Find out the types of workers’ compensation benefits you may be entitled to after a workplace injury, and what to expect when filing a claim.
Unfortunately, Americans get hurt at work every single day. Workers suddenly experience costly medical bills, lost wages, the possibility of never returning to their job, and even death.
Thankfully, people injured on the job may qualify for benefits under state-mandated workers’ compensation insurance. Workers’ comp benefits usually include medical expense coverage, disability wage benefits, and rehabilitation and death benefits.
All of these advantages help protect employees and their families from the unforeseen and tragic consequences that a workplace injury can cause.
Filing a workers’ compensation claim can get complicated. Many states have confusing laws that make it difficult to determine what benefits are available, and which workers qualify for benefits.
Let’s unpack everything you need to know about the different types of workers’ compensation benefits. Make sure you go after every bit of compensation you’re entitled to.
Medical Benefits for Workplace Injuries
People injured at work will require medical care and treatment. Fortunately, workers’ compensation covers a worker’s healthcare expenses for the injury with no waiting period.
This coverage includes medical costs for:
- Emergency room care
- Doctor fees
- Hospital visits and treatment
- Medical diagnostic tests
- Physical therapy
Medical benefits also include reimbursement for the cost of necessary medical equipment, like crutches and wheelchairs.
State workers’ compensation laws typically don’t cap medical coverage. Further, workers’ comp pays for medical expenses until a worker has recovered from their injury, or reached their level of “Maximum Medical Improvement” (discussed below).
Some states may restrict coverage for alternative medical treatments. For example, there may not be coverage for massage therapy, acupuncture, or pain therapy.
Other states may pay for these services but limit the number of a worker’s total medical visits. For example, your workers’ comp may cover chiropractic care, but limit your total number of chiropractic visits to 24. Or it may cover physical therapy for only a limited period of time.
In some circumstances, you (or your doctor) may have to get advance authorization for certain medical treatments.
Further, states have different rules as to whether you or your employer has the final say in choosing your healthcare provider.
Maximum Medical Improvement
A person injured on the job reaches their Maximum Medical Improvement (MMI) when their primary doctor says that their condition will not get any better with ongoing treatment.
MMI can take a number of weeks to achieve or even several months to years. The amount of time is based upon the specific injury and the worker’s response to treatment.
Once you reach MMI, your condition is not likely to improve despite ongoing treatment. At this point, the doctor may calculate a disability rating based on your current limitations.
MMI is important when discussing medical expenses because workers’ comp benefits normally pay for recommended medical treatment up until a worker reaches their MMI (or returns to work).
Post-MMI, workers’ compensation laws may still allow for coverage of certain medical expenses, but the coverage is often limited to secondary medical services. “Secondary medical services” are services like physical therapy, that help keep an injured body part functioning at its current level, without losing ground.
Workers’ Comp Managed Care Plans
Some states provide employers and their insurance companies with the option of providing medical care benefits through a managed care plan. Some states even require employers to adopt these plans.
A managed care plan may include:
- Medical Care Management System, which oversees a worker’s medical treatment to help ensure they return to work as quickly as possible.
- Provider Network, which is a group of medical care professionals that contract with an insurer to provide services at a discounted rate.
If a provider network is available, then state law may require you to get treated by a healthcare professional within the network.
Workers’ Comp Disability Wage Benefits
Wage replacement disability benefits are available under every state’s workers’ comp laws. These disability payments cover a portion of an injured employee’s wages following a work-related injury.
Workers’ compensation laws set forth four categories of disability that a worker may experience following their work injury. Your ability to work determines your disability category and wage replacement benefits are paid accordingly.
Four Categories of Workers’ Compensation Disability
- Temporary Total Disability (TTD): The worker is unable to return to any work for a limited amount of time.
- Temporary Partial Disability (TPD): The worker is restricted from performing some, but not all, of their work duties for a limited amount of time.
- Permanent Total Disability (PTD): The worker is unable to return to the workforce in any capacity.
- Permanent Partial Disability (PPD): The worker has permanent limitations that impact the type of work they can do.
State laws differ in terms of the amount of money a worker is paid for each disability category. For example, a permanently disabled worker might be compensated differently depending on whether they live in Illinois or California.
There are still some generalizations that we can make when it comes to all types of disability benefits.
Temporary Total Disability (TTD)
TTD benefits are most often paid as a percentage of a worker’s weekly wage. Most states use a percentage of 66 and 2/3 percent.
So, if your weekly wages before the injury averaged $2,000, you would receive TTD benefits in the amount of $1,333/week. That looks like a big cut in pay, however workers’ compensation wages are not generally taxable.
Most states impose some type of waiting period (for example, 7 days) before a worker is entitled to receive wage benefits. After the waiting period, if the worker is still unable to work, their weekly disability payment will be activated, often retroactive through the waiting period.
A worker usually will continue receiving TTD benefits until they return to work, reach their MMI, or state law says that the benefits should expire. Many state laws say that these benefits should end after an allotted number of weeks.
Temporary Partial Disability (TPD)
Workers that suffer a temporary partial disability can usually return to work with restrictions. They’ll often get assigned to a temporary “light duty” position that may be at a pay grade lower than the worker had before the injury.
For example, a worker may have hurt their back while loading boxes onto a shipping truck. While the injury will prevent them from performing heavy lifting, they could still probably work in a clerical position that pays less money.
TPD benefits are intended to compensate you for the difference between your wages prior to your injury and your wages in your restricted capacity.
In the above example, assume the worker made $2,000 per week in a warehouse job but then made $1,000 per week in the clerical position. TPD benefits will pay the worker a percentage of the $1,000 difference in wages.
TPD benefits typically end when you return to work at your pre-injury wages, or state laws dictate the benefits end because you’ve reached the maximum number of allotted weeks.
Permanent Total Disability (PTD)
A worker who is permanently and totally disabled will never return to the workforce again.
Permanent total disability benefits therefore provide qualified workers a percentage of their weekly wages for the rest of their lives. This percentage is often 66 and 2/3 percent of the workers’ weekly wage prior to the work accident.
Some states terminate PTD benefits when the worker reaches the age of retirement.
Permanent Partial Disability (PPD)
Some injuries that may involve a permanent partial disability include:
- Hearing loss
- Vision loss
- Loss of an appendage or limb
As with a Permanent Total Disability, a worker with a Permanent Partial Disability suffers a disability for the rest of their life. But unlike with a PTD, a person can return to some form of work with a PPD, although it may not be the same job type as before the injury.
Most states divide this disability rating into two different categories. These are scheduled and non-scheduled.
With a scheduled PPD, a worker suffers an injury that is listed on a state-provided schedule, meaning a list of injuries and corresponding compensation. The schedule sets forth the amount a worker will receive in benefit payments for their permanent injury.
For example, let’s say you lost a finger in a work-related injury. Your state may have a PPD schedule that provides payment of 20 weeks’ worth of wage replacement for the loss of a finger. If your average weekly wage benefit was $1,000 per week, you’d be entitled to a lump-sum payment of $20,000 for the loss of your finger.
If a worker suffers a non-scheduled PPD, then state law typically determines a benefit amount based upon an impairment rating or a disability rating.
Impairment Ratings for Work Injuries
When a doctor assigns a worker an impairment or disability rating, the process is often complex and we advise that the worker talk to a personal injury attorney for help.
Impairment ratings come into play when a worker with a PPD reaches their Maximum Medical Improvement. Once this event occurs, the worker’s treating physician will assign the worker with a specific disability/impairment rating.
A disability rating may range from one to 99 percent. The majority of these ratings are between 5 and 35 percent. A rating of 100 percent indicates a PTD.
When doctors assign a disability rating, they often use guidelines published by the American Medical Association’s “Guides to the Evaluation of Permanent Impairment.”
Keep in mind that once your physician decides on an impairment rating, the insurance company may want you to submit to an Independent Medical Examination (IME) performed by one of their doctors.
An IME usually results in a disability rating lower than the one provided by your treating physician. This means lower compensation for the worker and the issue is often best handled by a skilled workers’ comp attorney.
Once an insurer establishes a disability rating, it uses the rating to help determine how much it will pay in terms of PPD benefits.
Vocational Rehabilitation Benefits
Vocational rehabilitation benefits come into play if you experience an injury that prevents you from returning to your pre-injury position. These benefits are intended to cover training and tuition expenses associated with learning a new job.
Consider, for example, California’s workers’ compensation system. Under California law, workers receive a supplemental job displacement benefit (SJDB) if they can’t return to long-term work due to a permanent disability.
The SJDB is a $6,000 voucher that you can use to pay for:
- Education-related retraining or skill enhancement at a California public school
- Tuition, fees, books, other expenses
- Occupational licensing
- Professional certification fees
- Vocational counselor services
- Resume preparation
The voucher expires on the later of two years from the voucher date or five years from the date of your injury.
In other states, the worker’s compensation insurance company will require you to participate in recommended vocational training or risk termination of your benefits.
Workers’ Compensation Death Benefits
There are times when an employee dies because of a work injury. In this event, most states usually provide death benefits to the worker’s surviving relatives. “Surviving relatives” typically include children and spouses who were financially dependent on the deceased worker.
Death benefits include compensation for funeral expenses. These benefits may also provide some compensation for the loss of the deceased worker’s financial support.
Compensation for the loss of support is usually based on the deceased employee’s wages. State laws may cap this compensation at a certain amount.
Cases can get complicated when a worker is survived by a number of different family members. In such cases, it’s a good idea to meet with a skilled attorney to help maximize whatever death benefits are available to you or your family.
Liens with Third-Party Lawsuits
There are situations when employees suffer work-related injuries as the result of some third party.
Consider, for example, a scenario where you are hand-delivering a package for your employer. If you are crossing the street and get hit by a negligent driver, then you’d experience a third-party injury. The third party is the negligent driver.
In these circumstances, you’ll still get workers’ compensation benefits and you can also file a third-party lawsuit against the at-fault driver. In the lawsuit, you can seek compensation for all your damages, including the full amount of lost wages and an amount for your pain and suffering.
If you settle or win your case against the negligent driver, you can expect the workers’ comp insurance company to put a lien on your settlement. Workers’ comp has a right to seek reimbursement for the medical expenses and wage benefits it paid to you.
Workers may be injured in the course of their job duties by negligent drivers, defective machinery, dog bites, and other hazards not caused by the employer. If you win a settlement or award, workers’ comp has a right to seek reimbursement from your proceeds.
Most state laws say that an insurer can only take a lien for about two-thirds of what they paid to you.
Example of a Workers’ Compensation Insurance Lien
Lisa is a secretary in a busy downtown law office. The attorney she supports asked her to deliver some important documents to the local courthouse for filing.
The courthouse was a ten-minute walk from her office and it was a nice day. Rather than hail a cab, Lisa decided to walk to the courthouse. En route, she crossed a street during a “walk” signal at a crosswalk.
A driver approaching the intersection failed to see the red light. He slammed on the brakes to avoid the pedestrians in the middle of the road. Lisa saw the car and dove towards the sidewalk. She sustained a broken hip while trying to get out of the way.
Workers’ compensation insurance covered Lisa’s medical expenses and wage replacement during her recovery. In total, her employer’s insurance company spent $30,000 in benefits to Lisa.
Through her attorney, Lisa filed a lawsuit against the at-fault driver, seeking compensation for injuries, lost wages, and her pain and suffering. The case settled for $100,000.
Workers’ comp asserted a lien against Lisa’s settlement for the $30,000 that it already paid on Lisa’s behalf.
The state where Lisa lives caps workers’ comp liens at two-thirds of what is paid to a claimant. Lisa must repay $20,000, or two-thirds of the $30,000 that workers’ comp paid out on her behalf.
Workers’ compensation issues can get complicated and confrontational, especially when a worker suffers severe injuries that result in some level of permanent disability.
In these cases, you should speak with an experienced workers’ comp law firm for help with your claim. Keep in mind that you can consult with an attorney at any time prior to settling your case.
Most workers’ compensation lawyers provide free consultations. To further protect injured employees, most states impose caps on attorney fees for workers’ comp cases.
Fight for the benefits you and your family deserve. Contact a skilled lawyer today to help maximize your workers’ compensation benefits.
How Much is Your Injury Claim Worth?
Find out now with a FREE case review from an attorney…