Orthopedic Injuries And What You Need to Know About Workers’ Compensation

A number of workers risk injuries on a daily basis due to repetitive movements that can lead to them getting hurt and suffering orthopedic injuries. Orthopedic injuries that are most commonly reported are any injuries related to the foot, ankle, knee, hip, ankle, wrist, elbow, shoulder and spine. These types of injuries can make getting back to work very difficult. It not only impacts your ability to do your job well, but it brings with it the necessity for filing a workers’ compensation claim. As you’re dealing with the physical pain and discomfort of the injury, the burden of providing for yourself and your loved ones puts you under a tremendous amount of stress.

Proving Work-Related Orthopedic Injuries

For many, the prospect of filling out mountains of paperwork, dealing with insurance companies, and jumping through bureaucratic hoops seems like more trouble than it’s worth. However, while a sprained ankle may not be severe enough to warrant filing a workers’ compensation claim, a blown-out knee or an injured hip certainly requires immediate treatment and medical attention.

In order to prove that the orthopedic injury took place at work and for the worker’s compensation application to be successful, a doctor or orthopedic surgeon needs to provide some answers to the injury. Some information that orthopedic surgeons and physicians dealing with workers comp patients need to provide include:

  • knowing that the patient’s injury was work related
  • Identifying the percentage of the injury that was work related
  • Whether the patient is under any restrictions
  • Will the patient fully recover?
  • Expected recovery period

Filing For Workers’ Compensation

Fully funded by the employer, workers’ compensation comes in the form of cash benefits as well as medical care for injuries sustained by an employee in the course of doing their job. These weekly cash benefits and payment for medical care are provided by the employer’s insurance carrier and mandated by the Workers’ Compensation Board.

Although the procedure for filing a workers’ compensation claim is straightforward, there are some steps that should be taken immediately after sustaining an injury while when on the job. Firstly, get any First Aid or urgent care required to treat the injury. Secondly, be sure to notify your employer of the incident and how it occurred within 30 days of sustaining the injury. Make sure to include a written statement documenting the incident as well.

The Different Types Of Forms To Fill Out

The C-3 Form
After obtaining any necessary treatment and informing your employer of the incident, you should file a claim with the Workers’ Compensation Board by filling out a C-3 form. Consisting of six sections, the form will start by collecting some basic information about you and your employer at the time of the incident. The sections after that cover the events just before, during, and after the incident.

The Workers’ Compensation Board has a helpful step-by-step walkthrough if you need some guidance on filling out the form. Furthermore, make sure to fill out this form and send it to the right Workers’ Compensation Board district office within two years of sustaining the injury as a direct result of performing your duties at work or of knowing that an injury was sustained directly due to work.

The C-4 Form
Next, the doctor providing you treatment must fill out and send a Doctor’s Initial Report or C-4 to your Workers’ Compensation Board district office. The above-mentioned questions need to be fully answered for this form. Your employer, their insurance carrier, and you or your representative should all be provided copies of this form. Within ten days of the date of your injury or illness, your employer will report the incident to both their insurance carrier and the Board.

Within 14 days, you should receive a written statement from the employer’s insurance carrier detailing your rights according to the law. It’s important that this takes place within 14 days of receiving your employer’s report of your injury or with your first check, whichever comes first. Furthermore, if the carrier requires you to undergo diagnostic tests with a network they’re contracted with, they must provide you with the network’s name and contact information along with the statement of your rights.

Within 18 days of receiving your employer’s report of your work-related injury or illness, you should begin receiving benefits if you’ve missed more than seven days as a direct result of your injury. Otherwise, the insurance carrier must notify you or your representative and the Workers’ Compensation Board if they wish to dispute your claim.

If the carrier is not making payments due to the fact that the duration of your disability was less than seven days or that no time was missed, they must notify both you and the Workers’ Compensation Board. However, if you have not notified your employer of your injury in a timely manner, the carrier has the right to notify you and the Board within ten days of learning about the incident.

Receiving Benefits

If the carrier does not dispute your claim, you will regularly receive your benefits. Every two weeks, the insurer is required to notify the Board if your payments are discontinued or changed. Every 45 days, your doctor will fill out a C-4.2 form, a progress report on your injury, and send it to the Board. If all goes smoothly, the insurer will assess your need for rehabilitative services after 12 weeks. However, if you fail to notify your employer of your injury or file a claim, you may not be compensated for your injury.
All the paperwork involved with filing a workers’ compensation claim may seem daunting at first. However, the Workers’ Compensation Board offers instructions in multiple languages in addition to English to help you smoothly navigate this process. Lastly, many forms can be filled out and submitted online on the WCB site.

So, while sustaining an injury at work may be stressful, a bit of preparation and organization will go a long way toward ensuring that the process is as stress-free as possible. It is also worth mentioning that the system may not always work out as smoothly as it has been laid out here, and if that is the case, getting legal representation can also go a long way to ensuring a successful workers’ compensation claim.

Author Bio:
Tom Moverman established the Lipsig Bronx Firm with Harry Lipsig and his partners in 1989; The firm’s focus is in personal injury, construction accidents, car accidents, products liability, and medical malpractice.

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