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Puerto Rico Workers Compensation

Puerto Rico Workers Compensation

Introduction

The Puerto Rico Workers Compensation Law, also known as Ley de Compensación de Trabajadores de Puerto Rico, provides workers with compensation benefits for work-related injuries and illnesses. The law is designed to protect both employees and employers by establishing a no-fault insurance system to provide medical and wage replacement benefits to injured workers. In this article, we will explore the details of the Puerto Rico Workers Compensation Law, including eligibility requirements, types of benefits, and the claims process.

Eligibility Requirements

To be eligible for workers’ compensation benefits under the Puerto Rico Workers Compensation Law, an individual must meet certain requirements. The law applies to employees who work in the private sector, including self-employed individuals, as well as government employees. The law does not cover independent contractors or volunteers.

Additionally, the injury or illness must have occurred as a result of work-related activity, including accidents, repetitive motion injuries, and occupational diseases. The injury or illness must have also occurred during the course of employment. This means that injuries sustained during work-related travel, breaks, and other work-related activities may be covered under workers’ compensation.

Types of Benefits

Workers’ compensation benefits in Puerto Rico can be divided into two main categories: medical benefits and wage replacement benefits.

Medical Benefits

Medical benefits cover the cost of medical treatment related to the workplace injury or illness. This can include doctor visits, hospitalization, surgery, physical therapy, and prescription medication. In some cases, prosthetic devices and home healthcare may also be covered. The injured individual can choose their own healthcare provider, but the provider must be registered with the Puerto Rico Insurance Commissioner. The insurance company may require a second opinion in certain circumstances.

Wage Replacement Benefits

Wage replacement benefits cover lost wages due to the inability to work as a result of the workplace injury or illness. The amount of the benefit is a percentage of the injured individual’s average weekly wage, up to a certain maximum amount. If the individual is partially disabled and able to work, but not at their pre-injury capacity, wage replacement benefits may still be available.

The amount of the benefit and the duration of receiving it is based on the severity of the injury or illness. For example, if an individual is totally and permanently disabled, they may be eligible for lifelong wage replacement benefits.

Claims Process

The process for filing a workers’ compensation claim in Puerto Rico begins with notifying the employer of the workplace injury or illness. The employer is required to provide the injured individual with the necessary forms to file a claim with the insurance company. The individual must file the claim within three years of the injury or illness diagnosis.

Once the claim is filed, the insurance company will investigate the claim to determine whether the injury or illness is work-related and eligible for benefits. The insurance company may require a medical examination by a doctor of their choosing. The injured individual has the right to an attorney during the claims process.

If the claim is approved, the insurance company will begin paying medical and wage replacement benefits. If the claim is denied, the individual can appeal the decision through the Puerto Rico Insurance Commissioner.

Recent Updates to the Law

In 2018, Puerto Rico enacted several updates to its workers’ compensation law. These updates include changes to the claims process, the establishment of a medical fee schedule, and increases in certain benefit amounts.

One significant change to the claims process is the establishment of a voluntary mediation program. If an injured worker disagrees with the insurance company’s determination of their claim, they can request mediation. The voluntary mediation program is designed to provide a faster and less expensive alternative to traditional litigation.

The medical fee schedule establishes maximum allowable amounts for medical treatment related to workplace injuries and illnesses. The fee schedule is designed to help control costs and ensure reasonable rates for medical treatment.

Additionally, several benefit amounts under the workers’ compensation law have been increased. The maximum weekly wage replacement benefit amount has been increased from $133 to $180. The maximum permanent disability benefit amount has been increased from $193,800 to $250,000.

Conclusion

The Puerto Rico Workers Compensation Law provides important protections for employees who suffer from work-related injuries and illnesses. The law ensures that individuals who are injured on the job have access to medical treatment and wage replacement benefits. The recent updates to the law have made the claims process more streamlined and increased certain benefit amounts. As Puerto Rico continues to recover from the devastation of Hurricane Maria, a strong workers’ compensation system is vital to protecting the rights and well-being of workers across the island.


Guide to Puerto Rico Workers Compensation

If you have been hurt on the job in the territory of Puerto Rico, you may qualify for PR workers compensation coverage.  This is a type of benefit that covers almost all workers in the territory, and can pay for your medical costs and compensate your economic losses if you are temporarily or permanently disabled.  This guide will provide an overview of the Puerto Rico workers compensation system, including who qualifies for benefits and what to do if your employer denies your request for compensation.

Who Qualifies for Puerto Rico Workers Compensation?

All employers in the territory are required to provide PR workers compensation coverage for their employees.  If you are employed as an agricultural worker or sharecropper, you still qualify for Puerto Rico workers compensation benefits under the law.  Even domestic employees, like housekeepers and nannies, are entitled to PR workers compensation benefits if they are regularly employed by the same employer.

The only employees who do not qualify for Puerto Rico workers compensation coverage are executives and corporate board members, as well as those who are employed by the federal government.  Federal government workers have their own workers compensation program that is managed at the federal level.

What Injuries and Illnesses Qualify?

PR workers compensation is available to anyone who has been injured or made ill by their job.  If you have been hurt while performing your job duties or while at work, you are almost certainly eligible to receive Puerto Rico workers compensation.  Even if you caused the accident that led to your injury, you may still be able to claim PR workers compensation as long as the injury was not caused deliberately or due to illegal acts (like being under the influence of illegal drugs).

Illnesses that are related to your occupation may be compensated by Puerto Rico workers compensation insurance if you can demonstrate that they were caused or exacerbated by your working conditions.  For instance, a worker whose carpal tunnel syndrome is worsened to the point of needing surgery may be able to receive PR workers compensation for the surgery if typing at his or her place of employment exacerbated his or her pain or disability.

How Do I Request Benefits?

You should notify your employer of your injury and your desire to seek Puerto Rico workers compensation as soon as possible after you are hurt or diagnosed with an occupational illness.  Delaying notification could delay your benefits, and if you wait more than four months to notify your employer that you have been hurt, you may no longer qualify for PR workers compensation for that injury.

What If My Benefits Are Denied?

All workers whose benefits are denied by employers have the right to a Puerto Rico workers compensation hearing.  In order to get the best results at your hearing, you may want to hire a PR workers compensation attorney.  These attorneys specialize in helping people get the benefits they’re entitled to, and will often work for a percentage of your workers compensation award rather than an upfront fee.