Current through September 21, 2024
A person seeking an award of benefits under the Act must
submit a written application for benefits to the Division, on a form provided
by the Division. A report of injury is not a claim for benefits. W.S. §
27-14-503(a). A claim for
benefits may be filed by the injured worker, that worker's personal
representative, or, in case of an injured worker who is mentally incompetent or
a minor, the worker's legal guardian. In order to make an application, a
claimant shall submit one of the following:
(a)
Claim for
Reimbursement. A claim for reimbursement of any expense(s)
incurred by an injured worker because of his work-related injury must be
submitted on a form provided by the Division according to the procedure
outlined in Chapter 7, Section
3(a)
(iii)Medical Reimbursement to
Injured Worker.
(b)
Claim for Temporary Total Disability (TTD) Benefits (Lost
Wages).
(i)
When
Submitted. A claim for TTD must be filed within 60 days after the
first day of certified temporary total disability. W.S. §
27-14-404(d).
(ii)
Certification.
An award of TTD cannot be made without certification from a treating health
care provider that the worker is temporarily and totally disabled (that is,
incapacitated from performing any gainful employment for which the worker is
reasonably suited by experience or training). The certification shall specify
the reasons for the total disability and the expected period of
disability.
(iii) A physician
assistant shall be deemed a health care provider for purposes of examinations
and TTD certifications pursuant to W.S. §
§
27-14-404(d)(ii), 404(g) and
501(b), if the TTD certification is accompanied by or the Division has on file,
a written statement, signed and dated by the supervising licensed physician,
stating "I [insert name of physician] certify that the physician assistant
signing this form has authority to do so and that the certification is provided
under my supervision." W.S. §
33-26-502(b). Both the
supervising physician and the physician assistant shall have a continuing duty
to notify the Division immediately if a previously-designated physician
assistant is no longer employed by the physician, is no longer licensed as a
physician assistant in Wyoming, or is no longer authorized by the physician to
certify TTD.
(iv)
Where
Submitted. A claim for TTD benefits must be filed with the
Division. W.S. §
27-14-501(3).
(c)
Claim for
Temporary Partial (Light Duty) Disability (TPD). An employer may
make a written bona fide offer of temporary light duty work to an employee
receiving temporary total disability in accordance with W.S. §
27-14-404(j).
(d)
Initial Claim for Permanent
Partial Impairment (PPI) Benefits.
(i)
When Submitted.
An application for PPI benefits may be filed when a worker has suffered an
ascertainable loss as defined in W.S. §
27-14-102(a)(ii).
(ii)
Applications For PPI
Award. If a physician determines that the injury has resulted in a
permanent impairment according to the
American Medical Association's
Guide to the Evaluation of Permanent Impairment or its successor, the
physician shall notify the Division in writing. The Division shall file the
written documentation of permanent impairment, copying all parties. Based upon
the rating given by the physician, the worker may apply with the Division for
the appropriate award, pursuant to W.S. §
§
27-14-405 or 406.
(e)
Claim for Vocational
Rehabilitation Benefits.
(i) At
any time after the injury when medical evidence indicates that an injured
worker cannot return to employment as outlined in W.S. §
27-14-408(a)(ii) the worker
may submit an application to the Division on a form provided by the Division
for vocational rehabilitation benefits.
(ii) The Division may extend or increase a
rehabilitation program's limits defined in W.S. §
27-14-408(e)(ii) upon
consideration of one of the following extenuating circumstances:
(A) The injured worker's disability is so
severe as to limit his ability to complete his vocational rehabilitation plan
within specified time frames;
(B)
Medical services or complications prevent the injured worker from completing
his vocational rehabilitation program on time;
(C) The educational institution's scheduled
course offerings prevent the injured worker from completing the vocational
rehabilitation program on time; or
(D) Any other circumstance mutually agreed
upon by the Division, Division of Vocational Rehabilitation and the injured
worker.
(iii) The
application for vocational rehabilitation shall include a statement that the
applicant elects to accept vocational rehabilitation instead of any PPD award
under W.S. §
27-14-405(h) and (j) arising
from the same physical injury.
(f)
Application for Permanent
Partial Disability (PPD) Benefit. An application for PPD may be
filed no sooner than three months after the date of ascertainable loss or
threemonths before the last scheduled PPI payment, whichever date is later. and
must be filed within one year of the later date. W.S. §
27-14-405(h)(ii).
(g)
Miscellaneous Benefit
Application.
(i) Applications
for other benefits, including death benefits, permanent total disability,
benefits for dependents or survivors, and extended benefits shall be made to
the Division as soon as practical after the applicant becomes aware of
entitlement to such benefits and within applicable statutes of
limitations.
(ii) Where death
results from an injury, the claim for death benefits shall be filed by the
surviving spouse, by the guardian of a surviving spouse who is incompetent, by
the guardian of dependent minor children, by the worker's dependent parent(s),
or by the guardian of the worker's incompetent dependent parent(s).
(iii) Application for extended children's
benefits for education beyond the age of 18 and until the age of 21 may be made
with the Division. Beneficiaries will receive notification and must complete
and submit a Verification of Enrollment Form provided by the
Division.