Nebraska Workers’ Compensation Claims: Eligibility, Filing, and Appeals
All employers in Nebraska with one or more employees must carry workers’ compensation insurance. As in other states, the workers’ compensation system in Nebraska is a no-fault system that compensates injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must follow certain procedures required by Nebraska law.
Who Is Eligible for Workers’ Comp Benefits?
Workers’ compensation covers almost all employees in Nebraska. However, there are a few exceptions for employees engaged in certain types of work. For example, workers’ comp does not cover domestic household workers or certain farm workers, unless the employer chooses to provide coverage.
Workers’ compensation covers all injuries or illnesses that happen in the course of employment, including 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, such as injuries caused by repetitive movements at work (for example, carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (for example, cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
To reserve your right to benefits, you must report your injury to your employer as soon as it is practical. Depending on the severity of your injuries, this might be within a day or two. On the other hand, it might be longer if you are in the hospital with serious injuries and cannot ask anyone to notify your employer on your behalf. Once your employer has notice, it will notify its insurance company. The insurance company will then decide whether to accept or deny your claim.
How Do I Get Medical Treatment?
Once you give notice of your injury, your employer should let you know that you have the right to select a treating doctor. However, the doctor must be someone who has treated you or an immediate family member in the past. If you don’t have such a doctor, your employer can choose your treating physician.
However, you can select any treating doctor—even one with whom you have never treated—in the following situations:
- if your employer fails to tell you of your right to select a treating doctor who has treated you or family member
- for emergency medical care
- for major surgeries, or
- if your injury involved a dismemberment.
Once you have a treating doctor in your workers’ comp case, you will need your employer’s approval before switching to another treating doctor. This is true regardless of who selected your treating doctor.
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 can 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 disability benefits.
Total Disability Benefits
Nebraska provides total disability benefits to workers who are completely unable to work due to their injuries. These benefits are two-thirds of your average weekly wages, subject to a weekly minimum and maximum that is updated each year. For 2016, the weekly minimum is $49, and the weekly maximum is $785.
These benefits are called temporary total disability benefits while you are still recovering from your work injuries. You can receive these benefits until you’re able to return to work or until you reach “maximum medical improvement” (MMI)—the point at which your condition has stabilized and has improved as much as it is going to. If you are still completely unable to work after reaching MMI, you can continue receiving these benefits as permanent total disability benefits.
Temporary Partial Disability Benefits
If you are able to work while you are recovering from your injuries, but you are making less than you used to, you can receive temporary partial disability benefits. These benefits are two-thirds of the difference in your earnings, subject to the same maximum as total disability benefits. You can receive these benefits for as long as your wage loss continues, up to a maximum of 300 weeks.
Permanent Partial Disability Benefits
Once you reach maximum medical improvement, you will be evaluated for a permanent disability. If you have a permanent disability, but you are still able to work in some capacity, you can receive permanent partial disability benefits. The amount and duration of these benefits depend on whether the injury is listed on a state schedule.
Nebraska’s schedule lists injuries to certain body parts—such as a hand, arm, leg, foot, finger, toe, eye, and ear—and designates a maximum number of weeks for which benefits are paid. You can receive two-thirds of your average weekly wages, subject to the same maximum as total disability benefits, for the number of weeks listed in the schedule. For example, the schedule allows a worker to receive benefits for 150 weeks for the total loss of use of a foot. The award is typically paid in one lump sum.
If your injury is not listed on the schedule—such as a back or head injury—you will be considered to have a permanent partial disability as to the body as a whole. Your benefits will be two-thirds your average weekly wage, subject to the same maximum as total disability benefits, times your percentage of disability. These benefits are available for up to 300 weeks, minus any weeks that you’ve already received temporary or permanent disability benefits.
What If My Claim Is Denied?
If the insurance company denies your claim, you can file a petition with the Nebraska Workers’ Compensation Court. 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 appeal the decision. For more information on the appeals process, see our article on appealing a denial of your Nebraska workers’ comp claim.