Medical evidence is crucial to securing compensation in most types of workers’ compensation claims, including longshoreman claims filed under the Longshore and Harbor Workers’ Compensation Act (LHWCA). Generally speaking, any medical intervention you receive as treatment for an injury covered under the LHWCA will need to be documented for the purposes of processing your claim. More comprehensive medical evidence may be needed if you are unable to work for a period of time due to the effects of your injury. Call (228) 215-2787 anywhere in Mississippi to schedule a consultation with an attorney at Lott Law Firm experienced in resolving longshoreman claims.
General Workplace Injury Responsibilities
In the United States, people who do any kind of work for pay are divided into two categories based on their relationship to the parties for whom they do the work. Understanding this division can be useful in establishing who is eligible for workplace protections, and of what kind.
Independent Contractors
The first category consists of independent contractors, who may conduct work for the same businesses for a few hours to a few years, but in general have significant autonomy in how they handle the work itself. They also generally provide their own tools, and as a rule they are not prohibited from doing similar work for other clients at the same time (sometimes contractors may agree to a limited-duration non-compete clause, in order to carry out work on an especially sensitive project). These individuals file their taxes using 1099 forms to report their income, and are required to pay a 15.3% federal self-employment tax, according to the Internal Revenue Service (IRS).
Employees
The other category is employees. Both the IRS and the United States Department of Labor (DOL) define this category in terms of the degree of control the hiring party maintains over the worker’s schedule and the way he or she performs work for the business. While independent contractors may establish long-running relationships with some clients, and employees may be hired for only a season, generally speaking a working relationship with no defined end date is often suggestive of employee status, particularly when the worker’s primary responsibilities include tasks essential to the normal operation of the business.
Employees are also likely to do their work on a schedule set by the hiring party. They are frequently required to carry out their tasks at a specific location, such as an office or job site, and in many cases the tools they use to perform their essential tasks are provided by the business for which they work. They typically file their taxes reporting income via W-2 forms, and their Social Security and Medicare taxes are matched by contributions from their employers.
Implications for Workplace Injury Coverage
Independent contractors are generally responsible for their own workplace safety, as well as for establishing contingency plans for what to do if they are injured in the course of their work activities. The vast majority of workers in the employee category, however, are covered by workers’ compensation – a type of insurance most American employers are required to carry, and which covers the overwhelming majority of United States employees for medical care and lost income due to injuries sustained in the course of their work-related activities.
There are certain limited exceptions to this general rule, which vary by state. One exception that applies nationwide, however, is for workers in the maritime industry – in which coverage for workplace injuries is typically governed by one of two federal laws: The Jones Act, also known as the Merchant Marine Act, and of course the LHWCA. The two pieces of legislation cover different types of employee roles; a single employee may fall under either, depending on his or her job duties, but cannot be covered under both.
Who Is Covered By the Longshoreman Harbor Workers’ Compensation Act?
The LHWCA covers employees working in the maritime industry, primarily those in “support” roles. Examples include individuals involved in building or repairing ships, workers in harbor construction, and of course longshore workers. Some non-maritime employees may also be covered under the LHWCA if they are injured in the course of work performed on the “navigable” waters of the United States or the adjoining piers, docks, and shoreline. Excluded from the LHWCA are the members of a ship’s crew, as well as state or federal employees.
Some employees may be excluded from the LHWCA only if they are already covered by state-regulated workers’ compensation coverage. Examples in this category include employees who perform “office” tasks (i.e., clerical, technical and administrative work), those who are employed by waterfront hospitality establishments, marina employees not engaged in construction work, and non-maritime employees temporarily performing work on the premises of a client or customer in the maritime industry.
How Does LHWCA Differ From Workers’ Compensation for Land-Based Employees?
Land-based workers’ compensation programs make a useful point of comparison with longshoreman claims because many more Mississippi residents are familiar with the workers’ comp system overseen by the Mississippi Workers’ Compensation Commission (WCC) than with claims filed under the LHWCA, owing to the difference in sheer number of employees covered. Although the filing and processing protocols for longshoreman claims are somewhat different from the handling of claims filed with employers’ workers’ compensation insurance in Mississippi, the types of injuries covered and the kinds of medical evidence needed to support claims tend to be broadly similar.
Medical Evidence in Workers’ Compensation on Land
Most employees in the United States are eligible for workers’ compensation in the event that they are injured in the course of their on-the-job duties. The specific procedures for filing a workers’ compensation claim vary from state to state, as do the rules for how medical evidence for a claim will be collected and evaluated. Generally speaking, however, injured workers who are covered under state workers’ compensation laws can anticipate that they may be asked to submit a robust compilation of documentation from their medical visits, showing the extent of their condition and the progress toward recovery they have made (or, unfortunately, not made in some cases).
Independent Medical Examinations
Independent medical examinations may also sometimes be required, particularly in states, like Mississippi, which permit patients some degree of choice in the healthcare providers they see for work-related injuries. The medical evidence may be used to demonstrate the necessity of a prescribed treatment in some instances, but it may also be used to help show that the injury was actually caused by work-related activities, in cases where the employer’s workers’ compensation insurance provider contests the legitimacy of the claim. In cases that result in permanent disability, the medical evidence may also be used to document the injured individual’s Maximum Medical Improvement (MMI).
How Is Medical Evidence Used in Processing Longshoreman Claims?
The first way that medical evidence will typically come into play in a longshoreman claim is in the documentation many injured employees covered by the LHWCA will need to provide to their employers in order to show why they are taking time off from work. Minor injuries might not result in time off work; in that case, the medical evidence needed might be limited to documentation of treatment (e.g., stitches) received in an office or urgent care facility, along with any scheduled follow-up. In the event that you have to miss work due to a job-related injury, be sure to ask your supervisor for a disability slip or brief report describing your condition and identifying how long you are instructed to remain out of work for recovery. Submit this information to both your employer and the insurance company handling your LHWCA claim. Employers can generally self-insure or choose from a list of insurers authorized by the DOL to offer LHWCA policies.
Resolving Denied Longshoreman Claims
The second way that medical evidence may come into play in a claim filed under the LHWCA is in resolving the denial of a legitimate claim. The DOL explains that, in many cases, claims may be denied because some or all of the documents the insurer requires to approve a claim have not been submitted. In these instances, you may need to call your employer’s insurance company directly and ask what kind of medical evidence they need, and how they would like the information to be submitted.
Determining Compensation
In cases where an employee’s job-related injury or illness prevents him or her from working for more than a few days, the injured worker may have a longshore claim for wage replacement benefits. These benefits are generally partial, and their calculation is based on the employee’s usual rate of pay prior to injury. Medical evidence will be needed to prove the employee’s disability. The type and extent of medical evidence needed may depend on the type of disability wage replacement sought. The disability categories are as follows:
- Temporary partial disability
- Temporary total disability
- Permanent partial disability
- Permanent total disability
Generally speaking, permanent disability benefits are likely to require more extensive medical evidence than temporary ones, as approval of permanent benefits will typically require a physician’s assessment documenting that the individual has reached MMI.
Discuss Your Case With an Attorney
Navigating the longshoreman claim process can be challenging, particularly if your injuries are severe enough to keep you out of work for a time. Collecting medical evidence to support your claim can seem exhausting and overwhelming, at exactly the time when you need to be focusing on your own recovery. Call (228) 215-2787 today to speak with one of our experienced Mississippi attorneys about your case.