Utah Workers’ Compensation Claims: Eligibility, Filing, and Appeals

Learn about your rights and how to settle under the workers' compensation system in Utah.

Updated January 7, 2019

Virtually all employers in Utah are required to carry workers’ compensation insurance for their employees. The Utah 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 in Utah?

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 (such as a broken bone from a slip and fall) and occupational illnesses (such as cancer from exposure to asbestos).

What Should I Do if I’m Injured at Work?

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 in Utah?

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.

Temporary Disability

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, 2018, the maximum benefit is $879 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.

Permanent Disability

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 $747 per week (as of July 1, 2018). These 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 $586 per week (as of July 1, 2018). 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 with the Utah Labor Commission. To appeal a denial of your claim, you must complete a form called an “Application for Hearing – Industrial Accident Claim.” Once the Commission receives your appeal, it will ask your employer or its insurer to file a response called an “Answer” within 30 days. Once the Answer is filed, the Commission will schedule an in-person hearing before a workers’ comp judge. Hearings are scheduled at least four months out, but could be scheduled several months away. During this time, both parties are expected to gather evidence and prepare their arguments for the hearing.

Will I Have a Chance to Settle My Case?

The Commission has a voluntary mediation program called the Claims Resolution Conference program. If both parties agree to participate, the Commission will schedule an informal settlement conference. (If you’re interested in participating, you can request a settlement conference on the first page of your Application for Hearing.) A neutral third party will work with you and the insurance company to try to help you reach a voluntary settlement.

In Utah, there are two types of workers’ comp settlements: compromise agreements and commutation agreements. With a compromise agreement, there is some dispute over your injuries and you're agreeing to accept a portion of possible benefits to avoid going to a hearing. With a commutation agreement, you are already receiving weekly benefits, but you want them paid in a lump sum. All settlements must be approved by the Utah Labor Commission.

If you and the insurer can’t reach an agreement, your case will continue on to the hearing.

What Happens at a Workers' Comp Hearing?

The appeal hearing will take place in person at the Salt Lake City or St. George locations of the Utah Labor Commission. Hearings are scheduled for a minimum of two hours, but can take several hours depending on the complexity of the issues. At the hearing, each side will have the opportunity to present witnesses, submit documents, and make legal arguments. An administrative law judge will preside over the hearing and mail a written decision to the parties.

Can I Appeal the Judge’s Decision?

If you disagree with the judge’s decision, you may file a Motion for Review within 30 days. Your appeal will be heard by the Labor Commissioner or the Commission Appeals Board. If you’re still not satisfied with the Commission’s decision, you may appeal through the state court system by filing a Notice to Appeal with the Utah Court of Appeals.

Should I Hire a Workers' Comp Attorney?

Workers’ compensation hearings are similar to court procedures and follow complicated procedural rules. In most cases, an injured worker will need the assistance of an experienced workers’ comp lawyer to achieve a successful outcome. Workers’ comp attorneys usually work on a contingency fee basis, which means that they take a percentage of your recovery. This means you won't have to pay for attorneys' fees out of pocket, and state law limits the percentage that your attorney can take from your award.

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