The employee claims an accidental injury and that he reported it to his supervisor. The supervisor denies or doesn’t recall having received the claimed report. The case is denied. The employee seeks his own medical care and is recommended to have surgery. The employee tells the employer of that recommendation and asks that the employer provide the recommended treatment. The employer declines to do so. The employee has the surgery and files an Application for Adjustment of Claim. The employee didn’t report the accidental injury and had unauthorized treatment, so why should the employer consider a settlement?Read the rest of this entry »
Indiana Code 22-3-3-7 states:
“Once begun, temporary total disability benefits may not be terminated by the employer unless:”
- employee has returned to work,
- employee has died,
- employee has refused a medical examination or suitable employment,
- employee has received 500 weeks of TTD or the maximum compensation,
- employee is unable/unavailable for work for reasons unrelated to the injury.
“In all other cases, the employer must notify the employee in writing of the employer’s intent to terminate the payment of temporary total disability benefits * * * on a form approved by the board.”
Form 38911 is the form approved by the Board and the TTD may not terminate until four days after Form 38911 has been mailed.Read the rest of this entry »
How are you doing with EDI 3.1? Indiana is one of the first States to implement this reporting format. Our Indiana Worker’s Compensation Board has tried to limit the information requested and some States ask for even more detail. If you have any questions or issues with EDI 3.1, please feel free to contact the Indiana Worker’s Compensation Board (David Babcock or Jake Forte) for assistance. The start date for possible statutory penalties is December 1, 2019.Read the rest of this entry »
What happens when a child loses a parent to a work-related fatality? What happens when that family’s main source of income ends to their children’s educational opportunities and aspirations?
Kids Chance of Indiana (KCIN) is a non-profit that provides college and vocational scholarships to eligible children of Indiana workers who were totally disabled or fatally injured due to a work-related accident. Established in 1996, KCIN has awarded over 125 scholarships totaling more than $280,000.00, averaging approximately $2,400.00 per student.
But there is so much more we could achieve. KCIN would like to increase the number of scholarships awarded each year and raise the average amount awarded to $5,000.00, thereby further reducing our students unmet needs. It would take an additional $30,000 to $50,000 annually which, with the generosity of potential corporate partners and donors like you, we believe we can realize.
Please consider supporting KCIN as a corporate sponsor or by participating in our golf outing, which is our primary annual fundraiser. Click Read More for additional information regarding that event and sponsorships.
Further if you have a referral or knowledge of a child impacted by a fatal or totally disabling injury of a parent from an Indiana work accident please let me know so we can reach out to them. You can additional information on our website, https://www.kidschancein.org.
Thank you for your consideration and if you interested in sponsoring or have any questions regarding this worthy organization please contact Darren Dye at [email protected] or (317) 233-3394.
Vice-President Kids’ Chance of Indiana
An employer has the right to avoid the payment of Temporary Total Disability (TTD) compensation to an injured employee by tendering to the employee suitable light duty work. If the employee refuses such light duty work, then the payment of TTD compensation may be suspended during the period of refusal. This seems simple enough, but there are two important restrictions before a suspension will be valid.
The Indiana Worker’s Compensation Board is made up of seven persons appointed by the Governor of Indiana. The seven persons must be Indiana attorneys in good standing and are referred to as members of the Board. One of the members is designated as the chairman of the Board and is primarily responsible for the administration of the Board’s activities. The remaining six members are assigned to the six Statewide hearing districts and are primarily responsible for the adjudication of compensation disputes in those districts. All seven members constitute the full Worker’s Compensation Board for the purpose of appeals from hearing member awards.
There have been some recent changes in Board members. Doug Meagher has been appointed to District 5. (This is member Meagher’s second appointment to the Board.) Kyle Samons has been appointed to District 6. Sandra O’Brien has been appointed to District 1. All three appointees have substantial experience regarding worker’s compensation law and procedure and are excellent additions to the Board.
The Indiana Worker’s Compensation Board website contains guidelines regarding the role of a nurse case manager (NCM) in Indiana worker’s compensation cases. If you use a NCM in the administration of a worker’s compensation claim, you should be sure that your NCM is aware of and is in compliance with these guidelines in the course of delivering NCM services to your injured employee.
The Indiana Worker’s Compensation Act (Indiana Act) does not designate the use of any particular rating guide for the assessment of a Permanent Partial Impairment (PPI) rating. Many medical providers are familiar with the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) and the Indiana Worker’s Compensation Board (Board) has long accepted references to the AMA Guides in support of PPI ratings. It is possible that in the future the Board will require that PPI ratings be based upon the AMA Guides so as to avoid a medical opinion report which assigns a PPI rating without any objective support. Even so, there are certain areas where the use of the AMA Guides may not be appropriate:
There are many occasions where good faith disputes require a compromise resolution. The primary format for such resolution is commonly referred to as the “Section 15” agreement.
IC 22-3-2-15 is the statutory authority for such an agreement. Section 15 requires that such an agreement be approved by a member of the Worker’s Compensation Board and that such member should not approve an agreement which is not in accordance with the rights of the parties pursuant to the Worker’s Compensation Act.
The Section 15 settlement process can be abused when it forecloses the legitimate non-disputed rights of an employee, where the consideration is inadequate, or where other unrelated employee rights are adversely affected. The Worker’s Compensation Board has created a checklist for settlements. The checklist is posted on the Board’s website.
Compliance with the checklist will make the preparation of Section 15 and other settlement agreements more time-consuming. But, the additional information required by the checklist will give to the Board member an accurate basis upon which to consider and approve the settlement. Section 15 agreements with unrepresented employees will require compelling evidence of the dispute and the adequacy of the money to be paid. A Section 15 agreement should give consideration to the length of time within which the claim may be reopened and the likelihood and value of the additional benefits which may be due within that time. Section 15 settlements in otherwise compensable claims will be closely scrutinized.
In addition to the checklist, the Board has identified several areas which are NOT appropriate for inclusion in a Section 15 or other settlement agreement:
- Confidentiality clause which requires a forfeiture of the settlement payment in the event of a violation.
- Blanket release of any and all claims or release of rights other than those related to the worker’s compensation claim.
- Employee resignation as a condition of the settlement.
- Waiver of the statutory right to reopen the claim where the claim was otherwise compensable and statutory benefits are being paid pursuant to the settlement agreement.
The Board is also working on a procedure whereby settlement agreements and orders in litigated cases will be electronically transmitted to the appropriate hearing member for review and approval. Settlements in non-litigated claims will be electronically transmitted to an “Accident Files” mailbox for handling. The effective date for this approval process will be announced by the Board in the future.
- An employer with mobile or remotely based employees shall convey the required Worker’s Compensation Notice to such employees in an electronic format or in the same manner as the employer conveys other employment-related information. (This method for notice is in addition to the posting of the Worker’s Compensation Notice for fixed situs employees.)
- The permanent partial impairment (PPI) rating assigned by the attending physician must be tendered to the employee within 15 days after the date of the PPI report. The tender would include a properly completed Form 1043 Agreement for Permanent Partial Impairment, the PPI report, a Form 53913 Employee Waiver of Examination by Personal Physician and an amputation chart (page 2 of Form 2118 Physician’s Report), if necessary. When the signed Form 1043 Agreement for PPI is received from the employee, it must be submitted to the Worker’s Compensation Board for approval within 15 days of the date it was received from the employee. (This is intended to avoid delays in the PPI agreement process. The failure to comply with the 15-day deadlines may constitute a lack of diligence.)
- A self-insured employer is required to electronically submit Form 34401 First Report of Injury to the Board within 7 days after the employer’s knowledge of an injury, either actual, alleged or reported, that causes an employee’s death or the need for medical treatment beyond mere first aid. (There will no longer be a requirement of more than one day of disability before the First Report of Injury must be submitted. Insured employers submit the First Report of Injury to their insurer.) The “beyond first aid” reporting requirement so established is meant to be consistent with the reporting requirement set out in the OSHA regulations. (29 CFR 1904.7)
- The definition of an employer has been clarified to make clear that a corporation, limited liability company or limited liability partnership that controls the activities of another corporation, limited liability company or limited liability partnership, or a corporation and a limited liability company or a corporation and a limited liability partnership that are commonly owned entities, or the controlled corporation, limited liability company, limited liability partnership , or commonly owned entities and a parent corporation and its subsidiaries shall each be considered joint employers of the corporation’s, the controlled corporation’s, the limited liability companies’, the limited liability partnerships’ the commonly owned entities’, and the parent’s or subsidiaries’ employees for the purposes of the exclusive remedy protection of the Indiana Worker’s Compensation Act. (The addition of limited liability companies, limited liability partnerships and controlled and commonly owned entities clarify the application of the exclusive remedy to forms of business like the parent and subsidiary form of business.)