Workers' Compensation in Michigan
Workers' disability compensation was established in 1912 by the Michigan legislature as an employee benefit providing medical benefits and rehabilitation to employees who suffer injuries arising out of and in the course of employment. Michigan has a no-fault workers' compensation system; for work-related injuries, benefits are provided without regard to whose fault the injury is.
Generally, if an employee is injured traveling to and from work, there is no workers' compensation coverage. However, if the injury occurs on the employer's premises or during work-related travel, the employee is entitled to benefits.
Benefits are paid by employers either directly or through insurance companies. The following is a summary of your rights and responsibilities as an employee under Michigan's Workers' Disability Compensation Act.
Disability Defined
Michigan law defines disability as a limitation of an employee's wage earning capacity in work suitable to his or her qualifications and training, resulting from a personal injury or work-related disease. So, under the law, two conditions must be met to receive benefits: There must be a work-related injury or disease,
and
there must be wage loss. As long as an employee is considered disabled, they are entitled to receive benefits.
However, if the employer (or anyone else) offers the employee any reasonable employment, the employee must accept the job or risk losing benefits. Reasonable employment is work that the employee can perform, poses no clear and proximate threat to the employee's health, and is within a reasonable distance from the employee's residence.
Whether an employee can perform the job usually requires the expert opinion of a doctor. If a worker tries the job and is unable to perform it, benefits are resumed.
Notice and Claim
Give Notice Within 90 Days
If you are injured on the job, you must notify your supervisor immediately. Michigan law requires an employee to notify their employer within 90 days of an injury. It does not require that the notice be in writing. However, if the employer provides a form upon which to report an accident or injury, it is best if the injured worker uses this form. At the very least, when you are injured on the job, verbal notice should be given to a supervisor.
Make Your Claim Within Two Years
Michigan law requires that a worker must make a claim for compensation benefits within two years after the injury.
Medical Benefits
What Medical Benefits Can Be Received?
An employee injured on the job is entitled to all reasonable and necessary medical care. This includes chiropractic treatment, medical, surgical, and hospital services, dental services, orthopedic devices and appliances as prescribed by the treating physician, hearing apparatus, and nursing care. The responsibility to provide medical care continues indefinitely so long as the need for the care is related to the work-related injury.
Selecting a Treating Doctor: The Ten Day Rule
During the first 10 days of treatment, the employer has the right to choose the doctor. Unless given permission by the employer, an employee may not go to a doctor of their own choosing during the first 10 days.
After 10 days, the employee has the right to see the provider of their choice. However, this requires giving notice to the employer of the provider's name and the injured worker's intention to treat with the provider.
Handling Medical Bills
Generally, the chiropractic physician (or other healthcare provider) will send bills directly to the insurance company. If for some reason the worker pays the doctor directly, he or she is entitled to be reimbursed by the employer or insurance company.
Wage Loss
What Wage Loss Benefits Can Be Received?
Under Michigan law, an injured employee is entitled to wage loss benefits that are usually 80 percent of the
after-tax value
of the loss. Total earnings and fringe benefits (under certain circumstances) are considered in determining the employee's total wage loss. Fringe benefits can include the cost of health insurance, an employer's contribution to a pension plan, and vacation and holiday pay.
Determining Wage Loss
The Workers' Compensation Agency (WCA) publishes tables that are used to determine what 80 percent of the after-tax value of a given wage equals. Many factors are included in this calculation, including the tax filing status, the number of dependents, and the state and federal tax rates. The WCA also places a maximum rate (90 percent of the state average weekly wage for the year prior to the injury) on the amount of weekly benefits the injured worker may receive. If an injured worker is employed by more than one employer at the time of injury, the earnings from both employers are added together to calculate the average weekly wage.
Onset and Length of Wage Loss Benefits
Michigan law provides that no compensation is paid for an injury that does not last for at least one week. If the disability lasts beyond one week, the worker is entitled to benefits as of the eighth day after the injury. If a disability continues for two weeks or longer, then the worker is entitled to be paid compensation for the first week of disability.
Benefits continue so long as the worker is disabled. This could be for the rest of his or her life. Benefits are reduced 5 percent each year beginning with the year of the worker's 65th birthday. This reduction continues until the worker is 75 years of age. At that time benefits are reduced to 50 percent. They continue at that level for the rest of his or her life. There also may be a reduction if an employee receives old age Social Security benefits, pension or retirement, or benefits from a disability insurance program being paid by the employer. There is no effect on workers' comp benefits due to money being received from Social Security Disability.
Vocational Rehabilitation Benefits
Vocational Rehabilitation generally involves a rehabilitation counselor who works with the employer to assist in the employee's return to work as soon as reasonably possible. This could mean that the vocational rehab agency, either a state or local agency, aids the employee to work at the same job or a similar job with the same employer. In some circumstances, an employer can be required to provide up to two years of vocational rehabilitation services. If an employer offers these services, and the employee refuses, wage loss benefits
may
be terminated.
Denial or Termination of Benefits
Filing a Petition
If a claim for benefits has been denied or if benefits were paid and later terminated by the employer, the employee's best recourse is to file an
Application for Mediation or Hearing
(Form 104A)
with the WCA. This form can be downloaded from the WCA website:
The law requires that this form include detailed information about the injury. At the time it is filed the worker must also provide the employer with any medical records relevant to the claim that are in his or her possession. When the application is received by the agency, it is sent to, or served upon, the employer and its insurance carrier. The employer must then file a Carrier's Response Form providing detailed information from its point of view and must send medical records in its possession to the worker or the worker's attorney.
Obtaining an Attorney
In most workers' comp cases, both the employer and employee are represented by attorneys. Michigan law does allow individuals to represent themselves, but most trials involve complex legal issues and procedures best handled by attorneys.
Mediation
Mediation hearings are informal hearings with a WCA mediator who attempts to seek a resolution without a formal trial. Mediation hearings are scheduled in those cases that involve a claim for a closed period of time where the employee has returned to work, cases involving only a claim for medical benefits, cases in which the worker is not represented by an attorney, and any case in which the agency determines that the claim might be settled by mediation.
If the dispute is not resolved at the mediation hearing, the case is assigned a trial date before a workers' compensation magistrate.
Trial
Trials in workers' comp cases are held before workers' compensation magistrates, who act as judges, are appointed by the Governor, and hear only cases involving workers' compensation.
Most workers' compensation cases involve medical questions; therefore, the testimony of a doctor is often critical. The testimony of doctors is almost always recorded by a court reporter at a deposition. The deposition transcript is then used at a formal trial as expert testimony, along with the testimony of sworn witnesses. These procedures are best handled by an attorney.
Who to Contact for Questions or Information
Workers' Compensation Agency
7150 Harris Drive
P.O. Box 30016
Lansing, Michigan 48909
Toll-Free: (888) 396-5041
Michigan Association of Chiropractors
416 W. Ionia, Lansing, MI 48933
(517) 367-2225 " (800) 949-1401 "
fax (517) 367-2228