Employer’s 1^st Rpt. of Injury

14 days after employer’s knowledge of injury

Employee’s Rpt. Of Injury

Employee to give notice within 30 days of accident

If Occup. Disease

Employee to give notice within 30 days after first distinct manifestation of occupational disease

If Hernia

Must appear suddenly and must immediately follow accident; employee to provide notice within 30 days of hernia

Admit/Deny Employee’s Right to Compensation

15 days from notice of injury

Waiting Period

7 days

Waiting Period Recoverable After Disability

After 14 days whether consecutive or not payment due for entire period of disability including first 7 days

File Initial Claim

1 Year from injury or issuing date of check for last benefit

Right to Reopen

Capped body as a whole (BAW) cases; 1 year from loss of employment if same occurs within 400 weeks of return to work (RTW)

Dependency

1 year from accident/death or issuing date of last voluntary benefit

07/01/01-06/30/02

Hand

150

Arm

200

2 Arms

400

Thumb

60

1^st Finger( Index)

35

2^nd Finger (Middle)

30

3^rd Finger (Ring)

20

4^th Finger (Little)

15

Leg

200

2 Legs

400

Foot

125

2 Feet

400

Great Toe

30

Other Toe

10

Eye

100

2 Eyes

400

Ears (loss to hearing system)

150

Mental Faculties (psych)

Body as a whole

Body as a Whole (BAW) *

400/or benefits until age 65 / by age eligible for social security retirement.

BAW over age 60

260

Medical

Lifetime, reasonable and necessary and subject to utilization and review.

Temp. Total Disability (TTD)

66-2/3 of average weekly wage subject to maximum total benefit (currently $247,200.00).

Temp. Partial Disability (TPD)

66-2/3 of the difference between hourly wage and altered duty status wage.

Perm. Partial Disability (PPD)

Benefit rate times vocational disability limited by schedule.

Perm. Total Disability (PTD)

Disability compensation until eligible “by age” for social security retirement with lifetime medical. Must be BAW case.

Mileage/Travel Expenses

Available when employee is required to travel 15 miles from residence or workplace and to be compensated at no less than $.32 per mile.

Death/Dependence

Burial expenses, $7,500.00. If no dependents, $20,000.00 to estate. Dependents entitled to benefits during term of dependency not to exceed 400 weeks. Rate of payment varies based on number of dependents.

Second Injury Fund

Available in cases of PTD if employer has knowledge of prior disability. Available in PPD or PTD if there has been a prior award and combination of awards exceeds 100% to BAW.

Subrogation

Third party claims allowed. Lien is reduced by pro-rata share of reasonable fee for employee’s attorney, usually 1/3 and pro-rata share of expenses in third party action. No subrogation against uninsured motorist proceeds. Credit against future medical from subrogation recovery is not currently available.

Medical Records

Upon written request; 20 pgs. or less in length ($10.00); reports exceeding 20 pgs. additional $.25 per page (§ 50-6-204)

Causing medical or wage loss claim to be paid under health, sickness or accident insurance

$500 civil penalty

(§ 50-6-128)

Failure in bad faith to pay TTD benefits

25% of TTD claim awarded

(§ 50-6-225(j))

Failure to provide reasonable and necessary medical treatment or failure to reimburse employee

$500 civil penalty

(§ 50-6-128)

Failure to pay or reimburse medical expenses after judgment entered and within 60 days of demand

25% of unpaid expenses if refusal not in good faith (§ 50-6-225(l))

Failure to pay or reimburse reasonable and necessary medical expenses after judgment entered

Pmt. of employee’s attorneys fees in obtaining medical benefit and disc. costs

(§ 50-6-204(b)(2))

Failure to provide a person with authority at DOL mediation

Not less than $50 nor more than $5,000

(§ 50-6-237(c))

Failure to pay PPD or TTD when due

6% on unpaid installments

(§ 50-6-205(b)(3))

Failure to comply with order of DOL specialist within 15 calendar days of receipt of order

$10,000

(§ 50-6-238(d)(1))

Failure to file 1^st Report

$25 plus $25 for each subsequent 15 day period delay (Claim Handling Standards DOL)

Failure to notify Director of DOL of first payment

$10 each 15 days past required date of payment until notice received (Claim Handling Standards DOL)

Failure to pay first payment

$50 each 15 day period past required date payment is due until payment made

(Claim Handling Standards DOL)

Failure to notify Director of a denial of benefits

$10 each 15 day period past date of denial until notice received (Claim Handling Standards DOL)

Failure to pay benefits at least semi-monthly

$50 each 15 days past the date payment is due (Claim Handling Standards DOL)

Failure to provide notice of change of benefits

$10 for each 15 day period past date on which change or stop occurred for failure to file Form C-26 (Claim Handling Standards DOL)

SD-1

Statistical Data Form

C-20

1^st Report of Injury

C-21

Mo. Rpt. of Non-Compensable Injuries/Diseases

C-22

Not. 1^st Pmt. of Compensation

C-23

Not. Denial of Claim for Compensation

C-26

Not. Change or Term. of Compensation Benefits

C-27

Not. of Controversy

C-28

Not. of Lawsuit

C-29

Final Rpt. of Pmt. and Receipt of Compensation

C-30

Attending Physician’s Rpt.

C-30A

Final Medical Rpt.

C-31

Medical Waiver and Consent

C-32

Std. Form Med. Rpt. for Industrial Injuries

C-33

Case Management Notification

C-34

Case Management Closure

C-35

Utilization Review Notification

C-36/C-37

Utilization Review Closure

C-38

Case Manager Registration

C-39

Provider Registration for Utilization Review

C-40

Request for Assistance

C-41

Wage Statement

C-42

Agrt. Between Employer/Employee-Choice of Physician

Notice

Statute of limitations

Lack of causation - not arising out of or in course of employment. Arising out of refers to causal connection to work. Course of employment refers to time and place of accident. Recreational, break or lunch activities are within course of employment if within the hours of work and on the premises or otherwise determined to be a regular incident of employment and produce a benefit to the employer

Intoxication

Intentional self-inflicted injury

Willful failure to use safety devices or follow safety procedures

Horseplay

Unauthorized medical expenses

Misrepresentation on employment application