If you've been injured on the job, you're probably wondering what kind of benefits you'll receive. As part of a typical workers' compensation claim, in general, injured employees are entitled to four different kinds of benefits:
Workers’ compensation laws do not provide for additional benefits for pain and suffering. They are basically income protection laws. An injured employee receives benefits due to an inability to work. If pain prevents the employee from returning to work, then he/she will receive weekly compensation, but will not receive additional compensation for pain and suffering like in a personal injury case.
Disabled employees receive weekly compensation benefits. The length of the benefits differs from state to state, and depending on the type of benefit. Disability is classified in two different ways, 1) whether it is temporary or permanent, and 2) whether it is total or partial. Thus, an injured employee can have four different types of disability benefits (although not all states allow for permanent partial disability):
Temporary disability means that the employee is still recovering, and is expected to get better. Permanent disability means that the employee’s condition is stable, and is not expected to improve. Permanent disability is sometimes referred to as a point of maximum medical improvement (MMI). A person at MMI is not necessarily fully recovered; MMI just means that the person is not expected to get any better.
Total disability means that the employee cannot work at any type of employment; he/she is completely disabled. Partial disability means that the employee has some sort of work capacity, perhaps the ability to perform sedentary or light duty work.
This differs from state to state. States limit the length of time that you can receive temporary benefits for an injury. These limitations are in the range of three to seven years. There is generally no limit on the length of permanent disability benefits, except that some states terminate weekly benefits when the employee reaches age 65. Not all states provide for permanent partial disability benefits.
The amount of weekly benefits for total disability is usually 60% or 2/3 (66 2/3%) of the employee’s pre-injury average weekly wage (AWW). AWW is the employee’s actual earnings, including overtime, for a certain number of weeks before the injury (up to 52), divided by that number of weeks. However, most states have capped the maximum weekly benefit at around $1,000 per week, regardless of the employee’s AWW.
The benefits for partial disability are calculated in a different way. Since an employee on partial disability is assumed to be able to work, at least part time or in a light duty job, partial disability benefits are calculated by reducing the employee’s AWW by his/her current earnings or earning capacity. So, if the employee’s pre-injury AWW is $1,000, current earning capacity is $500, and he/she is in a state where total disability is 60% of AWW, his/her partial disability rate is:
.6 x (1,000 – 500) = .6 x 500 = $300 per week.
These benefits are awarded if an employee is diagnosed with a permanent physical impairment based on guidelines developed by the American Medical Association.
A permanent impairment is usually a limitation of use or restriction of motion in a body part.
As an example, let’s say that you injured your hand and have a permanent loss of strength and flexibility in that hand. A doctor, applying the AMA guidelines, might conclude that you have a 20% permanent impairment in that hand. Your state’s workers’ compensation law might provide for a $100,000 payment for a complete loss of use of a hand, so your permanent impairment would be worth $20,000 (100,000 x 20%). Some states also allow permanent impairment awards for scarring.
An injured employee is entitled to have all of his/her reasonable and necessary medical treatment paid. This often gives rise to disputes between the employee and the insurer. If the insurer believes that the employee’s treatment has dragged on too long, or that the treatment is not generally accepted in the medical community, the insurer may refuse to pay for the treatment on the grounds that it is no longer reasonable and necessary. The employee will then need to file a claim with the state workers’ compensation agency to try to get the treatment paid for.
Additionally, most states allow the employee to be reimbursed for all necessary transportation costs for traveling to and from the medical appointments, including mileage, tolls, and parking.
Vocational rehabilitation is job retraining. If an injured employee cannot return to his/her previous line of work, most states will require the workers’ compensation insurer to pay for retraining into a new line of work.