Utah Workers’ Compensation Claims: Eligibility, Filing, and Appeals
Learn about your rights under the workers' compensation system in Utah.
Virtually all employers in Utah are required to carry workers’ compensation insurance for their employees. As in every other state, the workers’ compensation system in Utah 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 Utah 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 should notify your employer and get medical treatment right away. In Utah, you have 180 days to report your injury to your employer without any negative consequences to your claim. However, it’s in your best interests to report your injuries right away. The sooner you give notice, the sooner you can start receiving workers’ comp benefits. And, insurance companies are less skeptical of claims when they are reported right away.
Once you give notice of your injuries, your employer must fill out a form called the “Employers First Report of Injury or Illness” and send it to its insurance company within seven days, along with a copy to you. The insurance company has 21 days to decide whether to accept your claim, deny your claim, or let you know that further investigation is required. If the insurance company decides to investigate further, it has another 24 days to decide whether to accept or deny your claim.
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 Utah, employers can select the doctor for the initial doctor’s visit, but only if they provided employees with notice of a Preferred Provider Organization (PPO) beforehand. If your employer hasn’t given you notice of a PPO, you may see a doctor of your choosing.
At your initial appointment, be sure to explain how your injuries happened and that they are work-related. Your doctor must fill out a form called the “Physicians First Report of Injury or Illness” within seven days. You can request a copy of this report from your doctor. This report, combined with your employer’s report, are the official start to your workers’ comp claim.
What Benefits Can I Receive?
All 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 set by law each year. As of July 1, 2016, the maximum benefit is $817 per week. Temporary disability payments are usually paid out every two weeks.
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 312 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, plus $5 for each spouse and dependent minor child (up to four). The same weekly maximum mentioned above applies to temporary partial disability benefits.
If you are found to be totally and permanent disabled, you will receive two-thirds of your average weekly wages. Weekly benefits are subject to a maximum of $694 per week (as of July 1, 2016). Permanent total disability benefits are available for as long as you are totally disabled. 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. Permanent partial disability benefits are two-thirds of your average weekly wages, subject to a maximum of $545 per week (as of July 1, 2016). The duration of your benefits depends on the impairment rating assigned to you by your doctor. For injuries to certain body parts listed in a state schedule, workers can receive benefits for one to 218 weeks depending on the severity of the disability. For unscheduled injuries, workers can receive benefits for up to maximum of 312 weeks depending on the severity of the disability.
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 Hearing” with the Utah Labor Commission. 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 within 30 days, which will be heard by the Labor Commissioner or Appeals Board.
For more information on the appeals process, see our article on appealing a denial of your Utah workers’ comp claim.