Workers Compensation – What You Need to Know

In most states, workers’ compensation benefits cover employees who get hurt. The employer’s insurance company pays for these benefits. The fault is irrelevant in these cases. Employees need to know how these claims work to understand their options if injured. 

Temporary Disability Benefits

Workers’ compensation benefits are designed to provide injured workers with a portion of their lost wages. A typical benefit is a weekly cash payment of about half an employee’s average weekly wage. Workers’ compensation benefit amounts are based on a formula established by law. This formula uses an injured worker’s average weekly wage, a pre-accident average weekly wage, and a percentage of the injured worker’s permanent impairment rating to calculate the temporary disability (TD) benefit amount. In addition to the injury or illness, a claimant must also be under the care of a licensed physician, chiropractor, psychologist, podiatrist, dentist, or certified nurse midwife to be eligible for workers’ comp benefits. When a claimant receives medical benefits, they must have their doctor or health care provider complete and sign a “Claimant’s Statement” and a “Health Care Provider’s Statement.” Short-term disability benefits are typically provided by an employer group plan or an individual private policy the employee purchased separately. The coverage bridges the gap between a work-related injury or illness and a return to total productivity. A qualifying illness or injury must significantly limit the ability to perform most types of work for a specified period – usually three, six, or 12 months.

Permanent Disability Benefits

Workplace injuries or illnesses sometimes happen slowly. Some, like carpal tunnel syndrome, can take months or even years to develop and cause disability. If this happens, workers’ compensation benefits can help cover medical expenses and replace some lost wages. Each state has its own set of rules for workers’ compensation, but most offer similar benefits. For example, wage replacement payments are usually two-thirds of the average weekly wage, up to a certain maximum per week. Doctors can also request approval for treatments not listed in the workers’ compensation guidelines. When a worker reaches “maximum medical improvement,” and a doctor determines that the injury or illness won’t improve, permanent disability benefits can be provided. Typically, these benefits last for the rest of the injured worker’s life. However, some states may stop payments at a certain point or restrict the amount that can be paid. While permanent disability payments are relatively generous, they cannot compensate for a worker’s lost wages. For this reason, it is essential that injured workers actively seek work or training opportunities even if their doctors recommend they do not. If they do not, the insurance company can challenge their claim and may deny them benefits.

Death Benefits

The death of a loved one is always devastating, but if that person’s passing was tied to their job in some way, it could feel complicated. In addition to the emotional turmoil, surviving family members may have to deal with issues surrounding their deceased loved one’s final paycheck and other benefits. Fortunately, the deaths of employees can be covered by death benefits as part of workers’ compensation. These are typically weekly payments equal to two-thirds of the deceased worker’s average weekly wage, up to a maximum set by the state. The payments are made to a surviving spouse or dependent children, with surviving spouses getting priority. For death benefits to apply, the deceased employee must have passed away due to a work-related injury or illness. This is why it’s essential to file a workers’ comp claim as soon as possible after an injury or diagnosis of a workplace-related illness. The rules around these benefits vary from state to state, so a workers’ compensation attorney can help explain how they are applied in your case. Insurance companies often try to delay or deny claims, so having a skilled lawyer can make all the difference.

Medical Treatment

Most states require employers to carry workers’ compensation insurance, which pays medical bills and partially replaces lost wages for injured or sick employees. It also reduces the risk of lawsuits by employees whose injuries or illnesses are related to work. Employers can purchase this insurance through private insurers or state-run systems. Alternatively, larger businesses may self-insure. In addition to covering the cost of necessary medical treatment, workers’ compensation covers two-thirds of an injured worker’s average monthly wage while disabled. Disability benefits are paid regardless of whether the injury or sickness was caused by accident at work or developed over time due to repeated tasks such as typing and lifting heavy objects, as in carpal tunnel syndrome or back problems. An employee must see a doctor approved by the state’s workers’ compensation program as soon as possible after a work-related injury or illness occurs. A qualified doctor can make recommendations for the patient regarding the best course of medical treatment, rehabilitation, and return to work. They will also play an essential role in filing a workers’ compensation claim, writing reports, and giving testimony in court. It is important to note that with few exceptions, all healthcare providers must be board authorized to treat a patient’s work-related injury or illness. A healthcare provider can check if they are authorized by contacting the Workers’ Compensation Board.

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