Ultimate Guide for Injured Workers: 10 Common Mistakes to Avoid [sample]

8/10/2019 Ultimate Guide for Injured Workers: 10 Common Mistakes to Avoid [sample]

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Attorney Michael P. Sullivan has practiced injury and disabilitylaw since 1990. Michael has been a presenter of local seminars

on disability law, was past Section Chair for the Social Security

Section of the local bar association, and regularly attends national

training seminars in disability law. Michael is a published author

and has appeared on television speaking on injury and disability

topics. He has an active practice and still personally attends

hearings with his clients. His years of disability experience have

given him an in depth knowledge of a host of medical issues, as

well as being adept at administrative law.

Michael P. Sullivan is a licensed attorney who practices law

in Kentucky for Sullivan Law Office. The main office is in the

Louisville, Kentucky area, although they service the Louisville,

Lexington and Southern Indiana area, as well as many

surrounding counties.

If you are injured on the job, your life can change in an instant. You may askyourself: What are my rights? What can I do? What doctor do I see? Where do I

go from here? Who do I tell about this injury?

If youve been injured on the job in Kentucky, there are some basic steps

you must take to protect your rights. THE ULTIMATE GUIDE FOR INJURED

WORKERS: 10 COMMON MISTAKES TO AVOIDexplains how Workers

Compensation works in Kentucky and outlines 10 mistakes that can reallycost you. From failing to notify your employer to losing the option to reopen

your case, THE ULTIMATE GUIDE FOR INJURED WORKERS will give you the

information you need to move forward with your Workers Compensation claim.

MICHAEL P. SULLIVAN

THIS IS AN ADVERTISEMENTKentucky does not certify legal specialties. Others in firm may perform some services. Main office - Louisville, KY

THIS IS AN ADVERTISEMENTKentucky does not certify legal specialties. Others in firm may perform some services. Main office - Louisville, KY

~Michael P. Sull ivan

I wrote this book because I wanted to get information

directly to injured workers. I feel that if you are better

informed, you can make better decisions. Better decisions

can lead to a better result for you; its that simple.


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The Ultimate Guide for Injured Workers:

10 Common Mistakes to Avoid

By

Michael Sullivan, Attorney

BSEE, MSEE, JD

THIS IS AN ADVERSTISEMENT

Kentucky does not certify legal specialties

Others in the firm may perform some services

Main office: Louisville, KY


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Published by vitalink Publishing House, a division of

vitalink, 4900 Falls of Neuse Rd., Suite 115, Raleigh, NC,

27609. Contact the publisher [email protected] formore information.

THE ULTIMATE GUIDE FOR INJURED WORKERS: 10 COMMON MISTAKES

TO AVOID

Author: Michael P. Sullivan

Sullivan Law Office

1500 Story Avenue

Louisville, KY 40206

(502) 587-0228(888) 587-0228

Michael Sullivan is an attorney licensed to practice in

Kentucky. Kentucky does not certify specialties of legal

practice.

All rights reserved. No part of this book may be

reproduced or transmitted in any form or by any means,

electronic or mechanical, including photocopying,

recording or by information storage and retrieval systemwithout written permission from the author, except for the

inclusion of brief quotations in a review.

Copyright 2012 by Michael P. Sullivan

ISBN 978-0-9847642-5-9

THIS IS AN ADVERSTISEMENTKentucky does not certify legal specialties

Others in the firm may perform some services

Main office: Louisville, KY
mailto:[email protected]:[email protected]


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Questions? Visit www.slodisability.com.


Introduction

My name is Mike Sullivan and I am an attorney at the

Sullivan Law Office in Kentucky. Our practice is focused

on injury and disability claims. My goal in providing this

book is to give injured Kentucky workers the information

they need to protect their rights. The book is intended to

answer many of your questions related to the Workers

Compensation process and explain some of the common

mistakes that others have made in the hopes that you

will avoid these pitfalls.

You may ask, Whats the catch? There isnt one. I have

advocated on behalf of the injured and disabled for many

years now, and understand how stressful these situationscan be. I am offering this book to injured workers for free

because I truly believe that knowing how the process

works will relieve some of your stress and allow you to

deal more effectively with the challenges you may face.

The old saying that knowledge is power is true. I amcertain you have a lot of questions. This book will

probably answer many of them. This helps me, as well.

How? If you decide to schedule a free, no-pressure

consultation with our firm, we will be able to get right

down to discussing your specific situation and solutions

instead of answering basic questions that I cover in thisbook. We start our meeting ahead of the game.


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Important Disclaimer

I am not allowed to give legal advice in this book!

The Kentucky Bar does not permit me to give legal advice in

this book. While I have significant experience in handling

Workers Compensation cases in Kentucky, each situation is

different. I can provide you with basic information about

Workers Comp cases and offer suggestions on ways to

identify potential problems, but please do not take anything

you read as legal advice unless I have met with you to discussyour specific case, you have decided to hire me, and I have

agreed in writing to accept your case.

If you have already hired another attorney to handle your

case, please read this:

If you have previously hired an attorney to represent you inthis matter, we need to know this. We normally do not take

cases away from other attorneys after they have begun to

work them. If you have a specific issue with the attorney

handling your case, we recommend that you sit down with

him or her and discuss your concerns. In many cases,

problems that arise are due to miscommunication and can be

cleared up with an honest and open conversation. If you both

agree that the relationship is not working out and you would

be better off with another attorney, we would be happy to

speak with you.


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Injured on the Job? What Now?

The majority of employers in Kentucky are required to

carry Workers Compensation insurance. This insurance

is intended to cover medical expenses and lost wages for

employees who are injured on the job. The entire

process is outlined by state statute and specific rules and

requirements must be followed by all parties.

If youve been injured on the

job somewhere in Kentucky,

there are some basic steps you

must take. First, let your

employer know as soon as you

are able, and then seek

medical treatment promptly.

(If the injury is life-

threatening, get to the

emergency room and notify

your employer as soon as

possible afterward.) Letting

too much time go by without doing either of those things

may put your health and welfare at risk, and may have an

adverse impact on your claim down the road.

Because of this risk, it is good to arm yourself with the

necessary information that will help your case to go

smoothly, such as which doctors may treat your injury

Occupational Illness

While most people

think about Workers

Comp as being for

those who are injured

in on-the job accidents,

workers with

occupational illnesses

are also covered. The

most common

occupational illness in

Kentucky is Black Lung.


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and what to do if you want to change doctors. There are

necessary forms to fill out and rules that need to be

followed throughout your claim.

In general, a typical pattern is that you get hurt on the

job, and you report it. You then get medical care, and as

that care progresses, you get better. You eventually heal

and then get on with your life. Maybe you talk to a

lawyer to see if you have a case.

Unfortunately, this process does not always go smoothly.

Often times, medical treatment is denied which then

requires an appeal (or appeals) that will need to be filed

in a timely manner. Any misstep on behalf of the

insurance company or by the injured worker may resultin delayed or even denied benefits. The best way to

avoid this from happening is to stay informed and keep

the insurance carrier informed.

Getting Medical Care

Your health should be your first priority. If your injury is

severe, go to the emergency room for treatment. Notify

your employer as soon as possible afterward of your

work injury. For non-life threatening injuries, you may

choose your own doctor, unless your employer has a

managed care plan. When you report your injury, your

employer should tell you if they have a managed careplan. In these cases, the employer will give you a list of


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doctors that you may choose from. Kentucky statute

allows you to change doctors once during treatment

without explanation.

When you meet with the doctor, make certain he or she

knows that you are being treated for a Workers Comp

claim and ask the doctor to provide ongoing updates to

the insurance company and your employer. This will help

ensure there are not interruptions in your benefits.

Wage Replacement

Kentucky Workers Comp law covers your medical

expenses from your work injury as well as a portion of

your lost wages. The calculations for the benefit amount

are outlined by statute. You will not be paid for the first 7

days you miss from your injury, unless you miss a total ofmore than 14 days. At that point, you would receive

benefits for the first 7 days you were out of work.

Lets break this down. While you are being treated for

the work injury and out of work (if all goes well during

this time of ongoing medical treatment) you will usuallybe paid a form of wage replacement, called Temporary

Total Disability Benefits (TTD). Insurance Carriers usually

pay this money directly to you while you go through the

prescribed treatment plan and are healing. How much

you get is based in part on something called your

Average Weekly Wage (AWW). The AWW is calculatedfrom your reported earnings, sometimes over the year


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before the injury, and sometimes the higher earnings

weeks are pulled from the quarters preceding the injury

to calculate the AWW. It can actually get complicated.

In general, the weekly benefit payment will be 2/3 of

your AWW, but no more than the Average Weekly Wage

maximum published by the state. The maximum weekly

benefit allowed by the state for 2012 is $736.19; the

minimum weekly benefit in 2012 is $147.24. Thesenumbers are adjusted annually.

For employees who are paid on commission or have

income that varies significantly from month-to-month or

quarter to quarter, the AWW mathematics can get

confusing. If this is the case, you may wish to consultwith an attorney sooner rather than later.

MMI & Impairment Ratings

Eventually, with treatment and time, you heal from the

injury (or heal as much as you are going to given the

nature of the injury). If you heal completely and are ableto return to work with the doctors release, benefits will

stop and life will go on as before. If, however, you do not

fully recover and are either partially or totally disabled,

benefits will usually still stop as soon as your doctor has

released you from his/her regular care, with the

understanding that you will not improve further (at this

point you are said to have reached Maximum Medical


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Improvement or MMI). You may or may not be able to

return to work, andyou dont have benefits coming in

anymore. You risk running out of money. Now things can

really get fun.

Once you reach MMI (and not everyone involved will

always agree as to whenyou reach MMI), you MAY be

assigned an impairment rating. The idea of an

impairment rating is to rate the degree of permanentimpairment to your body as whole caused by the work

injury. In Kentucky, a doctor will generally use a book

called The AMA Guidesto arrive at an impairment rating.

The regulations even go so far as to state what edition of

the Guidesis to be used!

Your rating is a percentage, and in theory, is a number

between 1 and 100. Some injuries are minor and heal

with no real residuals; in this case, you will not usually

get a rating as you have 0% impairment. Some injuries

are really severe and the ratings are rather high; at this

point, the worker is pretty much totally disabled. Note:the insurance company is not obligated to pay for and

secure a rating, but it is nearly impossible to fairly settle

or resolve your case without one.

Getting a Settlement

At any rate, lets say you have healed, reached MMI, andmanaged to get a valid impairment rating. Now it is time


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to talk settlement. This is a crucial time in your case.

You may be entitled to future and/or past monetary

benefits. You may be entitled to a lump sum or periodic

award for a permanent injury. This is also the time to

protect your future medical treatment, the right to

reopen your case for future medical, and discuss any

potential monetary benefits and vocational rehabilitation

(if necessary).

Settlements can get tricky. Lets just assume everyone

somehow agrees on the impairment rating, to protect

your future rights, and to calculate an award for you

based on your AWW and assigned impairment rating.

But wait, we havent talked about possible multipliers foryour award (i.e., if we all agree you cant go back to your

past work), and what about the GRID factor to be applied

to the rating? Perhaps you have some type of pre-

existing permanent impairment affecting the same area

of your body from thiswork injury. Now the carrier

wants to alter the settlement to reflect this fact. Heyshould this settlement award be calculated over 425

weeks or 520 weeks? Is there a discount factor to be

applied? Does this sound confusing? It gets better!

Lets continue to assume for some reason it is all going

really well, and we can agree on all the essential terms.

Nobody argues about the medical treatment you havehad to date, all your prescriptions have been covered,


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and all medical bills have been paid in a timely fashion. In

fact, lets assume nobody has issues with your future

medical benefits, and we are all eager to just get this

matter concluded.

So what next? Now we drop all the appropriate numbers

into the formula set out to adjudicate Kentucky claims.

Eventually a number drops out of this formula, and that

is your award for a permanent impairment. You mightreceive the settlement as a lump sum, or it may be paid

out over a number of years. We draw all this up using the

special Form 110, and everybody signs. We then send it

to Frankfort for approval. Hopefully, all is well, your

future benefit rights are intact, and you now move on

with your life.

Attorney Fees

But wait, we still have to disburse the money (especially

if you get some type of lump sum). If you used an

attorney, he or she is usually entitled to a fee. Attorney

Fees are governed by statute in Kentucky and must beapproved by the Dept. of Worker Claims (usually by an

ALJ). At my office, we always have a written fee contract

to employ us so there are no surprises, and our fees are

always contingent upon winning. This means if we dont

win your case in some fashion, you dont pay us an

attorney fee.


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The fee structure is set up by statute in Kentucky. It is the

same for all attorneys: 20% of the first $25,000.00; 15%

of the next $10,000.00; and 5% of the remainder.

Currently, we are fee capped at $12,000 by statute.

Sometimes there are costs associated with the pursuit

of a case, and these costs are generally advanced by the

attorney. Once the case is successfully concluded, these

costs are recovered in addition to the attorney fee.Please note the following which must be disclosed

under Kentucky rules: COURT COSTS AND CASE

EXPENSES WILL BE THE RESPONSIBILITY OF THE CLIENT.

This is the general rule for my office insofar as Workers

Compensation cases are concerned. Like any general

rule, there is a limited exception wherein we waive anycosts:

If we do not recover anything at all for you (e.g.

the case is lost), it is our longstanding office

policy to simply write off any costs we

advanced in your case. Under these limitedcircumstances we will NOT bill you, we do NOT

expect any reimbursement, and you will not

owe us these case costs. Our contracts reflect

this policy, and it is part of the employment

agreement.


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Getting back to the narrative: eventually you get your

award, your attorney gets paid, and life goes on

smoothly. If only it were that simple!

The reality is that some cases will go from start to finish

without a hitch. But just as surely as there are smooth

cases, there are cases that are nothing if not a bumpy

ride. Getting you from the day of injury to the payment

of settlement benefits is as much art as science. A goodattorney can help you navigate the pitfalls, and maximize

your recovery.

The remainder of this book illustrates some of the more

common pitfalls in these cases. Remember, we never

charge to initially talk to you about your case. You cancall anytime with questions, and we hope you do.

Ultimate Guide for Injured Workers: 10 Common Mistakes to Avoid [sample]

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