Vermont recorded 6,900 nonfatal workplace injuries in 2020. During the same year, the state registered an incidence rate of 3.6 injuries or illnesses per 100 full-time workers, which turned out to be higher than the 2.7 national rate. This was an indication that Vermont had a great need for a comprehensive workers’ compensation program.
Fortunately, it does have one. Vermont's mandatory workers' comp program provides medical assistance, income compensation, and rehabilitation for employees who were harmed due to or at work. On the other hand, it also protects employers from frivolous and costly lawsuits. The process for claiming in Vermont is also straightforward, with a decision being made within 21 days or so.
However, there are certain specifics to the program that employees should know. For instance, employees can make their own claims if their employers do not. To learn more about these details, keep reading about Vermont Workers' Comp Laws.
Vermont Workers’ Compensation Insurance Requirements
Generally, all businesses in Vermont with at least one part-time or full-time employee must have workers’ comp. Even individuals hired out of the state but now work in Vermont must be covered by the said insurance. However, the specific definition of the terms “worker” and “employee” in Vermont’s statutes allows for a few exemptions, which include persons who are:
Involved in amateur sports;
Real estate brokers or salespersons;
Involved in farm work and are being paid less than $10,000 annually;
Part of the employer’s family and living in the latter’s household;
Involved in a service within a private dwelling;
Sole proprietors or partners of unincorporated businesses;
Executive members of a limited liability corporation (note that only four members are excluded per LLC).
Note, though, that companies may still provide workers’ comp for the above-mentioned individuals, even if not required by law. Doing so will protect them from liability or personal injury lawsuits, which are usually more costly than workers’ compensation insurance.
Also, if a business leases employees rather than hires them, either the business itself or the leasing company must provide insurance.
Penalty for Businesses that Do Not Have Workers’ Compensation Insurance
To ensure that all employers in Vermont abide by the law, there is a strict penalty system being implemented against businesses that do not provide workers’ compensation insurance for their employees.
These are some of the penalties:
Maximum of $5,000 for every week a business fails to file a certificate of insurance or has falsified information relating to the certificate;
A maximum of $100 for every day of the first seven days a business fails to provide workers’ comp for its employees, and a maximum of $150 for every day following that period.
Stop-work order that is effective until a workers’ comp is secured; only businesses whose stalled operations affect public health may be exempted from the stop-work order, but they will have to pay $250 for every employee per day they have not provided insurance;
Maximum of $10,000 in penalties or fines and imprisonment for businesses that violate their stop-work orders.
Besides penalties for not having workers’ comp, employers in Vermont may be charged fines of:
Not more than $500 for employers who deducted workers’ comp costs from their employees’ salaries;
Not more than $1,000 for employers who did not submit statistical reports on employment, work-related accidents, and workplace safety.
Furthermore, it is not just employers who may incur penalties related to workers’ comp. Anyone — employer or employee — who gives false information to gain workers’ comp will be charged with a fine of not more than $20,000. They will also not get the benefits they were seeking by lying.
Where Can Businesses Obtain Workers’ Compensation Insurance?
Given such heavy penalties, businesses are motivated to provide workers’ compensation insurance to their employees. To do this, they must first know where to obtain workers’ comp.
Most businesses in Vermont obtain workers’ comp from private insurance companies, such as The Hartford and Insureon. The amount they pay these companies, also known as premiums, depends on several factors. These include the industry or type of work, estimated annual payroll, and history of work-related injuries.
There is also an option to self-insure. However, companies have to meet strict qualifications and file certain forms to be allowed to self-insure.
Vermont Workers’ Compensation Benefits
Workers’ compensation is designed to help employees when they are harmed while at or due to work. Such help comes in the form of one or more of these benefits:
Coverage of medical expenses;
Impairment or disability benefits;
Around two-thirds of usual work wages for time lost due to disability;
Death benefits to help with funeral costs and other expenses;
Supplement or support for dependents, especially children.
Note that the exact benefits and amounts vary per situation. For instance, those who have gotten minor injuries and do not have to miss work are unlikely to receive disability benefits, lost wages, or vocational rehabilitation. Meanwhile, you can only claim disability benefits if you are unable to work for at least four days due to injury or illness. Therefore, it is important to communicate with your employer your exact condition to receive your due compensation.
Also, not all illnesses or injuries are covered by workers’ comp. The law states that this insurance coverage is specifically for those caused by work. Therefore, if you had a heart attack while at your office, that does not automatically mean you will receive benefits. You have to prove that your office’s conditions caused the heart attack.
For instance, you are a firefighter and suffer a heart attack. The law states that the disabilities or deaths of firefighters due to a heart condition are considered to be covered by workers’ comp if the symptoms showed within 72 hours of being in the line of duty. Therefore, you would have to prove that you were performing firefighter duties within that time period.
The situation and requirements may also differ if you are an office worker rather than a firefighter. Therefore, it is best to collect as much evidence as you can, so your claim can be strong regardless of your profession.
How to File a Workers’ Compensation Claim in Vermont
Claiming workers’ comp in Vermont is, fortunately, a straightforward process, especially when both employer and employee cooperate. In this section, we will discuss the things you need to know about the process.
When Is the Deadline for Workers’ Compensation Claims in Vermont?
Timely compliance is essential for a favorable decision on an employee's workers' comp claim. Here are the important deadlines one must remember:
There is no deadline to notify an employer about an employee's work-related injury or illness. However, it must be done immediately to reach a swift and favorable decision on the workers' comp claim. Preferably, the employer is informed at the soonest time the employee becomes aware of their condition.
Employers must report the employee’s illness or injury to the Vermont Department of Labor within 72 hours of the latter's notification.
Insurance companies must accept or deny the employee's claim within 21 days of the notification from their employer.
During these periods, you will be provided with forms to fill out or a list of requirements to submit. Accomplish those within the deadlines. Failure to comply in time could be a reason for the denial of a workers' comp claim.
A Step-By-Step Guide on Filing a Workers’ Compensation Claim in Vermont
Remembering these steps in filing a workers’ comp claim can help you receive your benefits easily in case of a work-related accident or illness.
>1. Inform Your Doctor That the Illness or Injury Is Work-Related.
You must seek medical care immediately for your illness or injury. In doing so, do not forget to inform the doctor or health care provider that it is work-related. This will ensure that your medical expenses will be charged against or reimbursed by workers’ comp, instead of your health insurance.
As much as possible, seek medical care from a health care provider covered by your workers’ comp. The list may vary for emergency and non-emergency situations, so be sure to direct your query to your employer to receive the most accurate information.
2. Notify the Employer of Your Illness or Injury.
As soon as you are able (and also within the allotted deadlines), inform your employer of your work-related illness or injury. They will be the ones filing the workers’ comp, so they must know the details of your condition.
Furthermore, duly inform your employer if you are able to go back to work or not. Your ability to work and the extent of injuries or illnesses will significantly affect the benefits you will receive. If you must be absent from work, secure a doctor’s note signifying such. However, if you are able to work but with certain modifications or accommodations, inform your employer.
3. Support Your Employer in Filing a Workers’ Compensation Claim.
As mentioned, the second step is crucial so the employer can file a claim against the company’s workers’ compensation insurance. These are some of the forms they may have to file:
Form 1 (First Report of Injury) - must be filed within 72 hours since the injury. A copy is provided to both the employee and the insurance company.
Form 10 - used to request supplement or support for the dependent children of the employee with disability.
As they file the forms, try to help as much as you can. That is, you can provide your employer with copies of medical receipts and prescriptions. These will be used to support the claim. You may also have to fill out some of the forms by yourself.
4. File the Workers' Comp Claim Forms by Yourself (Optional).
If, for some reason, your employer refuses to file the forms for your workers' comp claim, you can do it yourself. To do so, contact Vermont's Department of Labor. They will provide advice on how to move forward without your employer's cooperation.
They will also supply the necessary forms, such as Form 5 (Employee's Notice of Injury and Claim for Compensation). Make sure to file your claim as soon as possible so as not to lose possible benefits.
Furthermore, be aware that employers cannot fire, reduce pay, or retaliate in any way should you file a claim without their support. If they do so, you can report them to the Attorney General.
5. Undergo Investigation.
After filing, a third-party claims adjuster will likely investigate the submitted claims. The findings of the investigation will influence their decision (reject or not reject the claim), so do your best to cooperate.
If there are forms to be filled out, complete and submit them immediately. Interviews may also be conducted with eyewitnesses. Thus, provide the names of those who saw you when the injury was incurred.
6. Receive Decision on the Workers’ Compensation Claim.
After the investigation, the third party will have to decide if they approve your claim. If the decision favors you, you will receive your benefits, which will depend on the severity or nature of your condition.
However, if your claim is rejected, there are still some things you can do. That will be discussed in the next section.
What Should One Do If a Workers’ Compensation Claim in Vermont Has Been Denied?
If an employee has been denied a workers’ compensation claim, they may appeal or contest the decision before the Workers' Compensation Program.
To do that, you must first identify the reasons for denial. They will be written in the notice you will receive. However, if the reason is too vague or confusing for you, contact the insurer. Inquire about the denial and ask how you may comply to modify the decision. Hopefully, they will provide alternatives so a complicated appeal and investigation may be avoided.
If the insurance company does not cooperate or negotiate with you to change the decision, you will have to appeal to the Vermont Department of Labor. Reread your denial letter to find the instructions for the appeal process. It will start with an informal conference, which is a call that will hopefully resolve the issue. Otherwise, the process will progress to a formal hearing. Additional forms will have to be filled out and filed, such as Form 6 (Notice and Application for Hearing).
You may also need expert legal advice to collect sufficient evidence for your contention, so it is best to hire a lawyer specializing in workers' comp. However, know that representation is optional, even during an appeal for a workers' comp claim. Throughout the appeal process, a specialist from the Department of Labor will ensure that the evidence is fairly and thoroughly reviewed, whether or not you have representation.
Legal Resources for Injured Workers in Vermont
Workers' Compensation - Vermont Department of Labor
Vermont's Department of Labor, specifically its Workers' Compensation Office, helps oversee workers' comp claims and their processes. Therefore, if you have any concerns while your claim is ongoing, such as disputes with your employer or insurance company, it is best to contact this unit. Furthermore, the office's website compiles important information relating to workers' comp in Vermont. It is a great reference for those starting the process of claiming workers' comp.
Vermont Bar Association - Lawyer Referral Service
More often than not, lawyers are not needed for workers' compensation claims. However, when complications arise, such as the denial of a claim or the employer not cooperating, then a legal expert's advice may be invaluable.
With that said, you may find a legal expert through VBA's Lawyer Referral Service. You can reach out for a referral at any time, as long as you do it online. Initial consultations cost $25 at most.
Vermont Occupational Safety and Health Administration
OSHA ensures that workplaces are safe and healthy for employees in Vermont. Therefore, if your work-related injury or illness was caused by unsafe workplace conditions, you may consider filing a complaint with VOSHA. Similar to workers' comp, employers cannot retaliate against employees who complain to the office. Complaints can even be made confidentially.
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