Kentucky workers are usually covered by the state’s workers’ compensation laws when they become sick or injured as an employee in their work place. In fact, in most cases it’s compulsory for employers to take out workers’ comp insurance so if an accident or injury takes place while at work the victim can expect to receive workers’ compensation payments to cover for loss of wages and medical treatment while recovering from an injury or a spell of ill health. Sometimes workers’ compensation claims are denied by the insurer. This doesn’t mean that this is the end as a worker can challenge the decision made by the insurer and with the help of a workers’ comp attorney may still get the workers’ comp he or she is entitled to receive. Workers’ Compensation Law in Kentucky Kentucky workers’ compensation is overseen by the Department of Workers’ Claims. The Kentucky's workers' comp program does not include everyone. Agricultural employees, some domestic workers and a few employees such as those working for religious organizations may not necessarily be covered by workers’ compensation. It’s mostly physical injuries that are covered and mental injuries which take place because of the impact of the physical injuries. Some occupational diseases, such as pneumoconiosis suffered by coal workers, mean special benefits for wage replacement and vocational retraining. Kentucky generally offers payments for medical treatment and loss of wages. Lost wages are calculated as 66 2/3% of the average weekly wage of the worker applying for workers’ comp. You may choose your own physician unless your employer has a managed care plan in place. Why Your Claim Could Be Denied You may think that if you are injured in your workplace and have to take time off work to receive medical treatment as well as recover from your trauma that you automatically qualify for workers’ compensation. Unfortunately, it’s not as simple as that. Your claim could be denied by your employer’s insurer for several reasons. One of the most common reasons is failing to submit the claim on time. Another reason is the claim that when your injury or sickness took place you were not at work at that time. Sometimes a workers’ compensation denial is simply a misunderstanding of information filled in on the form. There are some more serious reasons which will typically need challenging before a final decision is made about your eligibility for workers’ comp: You failed to make use of the safety equipment provided which led to your sickness or injury. You were drunk and disorderly while at work or had taken drugs which led to you being injured. The Kentucky Workers' Comp Appeals Process If your workers’ comp claim is denied or the amount awarded doesn’t seem enough you can file an appeal with the Department of Workers' Claims (DWC). The DWC will go about appointing an Administrative Law Judge (ALJ) who will listen to what you have to say. He or she will also listen to the insurers’ side of the story. Eventually the judge will arrive at a decision at a hearing which generally takes place at a DWC office. If in the end your claim is denied, it may be possible for you to apply to get your compensation claim resolved by the Department of Workers' Claims. If you don’t agree with the ruling, you could file within 30 days a notice of appeal challenging the Judge's decision. If in the end the decision doesn’t favor you, you can still submit a Petition for Review, a form of appeal, against the decision made by the judge. You should ensure all the vital evidence is available including witness’s accounts of how the accident happened, where and when it happened and detailed medical reports showing the extent of your injuries. Why a Workers' Comp Attorney May be of Help Considering the rules in Kentucky for employers when it comes to workers’ comp payments, it can seem like a relatively simple process. However, when a claim is made supported by evidence the insurer just wants to find any way of getting out of paying workers’ comp entitlements. You have your rights to contest and appeal any decisions but in order to be successful it’s a good idea to talk to an experienced workers’ comp attorney first who will decide if your case for worker’s comp is justified and likely to succeed.
