A Legal Guide to Vermont Workers’ Compensation Benefits

//

Laura Schaefer

The Green Mountain State of Vermont has unique rules and procedures for its workers’ compensation system. It was designed to provide payments for treatment (as well as lost wages benefits) for a work injury. Vermont workers’ compensation also covers occupational diseases that may have occurred instantaneously or over time.

Never ignore your Vermont workers’ compensation rights. File with a workers’ compensation attorney to guide you through the WC legal process.

Free Workers' Comp Evaluation

Have medical bills from a work injury? Click here to speak with a nearby attorney for FREE about your Workers' Compensation claim.

Vermont Employers Must Carry Workers’ Compensation

Workers’ compensation insurance is mandatory for all Vermont employers, which means that if you are an employee in this state, this program covers you.

In Vermont, the employee must prove they suffered a work injury to start a workers’ compensation claim. This is in stark contrast to other states that operate on a no-fault system.

The Vermont Department of Labor (VDOL) administers the program, which is provided through private carriers, although employers may also self-insure.

Exceptions to Vermont Workers’ Compensation Law

The law in Vermont is clear that there are several exceptions to coverage under the WC law. These are those who pursue or are:

  • Casual employment such as any type of service in or about a private dwelling
  • Agriculture or farm employment for an employer whose total payroll is less than $10,000 in a calendar year
  • Family members of employers that reside in the employer’s house
  • The sole proprietor or partner owners of an unincorporated business
  • A real estate broker or salesperson
  • An officer, member, or manager of a corporation or LLC

Furthermore, not all work injuries are covered under workers compensation in the state of Vermont. It is not allowed for injuries caused by an employee’s willful intent to injure him/herself or someone else.

It also doesn’t apply to injuries caused by or during the employee’s intoxication or by an employee’s failure to use a safety device that was provided.

Employer Penalties for Withholding Workers’ Compensation

For the first seven days without insurance, employers face a $100 penalty for each of those days. Beyond seven days, the penalty increases to $150 each day they refuse to cover their employees with Vermont workers’ compensation (Vt. Stat. tit. 21 § 692).

An employer or workers’ compensation insurance carrier which refuses or neglects to comply with an interim or final order of the Commissioner shall be assessed a penalty of $500.00 per occurrence.

An additional penalty of $100 per day is assessed for each day the employer or worker’s compensation carrier failed to comply after the date set for compliance. The total penalty cannot exceed $5,000 per occurrence.

Types of Losses Vermont Workers’ Comp May Cover

Vermont workers’ comp may cover lost wages from missing work days. It may also pay out benefits from:

  • A lost digit or limb
  • Loss of hearing or eyesight
  • Loss of range of motion due to a work injury

When a work injury results in permanent loss, Vermont employees are entitled to compensation for that impairment.

This must be rated by a medical provider according to the AMA’s guides to the Evaluation of Permanent Impairment.

Common Benefits of Vermont Workers’ Compensation

Depending upon the seriousness of your injury and whether it affects your ability to work, you may be entitled to one or more workers’ compensation benefits including:

  • Medical benefits
  • Wage replacement benefits
  • Permanent benefits
  • Vocational rehabilitation
  • Death benefits are available family members if the worker dies from a work injury

Keep in mind that Vermont workers’ compensation may not cover certain non-economic damages like pain and suffering and emotional distress.

Keep in mind that your employer’s workers’ compensation insurance should pay for all reasonable and necessary medical services and supplies related to an on-the-job injury.

This may include coverage for doctor visits and hospital treatment, as well as coverage for physical therapy, medication, chiropractic treatment and psychological counseling.

Temporary and Permanent Disability Benefits

Temporary total disability is based on the worker’s pre-injury average weekly wage. These types of benefits are offered if the employee cannot return to work for a temporary amount of time.

The employee receives two-thirds of their average weekly wage starting after the first three days of temporary total disability. The employee may also receive a weekly supplement for each of their dependent children.

Payments continue until maximum medical improvement is reached. A worker found permanently and totally disabled first receives temporary total payments until a medical end result has been reached or the worker can return to work.

After the carrier paid 330 weeks of benefits and the worker still cannot return to any type of gainful employment, permanent total benefits ensue.

Temporary partial disability is paid when the worker is only able to perform part-time work. It is paid at 2/3 of the difference between their full and part time pay.

If a worker suffers permanent partial impairment from the work injury, they’re entitled to additional compensation due to their condition. The American Medical Association’s rating system is used in most cases.

How to Start Filing Your Vermont Workers’ Compensation Claim

The Vermont workers’ compensation process starts when you recognize you suffered a work-related injury. This includes impairments that develop over time directly caused by employment.

If you are injured at work, here are the steps to take to start a Vermont workers’ comp claim:

1. Notifying Your Employer About Your Injury

Acquire emergency medical care if needed and tell the doctor that you’re there due to a work injury. You’re not required to pay any medical bills if they occurred due to an injury from work.

At first, your employer issues you a company doctor to assess your losses through tests and functional capacity evaluations. After that visit, you can choose your doctor through filing a Form 8 Change of Health Care Provider.

IMPORTANT: If you are unable to work you MUST get a doctor’s note.

2. Reporting to the Vermont Department of Labor

Employers must make a report within 72 hours of receiving notification of a work injury. They must pay for the time lost if your injury happens in the middle of a shift. Your employer should give you a copy of the report they file.

3. Actions Your Employer’s Insurance Company May Take

Afterwards, your employer’s insurance company has 21 days from your employer’s report to investigate your claim and determine if your injury is covered. The insurance adjuster should contact you for information about your injury.

The insurance company will send you a Form 7 Medical Authorization so they can access your medical records related to the injury.

Return the Form 7 Medical Authorization promptly and tell your employer’s insurance company about any medical appointments and any contact information changes.

If you don’t hear from your employer’s insurance carrier, contact the Vermont Department of Labor at (802) 828-2286.

Crucial Evidence to Gather for Your Claim

What’s unusual about Vermont workers’ compensation rules is that the employee has the burden of proof regarding their work injury. Your statement alone is not enough, and you must submit evidence supporting your claim.

If the employee submits evidence, the employer, through its carrier, may submit contrary evidence. Evidence may include:

  • Medical records
  • Witness statements
  • Documentation of other information relevant to the claim

If the employee and the employer’s workers’ comp insurance carrier submit contrary evidence, the employee’s evidence must be the stronger of the two. Contact an attorney to help strengthen your case.

How are Vermont Workers’ Comp Settlements Calculated?

Vermont workers’ compensation settlements are made up of two-thirds of the injured employee’s average weekly wage (AWW) and the benefits they’re eligible for.

The AWW is based on gross earnings for 26 weeks before the injury, not including the week of the injury. These include overtime, tips, bonuses, and the market value of any benefits provided.

The weekly amount increases by a cost of living adjustment (usually 2-3%) on July 1st, if the employee has been receiving weekly checks for more than six months.

Can You Get Fired for Filing Workers’ Compensation in Vermont?

No, you’re unable to get fired for filing workers’ compensation in Vermont as that’s considered an adverse action. It’s also illegal to reduce your hours or withhold promotions because you made a workers’ comp claim.

If your employer fired you because of your workers’ compensation claim, contact the Vermont Attorney General’s office.

What if Your Vermont Workers’ Compensation Claim was Denied?

If your Vermont workers’ comp claim was denied, read the denial letter and consult a workers’ compensation attorney to guide you through the appeals process.

You have the right to appeal the decision by filing a Notice and Application for Hearing (Form 6) with the Vermont Department of Labor.

The first thing that will happen after you file this application is an informal telephone conference. This is when you can present your case and attempt to resolve the dispute.

If the informal hearing doesn’t reverse your claim denial, you can request a formal in-person hearing to present further evidence. You can then appeal to the Vermont Superior Court directly.

In Vermont, an injured employee has six months from the date of injury to file a WC claim. A worker may only pursue a claim after the six-month limit if they can show that the employer/carrier had knowledge of the accident. A claim can never be started more than six years from the date of injury.

Find a Vermont Workers’ Comp Attorney Through LegalASAP

Analyzing a workers’ comp case may require the expertise of a professional who knows Vermont’s laws. Luckily at LegalASAP, our attorney network of 500+ law firms throughout the United States can answer your legal questions.

Our professionals mostly work under contingency, meaning their services are paid-for through your settlement and you pay nothing up-front.

Ready to see if you may qualify? Complete your free online workers’ compensation case evaluation now!

Laura Schaefer

Laura Schaefer is the author ofThe Teashop Girls,The Secret Ingredient, andLittler Women: A Modern Retelling. She is also an active co-author or ghostwriter of several nonfiction books on personal and business development. Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world. Visit her online at lauraschaeferwriter.com and linkedin.com.