Workers’ Compensation, (WC) is designed to compensate the injured employee for an injury, death, or occupational disease occurring while the employee is on the job. The payments include all authorized medicine, and medical, doctor and hospital bills. If the employee is unable to work for more than three days, they are paid compensation based on their average weekly wage. The average weekly wage is calculated based on earnings before the date of injury.
If you were injured on the job, you should know that documents need to be filed correctly within the appropriate number of days. You must follow all the rules and procedures or you might not get all the benefits you have a legal right to receive.
There is no compensation for pain and suffering.
Do I qualify for Workers’ Compensation benefits?
Temporary Total Disability (TTD)
An employee is entitled to TTD when the employee is unable to work due to medical restrictions. The amount of the TTD payment is 2/3 of the weekly wage, including overtime and insurance benefits, up to a maximum determined by the year of injury. It is payable at least every two weeks. It is payable until the employee is capable of going back to work.
Temporary Partial Disability (TPD)
TPD is payable to those persons who are unable to return to work full-time but are able to resume work in a different capacity or on a part-time basis. The amount that the person is compensated is 2/3 of the difference between their present earnings and pre-injury earnings up to a maximum determined by the year of injury. It is payable at least every two weeks until the person reaches maximum medical improvement.
Permanent Partial Disability (PPD)
PPD occurs when full recovery from the injury is not possible; for example, a loss of arm, fingers, or restricted mobility in the back. The amount of disability depends on the severity of the injury. Certain types of injuries or losses are scheduled awards meaning that the law has defined the amount of compensation to be granted to them. Claimants who have extremity (legs, feet, arms, hands, fingers, eyes, shoulder) injuries are limited to scheduled awards. For the non-scheduled award the disability is rated as a percent of the body as a working unit. The following factors are taken into consideration: a doctors determination of medical impairment, life expectancy, the weekly temporary disability rate.
Permanent Total Disability (PTD)
PTD occurs when a person loses both hands, both eyes, both legs, or a disability determination by an administrative law judge stating that the employee is totally disabled after considering the medical impairment, educational background, work history, etc. PTD is payable at the rate of 66 2/3 % of the employee’s salary for life. In order to qualify, the person must be unable to earn any wages.
How do I change doctors?
You may change to a physician from the designated list your employer provided you within 7 days of your accident, after you have reported it. You have up to 90 days from the date of your accident, if you have not been placed at maximum medical improvement (MMI). Otherwise, you may change your physician by making a written request to the employer or insurance carrier. If the permission is neither granted nor refused within 20 days, the employer’s insurance carrier is deemed to have waived any objection. (Frequently, the employer and insurance company object to any change in physician and the issue needs to be brought before a judge for determination). If you change doctors without requesting permission in writing, the insurance company may refuse to pay these bills.
What happens if I do not agree with a doctor’s rating?
If you disagree with the doctor’s impairment rating or the date of maximum medical improvement, you may request an Independent Medical Examination (IME). If you are objecting to a Final Admission of Liability, you must send in your objection and propose the name or names of a Level II accredited physician within 30 days of the date of the final admission. The rules are very specific and you must follow them to the letter. It is in your best interest to consult with an attorney so you do not miss any deadlines.
If I am awarded permanent partial disability benefits, can I get the money all at once instead of in weekly payments?
An employee may obtain a lump sum payment on almost all permanent disability awards. For certain types of awards lump sum payments are not granted until six months have passed from the date of injury. Further, the lump sum payment must be justified and such action must be shown to be in the worker’s best interest.
If you receive a permanent partial disability award, you may request the automatic payment of up to $10,000 in a lump sum without waiving your right to prosecute the claim for additional permanent disability benefits. Or, you may request a maximum lump sum payment of benefits on your claim. The maximum amount allowable changes each year.
How does Social Security Disability Insurance (SSDI) work?
What is SSDI?
Social Security Disability Insurance is determined according to Social Security (SS) regulations and Federal law. Disability means that you are so severely impaired physically or mentally that you cannot perform any substantial and gainful work. This impairment must last, or be expected to last, at least twelve months or must be expected to result in death.
If you meet this criteria, you may qualify to receive monthly cash disability benefits. The disability determination for SS is independent of any disability determination for Workers’ Compensation, automobile accidents or under any other law.
In addition to meeting SS disability rules, in order to qualify for disability benefits you must also meet special insurance requirements. First, you must be fully insured. This means that you have worked enough over your entire work history and enough in each year to have earned sufficient credits. This requirement varies by your age.
Second, you must be disability insured. For people over 30 years old this means you must have worked in five of the ten years before your disability begins and earned a sufficient amount in each year. For people 30 years old or younger the rules are somewhat different. Ask your lawyer concerning these rules.
The Waiting Period
Disability benefits are not paid for the first five full months that you are disabled. For example, if you become disabled on January 1st, the first month for which benefits are payable is June. Once you are found to qualify for disability benefits, benefits may be paid retroactively excluding the first five months of disability.