’s not available, you have the right to be reinstated
to any other job that is vacant and suitable. There are many rules
that must be followed to make a request for reinstatement. In general,
reinstatement must be requested by the earlier date of one year from
the date of disability, 30 days from a finding of maximum medical
improvement, or 10 days from the date that you are notified in writing
that your doctor released you to return to work.
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