Workers’ Compensation in Michigan: Resources

We have compiled resources and information to help injured workers in Michigan understand their workers’ compensation rights.

 

Overview and Eligibility Requirements

Filing the Claim and Calculating Benefits

Legal Information

Michigan Agencies

Forms

 Answers to your Frequently Asked Questions

Michigan Flag- contact us for workers compensation questions

 

 

 

 

 

 

OVERVIEW & ELIGIBILITY REQUIREMENTS

 

What is the legal basis for workers’ compensation in Michigan?

Michigan employees are protected by an important law known as the Worker’s Disability Compensation Act of 1969 (WDCA). It requires payment to individuals who are hurt on-the-job, regardless of fault. Some employers purchase insurance to cover these benefits while others get approval from the state to be self-insured. Employers who do not comply with the law can be found personally liable.

 

What types of injuries make workers eligible for compensation?

  • Personal injuries that are attributable to a single event.
  • Occupational diseases.
  • Repetitive trauma.

 

What benefits are available?

  • Weekly Wage Loss Benefits
  • Medical Benefits
  • Vocational Rehabilitation Benefits
  • Total and Permanent Disability Benefits
  • Specific Loss Benefits
  • Death Benefits

 

What are the maximum payouts for each type of benefit?

  • Weekly Wage Loss Benefits: Maximums are limited by the state average weekly wage (SAWW). In 2016, 90% of the SAWW was equal to $842 per week and was the maximum compensation rate.
  • Medical Benefits: All reasonable and necessary medical treatment is covered without deductibles or co-pays. Employees are required to wait 28 days before selecting their own doctor.
  • Vocational Rehabilitation: Employees can seek a maximum of 2 years for retraining or education.

 

What are the basic requirements for benefits eligibility?

  • Wage loss benefits are paid to employees who show an inability to earn maximum wages in a job suitable to their qualifications and training. If a person can only perform a lesser paying job, differential wage loss benefits are owed. Benefits can be reduced if a person has a “wage earning capacity” but is not working.
  • Medical benefits cover all reasonable and necessary treatment. This includes doctor visits, prescription medications, attendant care, physical therapy, injections, hospital stays, and surgery. It can also include dental care, prosthetics, eyeglasses, hearing aids, wheelchairs and other appliances necessary to cure or relieve the work injury.
  • Vocational rehabilitation includes payments for education and retraining if necessary to return an employee to the workforce.

 

When can I expect payments to start?

  • A person must be off work for at least 1 week before entitlement to wage loss begins. However, if disability lasts longer than 2 weeks, benefits are covered from day 1. Checks are not typically considered late until 30 days past due. According to statistics compiled by the Agency, the average wait time was 17 days from becoming due.
  • Medical benefits begin immediately. However, an employee cannot select his or her own doctor until 28 days from the start of medical care.

 

blog1

WEEKLY WAGE LOSS BENEFITS

 

What are weekly wage loss benefits?

Michigan law requires payment to individuals who are unable to work because of a workplace accident or injury. This is to compensate for lost wages during any period of disability. Wage loss benefits are based upon a percentage of earnings.

 

How much will the injured worker be paid?

An injured worker is paid benefits equal to approximately 80% of the after-tax value of what they were earning at the time of injury, or about 60% of gross pay. It is calculated by averaging the worker’s total wages from the highest paid 39 weeks of the 52 weeks immediately preceding the date of injury. Tax status, number of dependents, and discontinued fringe benefits also factor into this calculation.

 

What is the maximum benefit the injured worker can receive?

Wage loss benefits are capped at 90% of the state-wide average weekly wage.  The 2016 maximum weekly benefit is $842.00.

 

Can the injured worker lose their benefits?

Weekly wage loss benefits can be reduced or terminated in three ways:

  • The injured worker rejects a bona fide offer of reasonable employment without good and reasonable cause.
  • An injured employee finds post-injury employment earning the same or more than he or she did before the injury.
  • It is determined that the injured employee has a “wage earning capacity” and is only partially disabled.
  • A physician selected by the insurance company says the injured worker is not disabled and can return to work.
  • A physician selected by the insurance company says an employee needs no additional medical treatment.

 

 

MEDICAL BENEFITS

 

What kind of medical benefits can an injured worker receive?

The WDCA’s medical benefits guarantee provides that employers will pay for the medical care necessitated by a worker’s work-related injury or disease. This includes medical services and medicines, nursing care, medical appliances (dental service, crutches, artificial limbs, etc.) and rehabilitation or treatment.

 

Who is eligible for medical benefits?

To be eligible for workers’ compensation medical benefits, an injured worker must establish that the medical care sought is reasonable and necessary.  Medical benefits must be provided to an injured worker for as long as the worker needs them — which could be the rest of the worker’s life.

 

Can the injured worker choose their own doctor?

Not initially. For the first 28 days after an injury, the injured worker must treat with a physician of the employer’s choosing. After 28 days, the employee may treat with a physician of their own choosing after notifying the employer.

 

Can family members receive payment for helping with activities of daily living?

Attendant care services are available for people who need help with daily activities. This includes getting dressed, using the bathroom, taking medications, preparing meals, and other tasks. Family members can receive payment up to 56 hours per week. A professional can also be used and is not limited in hours.

 

 

VOCATIONAL REHABILITATION BENEFITS

 

What are vocational rehabilitation benefits? Will they help me return to work?

The WDCA’s vocational rehabilitation benefits guarantee provides that an injured worker shall be provided those vocational rehabilitation services that are reasonably necessary to restore him or her to useful employment. Services covered include counseling, training, job placement assistance, transportation costs, and tuition reimbursement.

 

How long do these benefits last?

These benefits are provided for 1 year, but can be extended for 1 additional year with approval of the Workers Compensation Agency.

 

 

SPECIFIC LOSS BENEFITS

 

The worker has lost a (toe, finger, hand, limb, etc.). Are they eligible for specific loss benefits?

The WDCA ensures that workers who suffer the loss of a specified body part will receive benefits for a guaranteed minimum amount of time. The guaranteed minimum differs according to the body part lost:

  • Non-great toe – 11 weeks
  • Great toe – 33 weeks
  • Fourth finger – 16 weeks
  • Third finger – 22 weeks
  • Second finger – 33 weeks
  • First finger – 38 weeks
  • Thumb – 65 weeks
  • Foot – 162 weeks
  • Eye – 162 weeks
  • Leg – 215 weeks
  • Hand – 215 weeks
  • Arm – 269 weeks

 

DEATH BENEFITS

 

What benefits are owed for the death of a family member?

The WDCA’s death benefits guarantee provides compensation to the dependent(s) of a deceased worker, including payment of a portion of the worker’s funeral and burial expenses. The amount paid to the dependent(s) is determined by the nature of their relationship(s) to the worker.

 

How long do death benefits last?

An employer’s duty to pay death benefits ends at 500 weeks from the date of death. (If a dependent is under age 16 at 500 weeks, the employer may be required to pay additional weeks.)

 

What are the different types of dependents? How much money do they receive?

Children under the age of 16 are presumed dependent, and the employer will pay them a weekly amount equal to 80% of the employee’s after-tax average weekly wage for 500 weeks.  Other family members must prove factual dependency to receive benefits.

 

Is a spouse a dependent?

A spouse could be found to be wholly or partially dependent. This determination can be very complicated, as several factors must be considered, including whether the spouse has additional income.

 

Do employers pay for the funeral and burial expenses?

Yes. Employers are also required to pay for the funeral and burial, up to $6,000.

 

 

DISPUTED BENEFITS

 

Could an injured worker be disqualified from receiving benefits?

Workers might be disqualified from receiving benefits under certain circumstances:

  • The injury was incurred in the pursuit of an activity the major purpose of which is social or recreational.
  • The worker was injured by reason of their own intentional and willful misconduct.
  • If an employee is terminated from reasonable employment for fault of the employee.
  • The injury occurred because of drug or alcohol abuse.

 

Do employers ever try to avoid paying benefits?

Employers may use several tactics to avoid paying benefits. An employer may take the approach that a worker’s claimed injury did not occur during the course of employment. Or, an employer may contend that the worker disqualified themselves from receiving benefits through their own actions, such as intentional and willful misconduct.

 

How do employers use ‘wage earning capacity’ to dispute benefits?

To get weekly wage loss benefits, a worker must have suffered a “disability” as defined by the WDCA. An injury qualifies as a disability when it has limited the employee’s ability to earn maximum wages. The vocational assessment and the independent medical examination are the two main tools used by employers to challenge an injured worker’s eligibility for weekly wage loss benefits. The vocational assessment could find an injured worker has a “wage earning capacity” regardless of their disability. The independent medical examination could find an injured worker is fully recovered and able to resume gainful employment.

 

Can an injured worker receive other benefits while on workers’ compensation?

Depending on what other injury-related benefits an injured worker may be receiving, the WDCA allows his or her employer to reduce its workers’ compensation obligation by the amount of those other benefits. Examples of benefits that trigger this consolidation of benefits —called “coordination”— can include old-age social security benefits, unemployment, as well as pension and retirement plan payments.

 

 

FILING CLAIMS

 

How long does the injured worker have to report the injury?

An injured worker must provide notice of injury to the worker’s employer within 90 days after the injury occurred.

 

How long does an injured worker have to file a claim?

An injured worker has 2 years to file a claim for workers’ compensation benefits.

 

Can an injured worker sue their employer if they are receiving workers’ compensation?

The WDCA is a legislative compromise between employers and workers. In return for the employers’ promise to provide injured workers with the benefits described above, regardless of fault, workers promise to relinquish their right to sue employers for injury-related pain and suffering — except under very limited circumstances, such as intentional injury by the employer.

 

Can an injured worker challenge a denial of benefits?

Yes. Workers’ compensation benefits become disputed when the  employer or its insurance company refuses payment. The injured worker or their dependent(s) can start a formal process by filing application for mediation or hearing with the Workers Compensation Agency.

 

Can an injured worker settle a claim for workers’ compensation benefits?

Employees can trade wage loss and medical benefits for a lump sum cash payment. The amount will depend on several factors including age, extent of disability, and future medical costs.

 

Photos via Pixabay

Injured On The Job: A Guide to Michigan Workers Compensation Law Injured On
The Job
A Guide to Michigan Workers Compensation Law Free Book
Free Consultation