You’re climbing the stairs at work, miss a step and fall, twisting your ankle. Is that a work injury? You feel a twinge in your back lifting a full box of computer paper. Is that a work injury? You’re walking down a hallway at your company and, as you turn a corner, you bump into a co-worker and fall, hitting your head on the floor. Is that a work injury?
The answer is YES to all of these questions. Any time you become injured at work, it is a work injury and you should report it to your employer right away.
This seems like common sense since there is a law that requires workers’ compensation coverage for employees injured on the job. Under state law, all employers with one or more employees must purchase workers’ compensation insurance (or be selfinsured) to provide wage replacement and medical benefits to employees injured on the job. Also, in exchange for the presumption that an injury is compensable if it occurs in the course of employment, the employee cannot sue the employer for a work injury.
(Note: Waterfront workers are covered under the federal Longshore and Harborworkers Act.)
Many workers do not report work injuries. Why? Because the employee thinks reporting an injury will affect his/her future with the company. Because the employer tells employees that work injuries are costing the company money and these costs affect the company’s bottom line—and their pay raises and benefits. Because the employee thinks the injury is minor and not worth the hassle of reporting it. Because the employee thinks he/she may bear some responsibility for the accident occurring in the first place.
But what happens when the injury leads to something more serious? Take the example of the employee bumping into a co-worker and hurting his head. The employee may think it was his own carelessness that caused the accident, but was it intentional? Or was it an accident? As it occurred at work, the injury should be compensable. While the injury may seem minor at first (maybe a bump on the head or a headache), what if it leads to a more serious brain injury which prevents the employee from working for the rest of his life?
Benefits of Workers’ Comp
If the accident is considered workrelated, the employee is entitled to have all medical treatment for the injury paid for by the employer’s workers’ compensation insurance carrier. That may include an emergency room visit, ambulance services, doctor’s fees, MRI’s, hospitalization, and medication. If it was not covered under workers’ compensation, the employee could pay several hundred dollars, if not more, in copayments.
If the accident is considered workrelated, the employee would also be entitled to wage replacement benefits, called Temporary Total Disability (TTD) payments, after a three-day waiting period. If the employee cannot return to work for a temporary period, the insurance carrier will pay weekly TTD benefits at 66-2/3% of the employee’s average weekly wage (AWW) up to the state’s AWW, which is currently $747. TTD benefits are not taxable. If it was not a compensable injury, the employee would need to take sick leave, maybe vacation, and may end up with no income.
What should you do when you are injured on the job?
• Report the accident to your employer immediately. Don’t wait a day or two to see how you feel.
• Find witnesses and get their names, phone numbers, and what they saw/ heard.
• See a doctor right away and let him know the accident occurred at work.
• File a WC-5 form, even if the employer is required to file an injury report. The WC-5 is your report of a work injury.
• Keep a journal of your notes of all doctor visits, communications with the employer and the insurance carrier, and any hearings. Keep your paperwork for the claim in one place.
• Contact your business agent, who can assist you with workers’ compensation claims. You are entitled to have treatment from a physician of your own choice, but if you want to make a change, you can only do it once. To see a specialist, get a referral from your attending physician for a consultation.
You need representation
Although state law requires compensation for injuries sustained in the course of employment, employers and insurance carriers often try to find ways to make the injury not compensable. A frequently used tactic is to declare the claim “denied pending investigation.” An outright denial requires a written report to the State Department of Labor within 30 days to support the denial, but there is no specific time limit for an “investigation.”
So what do you do? Ask for a hearing with the Department of Labor’s Disability Compensation Division. An impartial hearings officer will consider arguments from both sides and make a decision. Employers and insurance carriers are often represented by attorneys well-versed in the law and the process. You can represent yourself at the hearing, but it may be best to have someone, like your business agent or an attorney, represent you.
While you are disabled due to a work injury, you may be asked by the insurance carrier to be examined by an “independent” medical doctor, who is supposed to be impartial and unbiased. However, always be mindful that this doctor is hired by the insurance carrier. His report to the carrier may be used to determine compensability, to allow or disallow medical treatment plans, and even to determine the degree of permanent partial impairment. You need to be cooperative, respectful, and honest while being examined. Do not exaggerate symptoms, but do not minimize them either.
Work injuries are serious business
Being injured on the job can be troublesome. You’re injured, you may not be able to work, you’re not sure if your bills will be covered or you’ll have any income, and you may have a permanent impairment. But the bottom line is: report the injury and get representation.
Call your Business Agent or the ILWU Office nearest you today if you have a question about an on-the-job injury.
Hawaii: 935-3727
Maui: 244-9191
Kauai: 245-3374
Oahu: 949-4161
Longshore: 949-4161