What You Need to Know Regarding Your Claim
This information is designed to assist you through your Workers' Compensation process as quickly and smoothly as possible. The overall goal of Workers' Compensation is to assist you in recovering from your injury and to help you return to work. This information is not meant to be used as a legal source of reference.
- Medical Benefits
- Travel Reimbursement
- Independent Medical Exams
- Temporary Total Disability
- Denial of Benefits/Hearings
- Return to Work
- Return to Work - Light or Modified Duty
- Permanent Partial Impairment
- Vocational Rehabilitation
- Permanent Partial Disability
- Permanent Total Disability
- Death Benefits
- Attorneys and Fees
- Payment Dates
1. Medical Benefits
The Workers' Compensation Division will pay for medical treatment if it is:
- Directly related to the injury or condition caused by the work activities,
- Reasonable and necessary.
You are responsible for giving your claim number to everyone providing medical services related to your work injury. If you are billed by a provider, you will need to contact them with your claim number so that they will bill us directly.
You choose your primary healthcare provider (doctor of medicine, chiropractic or osteopathy, optometrist, podiatrist, psychologists or advanced practitioner of nursing). Once you choose your primary healthcare provider, you may not change without a referral from your primary healthcare provider or upon receiving a written final determination of approval from the Division after you have submitted a Request for Change of Health Care Provider form.
When choosing a healthcare provider, you need to keep the following in mind:
- The Division will only pay mileage reimbursement to the closest available healthcare provider.
- All medical bills are reviewed, and if appropriate, paid by a fee schedule. Healthcare providers providing services within the state of Wyoming cannot bill you for the charges in excess of the fee schedule.
- You are responsible for any personal items or treatments not related to your injury.
- If you choose an out-of-state provider, you may be billed for charges in excess of the fee schedule.
Give your claim number to everyone providing medical services for the work-related injury or condition. Medical bills cannot be paid without a claim number.
Medical care should be obtained in Wyoming if possible (See Temporary Total Disability Incentive).
All injury related medical bills must be sent directly to the Division by the provider. If you receive a bill, ask the provider to submit the bill directly to the Division.
If you move out of the state of Wyoming, it is your responsibility to find a healthcare provider that will accept you as a patient and bill Wyoming Workers' Compensation.
2. Travel Reimbursement
The Division will reimburse travel expenses for travel to the closest available medical or hospital care needed to treat your work related injury.
If you must travel to obtain medical services, you will be reimbursed at authorized rates published in the current Wyoming Workers' Compensation Rules and Regulations and Fee Schedule.
You must submit a reimbursement voucher and attach the original receipts for meals and lodging. You must also attach verification of your appointment from your healthcare provider.
Travel reimbursement shall NOT be paid for:
- Travel less than 10 miles one-way.
- Travel other than that necessary to obtain the closest available medical or hospital care need.
- Travel to pick up prescriptions or x-rays.
- Claims submitted after one year from the date of travel.
- Travel, other than motor vehicle, unless arranged by your Claims Analyst.
- Individuals other than the injured worker, unless medical necessity is established by the treating healthcare provider. A letter of medical necessity must be attached to the reimbursement voucher.
3. Independent Medical Exams
Medical examinations may be requested by either the Division or your employer. The examination is a medical evaluation of your condition. If an assessment of your permanent physical impairment is required, you will receive an impairment rating. However, the doctor providing this examination/assessment will not be taking over your medical care. You should continue to see your primary healthcare provider.
Failure to attend all medical examinations scheduled by the Division could jeopardize your benefits.
You will receive written notification with whom, where and when this examination/assessment will take place.
You may qualify for travel reimbursement to attend an independent medical examination.
4. Temporary Total Disability
You may qualify for Temporary Total Disability benefits if you are unable to work as a result of your work-related injury.
Temporary Total Disability benefits are not allowed for the first three days of disability unless you are off more than eight days.
You must apply for Temporary Total Disability benefits using an Application for Temporary Total Disability. A report of injury is not a claim for Temporary Total Disability benefits.
- You complete the top portion (remember to sign and date).
- Your healthcare provider completes the lower portion.
- Upon completion, submit the form to the Division.
Temporary Total Disability benefits are the equivalent of 2/3 of your gross monthly wage at the time of injury, but cannot exceed the Statewide Average Wage for the quarter you were injured. Temporary Total Disability benefits are not taxable.
Temporary Total Disability Incentive: Monthly benefits may increase by 3 percent of all medical care is received entirely in Wyoming, or if the distance from your residence to an in-state healthcare provider is at least 100 miles greater than the distance from the employee's residence to an out-of-state medical provider. This also applies if the employer has a contractual agreement with an out-of-state provider.
Temporary Total Disability benefits are paid twice a month with 1/2 of the monthly award paid on or about the 15th of the month and 1/2 paid on or about the 30th of the month.
During the time you are on Temporary Total Disability you must:
- Keep in contact with your Claims Analyst,
- Be involved in an active treatment program, and
- Attend all appointments.
5. Denial of Benefits/Hearings
Each determination or award is an administrative determination of the rights of the employer, the employee and the disposition of money within the Workers' Compensation account as to all matters involved. No determination shall be final without notice and opportunity for hearing as required by the Workers' Compensation Act.
When parties cannot agree upon the worker's right to compensation under the Workers' Compensation Act or any other final determination of the Division, any interested party may request a hearing before a hearing examiner by filing a written request for hearing with the Division within 15 days after the date the notice of the final determination was mailed by the Division.
If your employer objects to a Division determination that your injury is compensable and your treating healthcare provider has certified you as Temporarily Totally Disabled, you may apply for an interim benefit while the case in under appeal. The interim benefit will not exceed three months of Temporary Total Disability benefits. Only one interim benefit may be awarded per injury.
Contact your Claims Analyst for additional information.
6. Return to Work
You must notify the Division immediately when you return to any work. This includes self-employment, temporary or part-time work of any kind. You must report your gross earnings and provide written verification to the Division.
If your healthcare provider releases you to light or modified work, you must notify your employer and the Division immediately.
Temporary Total Disability Benefits will cease when it can be determined you have an ascertainable loss (Permanent Partial Impairment) due to the work-related injury. Temporary Total Disability Benefits will also cease when you have sufficiently recovered from your work-related injury and are capable of returning to work.
If Temporary Total Disability Benefits have ceased and you are not immediately returning to full-time work, you may wish to file a claim for unemployment benefits. Additional Information may be obtained from your local Workforce Center.
7. Return to Work - Light or Modified Duty
Employers are encouraged to provide temporary light or modified duty for injured employees within their medical restrictions.
Light duty is an interim step in the physical conditioning and recovery of an injured employee with temporary restrictions with the goal of returning to his/her original job.
Light duty work reduces lost time days, decreases the injured employee's disability experience, maintains employee/employer relationships and improves employee morale.
National studies support that most employees return to full time work sooner and heal faster when participating in some gainful and meaningful light or modified duty work. These studies demonstrate the cost of claims increase 21 percent to 33 percent when return to work does not occur within the first 3 weeks. Costs of claims increase by 55 percent after the first 30 days.
Early and safe return to work benefits all parties. Light/modified duty can help the injured employee stay active and involved, which contributes to quality of life. A successful return to work program also benefits the employer who regains an active member of the workforce and reduces Workers' Compensation costs.
When a bona fide written offer of light or modified duty is made by the employer and approved by the health care provider, the injured employee has the opportunity to earn wages and a get a portion of his/her Temporary Total Disability benefits at the same time. The reduced Temporary Total Disability is called Temporary Partial Disability and these payments are not charged to the employer's Workers' Compensation account.
Temporary Partial Disability benefits are paid at the rate of 80 percent of the difference between the employee's light duty wage and their actual monthly earnings at the time of the injury, as long as the total earnings from employment do not exceed 95 percent of the actual monthly earnings at the time of injury. Temporary Partial Disability can not exceed the statewide average monthly wage from date of injury.
If the injured employee refuses the light/modified duty offer, in most cases, their Temporary Total Disability payments will be reduced by 2/3rds.
Employers and Injured Employees should contact their Claims Analyst for more information.
8. Permanent Partial Impairment
You may qualify for this benefit if, as a result of your work-related injury or condition, you have sustained permanent impairment. A qualified healthcare provider will determine the percentage of impairment attributed to your work-related injury. This impairment may also be referred to as ascertainable loss.
All physical impairments are measured according to the most recent edition of Guides to the Evaluation of Permanent Impairment by the American Medical Association.
When an impairment rating is received by the Division, an award will be calculated and the Division will notify you of the value. You will be given the opportunity to either accept or object to this award. You must notify the Division of your decision. If you agree with the impairment rating, you must submit an application for a Permanent Partial Impairment award. The Permanent Partial Impairment benefits are paid monthly and cannot be disbursed in a lump sum.
A Final Determination for Permanent Partial Impairment benefits will be issued. If you disagree with the determination, you must submit, in writing, an objection and request a hearing before the deadline given on the letter of determination.
If you or your employer disputed the physical impairment, a second opinion will be obtained and the Division will consider both ratings. The second opinion will be scheduled by the Division. Prior awards will reduce the amount of this benefit.
9. Vocational Rehabilitation
You may qualify for this benefit if you have a permanent impairment due to a work-related injury, and you are unable to return to any work in which you were employed during the three years before this injury, because of the impairment.
Injured workers who qualify for this benefit will work with the Vocational Rehabilitation Division in developing an Individualized Plan for Employment, with the goal of returning to gainful employment.
This benefit may cover costs of education, retraining, living expenses and/or accommodation to previous employment. If you choose this option, you waive your right to a Permanent Partial Disability Benefit. You must apply in writing using the Application for Vocational Rehabilitation Benefits, and supply all information requested by the Division. Contact your Claims Analyst to obtain this form.
10. Permanent Partial Disability
Permanent Partial Disability Benefit is an economic loss to an injured employee resulting from a permanent physical impairment.
You may qualify for payment of a Permanent Partial Disability award if:
- You have been awarded a Permanent Partial Impairment award.
- You are unable, because of your work-related injury, to work at any occupation at a comparable or higher wage for which you are suited by experience and training.
- You have actively sought suitable employment after receipt of a Permanent Partial Impairment award.
- You are considered actively seeking work if you provide tangible evidence of the work search which includes a minimum of five contacts per week over the course of a six week period immediately preceding the date of the application or immediately following the date of application.
- The work search must be made for work you are reasonably qualified to perform and are willing to accept.
- You apply in writing for this benefit using the Application for Permanent Partial Disability. Contact your Claims Analyst to obtain this form.
11. Permanent Total Disability
You may qualify for a Permanent Total Disability award if the work-related injury permanently incapacitates you from performing any gainful employment for which you are suited by experience and training.
You must apply for this benefit using the Application for Permanent Total Disability. Contact your Claims Analyst to obtain this form. Dependent children's benefits are payable to age 21 or age 25, if the dependent is enrolled in post secondary education. If the dependent is physically or mentally incapacitated, benefits are payable until the child dies or is qualified for and receiving benefits under the Medicaid home and community based waiver program.
When your Permanent Total Disability award is exhausted, you may qualify for an extension of benefits only if you are still unable to work at any gainful employment. Extended benefits must be applied for annually using the Application for Extended Permanent Total Disability. Contact your Claims Analyst to obtain this form.
12. Death Benefits
In all cases of injury resulting in death, an Application for Death Benefits must be filed with the Division within one year from the date of death. The date of death, regardless of the date of injury, will be used to determine benefits. Dependent children's benefits are payable to age 21 or age 25, if the dependent is enrolled in post secondary education. If the dependent is physically or mentally incapacitated, benefits are payable until the child dies or is qualified for and receiving benefits under the Medicaid home and community based program.
The application for death benefits will be reviewed to determine if all appropriate documents were submitted to substantiate entitlement to surviving spouse and/or dependent children. Appropriate documents would include:
- Death Certificate
- Marriage Certificate
- Birth Certificate of surviving spouse
- Birth Certificate of each dependent child
- Adoption order if applicable
If stepchildren are claimed as dependents, proof of spouse custody agreement must be received.
A spouse receives benefits based on a percentage of wages at the time of death compared to the Statewide Average Wage for 100 months. If there is no spouse, the child or each child will receive a portion of the spouse benefit for 100 months in addition to their monthly benefit in accordance with Wyoming Statute 27-14-403(c). If there are no dependents and the case is compensable it will be opened for payment of funeral and medical expenses only.
The burial expenses of the deceased employee shall be paid in an amount not to exceed $5,000, together with an additional amount of $5,000.00 to cover other related expenses, unless other arrangements exist between the employer and employee under agreement.
13. Attorneys and Fees
In a contested case hearing, the hearing officer may appoint an attorney to represent you. Once you are legally represented, communication with the Division should be through your attorney. The hearing officer may allow an appointed attorney reasonable fees for service at the conclusion of the proceedings.
According to the Workers' Compensation Act, any person(s) who knowingly makes or allows any misrepresentation or false statements to be made for the purpose of receiving payments under the Act is guilty of a misdemeanor or felony under Wyoming law.
14. Payment Dates
Checks are mailed from Cheyenne on the posted mailing dates. Direct deposit funds are normally deposited in the account three (3) business days after the mailing dates.
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