By Donna Motley, Vice President of Claims

The basic premise of Workers’ Compensation is simple – if an employee sustains an injury at work, medical treatment and when applicable, wage loss benefits, are paid. In exchange for that benefit, the injured worker gives up the right to “sue” the employer. Following are some facts you may not know:

Michigan is a “no fault” state. Translated, that means it does not matter whether or not an employee followed proper procedures, took a short cut or made an unwise decision – they would still be entitled to Workers’ Compensation benefits. However, if an employee had been trained and did not follow proper procedures, or took it upon themselves to take a short cut and an injury resulted, disciplinary action should be taken by the employer. If the same employee is repeatedly injured in the same manner, even after being disciplined for the initial act, we would have a basis on which to deny the claim.

The mere allegation of “pain” does not constitute a Workers’ Compensation claim. There could be a lot of reasons a person has pain. The Workers’ Compensation Act dictates that a work related injury must “arise out of and in the course of” employment. Everything that happens at work is not a Workers’ Compensation claim. Employees on a “personal mission” – i.e. an employee sustaining an injury while going to their car to retrieve their cell phone, is not in the course of employment. An employee that is injured from a “trip and fall” for no apparent reason or because their shoe lace was untied, is not a work related injury. It is not Workers’ Compensation if an employee faints, has a diabetic reaction or collapses from dehydration. However in these cases, if the employee sustained an injury because they hit a piece of machinery on the way down to the floor, we would be responsible for said injury only, not the underlying cause.

If an employee sustained an amputation and wants or needs a prosthesis, Workers’ Compensation is not required to provide the latest and greatest prosthesis available. We are only required to “make them whole”. This makes a difference when you consider the continual advancements being made in medicine. Particularly in this day and age where everything is digital and computerized. I currently have a case where the employee amputated three fingers and is requesting a prosthesis that costs $120,000 and needs to be replaced every five years.

If an employee, while on restrictions as the result of a work related injury, loses their job (or is permanently laid off), they have the responsibility, and will be required by us, to look for work within their qualifications, education and training. If they fail to do so, we have the right to reduce their wage loss benefits by the amount they could be earning. (Most injured workers retain an attorney as soon as we instruct them to start looking for work and provide us with the results of their job search.)

If a case becomes litigated, our ultimate goal is to obtain a “Redemption” – which is full & final settlement of any & all claims, past, present or future, for wage loss and medical benefits, vocational rehabilitation; for all injuries, diseases and/or disability caused, precipitated or aggravated by employment. In settling, the employee agrees to accept full responsibility for any and all liens or claims for reimbursement made by third parties against possible recovery of compensation benefits. We obtain a resignation of employment, waiver of seniority and release of all claims from the employee. The employee cannot later sue the employer for wrongful discharge, breach of contract, discrimination, Americans with Disabilities Act violation, etc. The Redemption is a hearing presented before a Magistrate where everything is fully explained to the employee; the employee has 15 days to appeal the settlement.

The Workers’ Compensation Act is continually being challenged and new case law comes along periodically. That is why we investigate all claims and ask a lot of questions. A “slip & fall” is not just a slip & fall”. Just because an incident occurred while at work, does not make it Workers’ Compensation. The details of a claim make a difference!