Vermont Workers' Compensation Claims: Eligibility, Filing, and Appeals
Learn about your rights under the workers' compensation system in Vermont.
Workers’ compensation in Vermont is a mandatory insurance program designed to compensate injured workers for medical care, lost wages, and permanent disabilities. Employees who are involved in workplace accidents, who sustain repetitive motion injuries (such as carpal tunnel), or who develop occupational diseases, are normally eligible for benefits.
Workers’ Compensation insurance coverage is required of all employers in Vermont. Employers must provide workers’ comp coverage for all of their employees. The Vermont Department of Labor (DOL) begins with the assumption that a worker is an employee. To avoid providing workers’ comp coverage for a worker, an employer must prove that the worker is an independent contractor and not an employee. In general, an independent contractor is someone who is hired to perform a job that is not central to the employer’s business and whose work is not subject to control by the employer. Also, to be an “independent contractor” the individual must generally have employees of his or her own.
Filing Your Claim
Under Vermont’s Workers’ Compensation rules you should report your workplace injury to your employer as soon as possible. If you delay in giving notice, you may lose your right to collect benefits. Never assume that your employer knows about your injury, and make sure that you keep written documentation of your notice.
Once you’ve reported your injury, your employer must complete and file a First Report of Injury form (Form 1) with the Vermont DOL within 72 hours and must send a copy to you. If you do not receive your copy, or suspect that your employer did not timely notify the DOL, you must file your own notice with the DOL, called a “Notice of Injury and Claim for Compensation” (Form 5).
Your employer’s insurance company typically has 21 days from receiving notice of your claim to accept or reject your claim. Any denial must state the specific grounds for the denial. If the insurer accepts your claim, it must complete a standard form called a “Compensation Agreement” and immediately start your benefit payments. The agreement will list the exact amount to be paid to you each week in temporary disability or permanent disability benefits.
Obtaining Medical Treatment
In the event of an emergency, you should seek medical care immediately from the nearest health care provider. Make sure to tell the provider that you have sustained a job-related injury. For all non-emergency care, Vermont law allows your employer to select the doctor for your initial medical treatment. After that first visit, you can choose your own medical provider by filing an Election Form with the DOL and your employer.
The workers’ comp insurer is responsible for covering all reasonable and necessary medical care related to your workplace injury. This includes doctors’ appointments, hospital care, medications, and other treatment recommended by your doctor and authorized through workers’ comp.
Temporary Total Disability
If your doctor determines that you are completely unable to work while recovering from your injuries, you will be eligible for temporary total disability (TTD) payments for lost wages. Temporary total disability is generally about two-thirds of your average weekly wages, subject to a minimum and maximum amount that are set by the DOL each July. As of July 2016, you cannot receive less than $420 or more than $1,259. In addition to the weekly TTD benefits, you can receive an additional $10 per week for each dependent child.
TTD benefits are available for up to 104 weeks of continuous payment, at which point the DOL will determine if payments should continue.
Temporary Partial Disability
Your doctor may allow you to return to part-time or modified work while you are still recovering. For example, your doctor may clear you for “light duty” work, which places restrictions on the type or amount of work you can perform based on your medical condition.
If your earnings for part-time or light duty work are lower than what you previously made, you will usually be entitled to temporary partial disability (TPD) benefits. TPD payments are generally two-thirds of the difference in your earnings. TPD benefits are also available for up to 104 weeks of continuous payment, at which point the DOL will determine whether payments should continue.
Permanent Partial Disability
When your medical condition has stabilized, your doctor will determine whether you have any permanent physical or mental limitations as a result of your workplace injury. To receive permanent disability benefits, you must have suffered a loss of function of a body part. A change that doesn’t affect your ability to function, such as a scar or slight disfigurement, will not qualify for permanent disability benefits.
The amount of your PPD benefits, and how long you will receive them, depends on the nature and severity of your permanent disability. Your doctor will issue a report, stating the level of your permanent impairment and proving a disability rating to your body as a whole, which is stated in the form of a percentage.
Your permanent impairment rating is then multiplied by 405 weeks, in order to determine how long you will receive PPD payments. You will receive two-thirds of your average weekly wages for that period of time, subject to the minimum and maximum amounts stated above. For example, a worker with a 20% rating will receive benefits for 81 weeks (20% × 405 weeks). If the worker’s average weekly wage is $900, he or she will receive two-thirds of that amount, which is $600. The worker will receive $600 per week for 81 weeks, for a total of $48,600.
The above formula is used for all injuries, except for injuries to the spine. For spinal injuries, there is a minimum disability rating of 60%, and benefits are based on 550 weeks, instead of 405 weeks.
Permanent Total Disability
For a permanent total disability (PTD), where you cannot return to your job or secure any gainful employment, you will receive two-thirds of your average weekly wage, subject to the same minimum and maximum amounts that apply to TTD.
PTD benefits will be paid for at least 330 weeks. If by that point, you still have no reasonable prospect of securing employment due to your injuries, your PTD benefits will continue.
The Vermont DOL initially hears any dispute between your and your employer (and its workers’ comp insurer). To challenge a denial of your claim, you must file an appeal with the DOL. The DOL will first hold an informal telephone conference in which the parties must explain their positions. The DOL will then issue a written decision based on this informal conference. If you disagree with the decision, you can appeal the decision by requesting a formal in-person hearing.
If you are still not satisfied with the result of the formal hearing, you can then appeal through the Vermont state court system.