Indiana Workers’ Compensation Claims: Eligibility, Filing, and Appeals
Nearly all employers in Indiana are required to carry workers’ compensation insurance for their employees. As in every other state, the workers’ compensation system in Indiana is a no-fault system designed to compensate injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must take certain steps required by Indiana law.
Who Is Eligible for Workers’ Comp Benefits?
Workers’ compensation covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers’ comp. On the other hand, injuries that occur while you’re off-duty are generally not compensated through workers’ comp. For example, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers’ comp. For more information, see our article on what types of injuries are covered by workers’ comp.
Workers’ comp covers both traumatic injuries and occupational illnesses. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
If you’re injured at work, you must give notice to your employer within 30 days or your claim may be denied. However, it’s usually in your best interests to report your injuries immediately. The sooner you give notice, the sooner your workers’ comp benefits can start. And, insurance companies are less skeptical of claims when they are reported right away.
If your injuries cause you to be out of work for more than one day, your employer must fill out a form called the “Employer’s Report of Injury” and send it to its insurance company within seven days, along with a copy to you. The insurance company must then file the report with the Workers’ Compensation Board of Indiana. The insurance company has 29 days to accept or deny your claim.
You can confirm that your employer filed a report of your injury by going to the Indiana Workers’ Compensation Board website.
How Do I Get Medical Treatment?
In an emergency, you can choose which doctor or hospital to seek treatment from. For all non-emergency care, you’ll have to follow the workers’ comp guidelines for selecting your treating doctor. In Indiana, employers have broad rights to select the medical providers who treat an injured worker. The one exception is where the employer refuses to provide the worker with reasonable and necessary medical care.
What Benefits Can I Receive?
All reasonable and necessary medical treatment related to your work injury will be covered through workers’ comp, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You’ll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive temporary disability payments and a permanent disability award.
You will be eligible to receive compensation for wage loss during the time you are temporarily disabled and unable to work. Temporary total disability payments are two-thirds of your average weekly wages, subject to a maximum of $780.00 per week (as of July 2016).
You can continue to receive temporary total disability until your doctor finds that you’ve reached maximum medical improvement (MMI), meaning that your condition has plateaued and is not expected to improve. These benefits are available for a maximum of 500 weeks.
If you’re able to return to part-time or light-duty work while you’re recovering, but earn less than your normal wages, you may eligible for temporary partial disability benefits. Temporary partial disability benefits are two-thirds of the difference in your average weekly wages, subject to the same minimum and maximum weekly amounts. These benefits are available for a maximum of 300 weeks.
If you are found to be totally and permanently disabled, you will receive the same weekly amount that you received in temporary total disability payments. Permanent total disability benefits are available for up to 500 weeks. These benefits are available only to workers with severely debilitating injuries. Workers are considered totally disabled only if they cannot return to their jobs and other work is not reasonably available to them.
For most other workers, permanent partial disability benefits are available. In Indiana, these benefits are called permanent partial impairment (PPI) awards. Your award will be based on the permanent impairment rating assigned to you by your doctor, as well as a state schedule that lists degrees of impairment based on loss of use of certain body parts. Injuries that are not on the schedule, such as back injuries, are rated as a percentage of loss to the whole body.
For each degree of impairment, you will receive the following amounts:
- Degrees 1 to 10: $1,517 for each degree impairment
- Degrees 11 to 35: $1,717 for each degree impairment
- Degrees 36 to 50: $2,862 for each degree impairment
- Degrees 51 to 99: $3,687 for each degree impairment
For example, the Indiana schedule states that injury to the thumb is worth 12 degrees. If your doctor assigns you a 100% impairment rating of the left thumb, you will receive $1,517 for the first ten degrees of impairment and $1,717 for the last two degrees of impairment, for a total of $18,604.
If you received more than 125 weeks of temporary total disability payments, the insurer may get a partial credit against your PPI award.
What if My Claim Is Denied?
If your workers’ comp claim has been denied, or the insurance company is disputing any portion of your claim, you have the right to appeal the decision. To pursue an appeal, you must file a form called an “Application for Adjustment” with the Indiana Workers’ Compensation Board. A hearing will be held before a workers’ comp judge, who will issue a written decision. If you disagree with the judge’s decision, you may file an appeal with the Full Workers’ Compensation Board within 30 days.
For more information on the appeals process, see our article on appealing a denial of your Indiana workers’ comp claim.