1. SAFETY RULES: You should follow all written rules of safety and other reasonable policies and procedures of the employer.
2. REPORT ALL INJURIES: You must report any accident immediately, but not later than 30 days after the accident, to your employer, your employer’s representative, your foreman or immediate supervisor. Failure to do so may result in the loss of the benefits.
3. MEDICAL TREATMENT:You must accept reasonable medical treatment and rehabilitation services when ordered by the State Board of Workers’ Compensation or the Board may suspend your benefits.
4. MISCONDUCT: No compensation shall be allowed for an injury or death due to the employee’s willful misconduct.
5. KEEP COMPANY INFORMED: You must notify the insurance carrier/employer of your address when you move to a new location. You should notify the insurance carrier/employer when you are able to return to full-time or part-time work, and report the amount of your weekly earnings because you may be entitled to some income benefits even though you have returned to work.
6. MOVE OR MARRIAGE: A dependent spouse of a deceased employee shall notify the insurance carrier/employer upon change of address or remarriage.
7. ATTEMPT WORK OFFERED IF DOCTOR APPROVES: You must attempt a job approved by the authorized treating physician even if the pay is lower than the job you had when you were injured. If you do not attempt the job, your benefits may be suspended.
8.ONE YEAR TIME LIMIT: If you believe you are due benefits and your insurance carrier/employer denies these benefits, you must file a claim within one year after the date of last authorized medical treatment ... or TWO YEAR LIMIT: you must file a claim within two years of your last payment of weekly benefits or you will lose your right to these benefits.
9 ONE YEAR LIMIT FOR DEPENDENTS:.If your dependent(s) do not receive allowable benefit payments, the dependent(s) must file a claim with the State Board of Workers’ Compensation within one year after your death or lose the right to these benefits.
10.ONE YEAR TIME LIMIT FOR MILEAGE EXPENSE: Any request for reimbursement to you for mileage or other expenses related to medical care must be submitted to the insurance carrier/employer within one year of the date the expense was incurred.
11. DRUG TESTS: If an employee unjustifiably refuses to submit to a drug test following an on-the-job injury, there shall be a presumption that the accident and injury were caused by alcohol or drugs. If the presumption is not overcome by other evidence, any claim for workers’ compensation benefits would be denied.
12. FALSE STATEMENTS: You shall be guilty of a misdemeanor and upon conviction shall be punished by a fine of not more than $10,000 or imprisonment up to 12 months, or both for making false or misleading statements when claiming benefits. Also, any false statements or false evidence given under oath during the course of any administrative or appellate division hearing is perjury.
How can you jeopardize your worker's compensation benefits?
• Failure to report injuries promptly.
• Failure to cooperate with employer and authorized treating physician regarding medical evaluations, treatment, rehabilitation services and claim investigation.
• Refusal to return to suitable employment.
• Working elsewhere while receiving Temporary Total Disability Benefits.
• Submittal of fraudulent information.
• Refusal to take a drug test.
• Refusal to submit to a medical examination by the authorized treating physician, at reasonable times.