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Workers' Comp: Overview of Benefits

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Every year, millions of people in the United States become sick or are hurt at work. Fortunately, many of those harmed through job-related injury or illness are entitled to workers' compensation benefits. Workers' compensation benefits generally include medical expenses, partial wage replacement and death benefits (for families of deceased employees).

If you are hurt or fall ill at work, it is important that you find a lawyer who specializes in workers' compensation as soon as possible. Workers' compensation claims are sometimes the only legal recourse for these types of injuries. If your claim is not filed properly, you risk losing some or all of the benefits to which you are legally entitled.

Medical Benefits

Workers' compensation medical benefits generally include all reasonable and necessary medical treatment following your work illness or injury. Some programs allow workers to choose their treating physician(s) while other programs require workers to obtain medical treatment through a contracted health care network or list of physicians pre-approved by your employer or workers' compensation insurance carrier. However, emergency care should always be covered no matter who the provider. Covered medical expenses should include:

  • Emergency treatment
  • X-rays, MRIs and other diagnostic testing
  • Doctors visits
  • Medications
  • Surgery
  • Hospital care
  • Travel expenses/mileage reimbursement

Medical care (including any co-payments) should be paid directly by the employer or insurance provider, not the employee. If you are having trouble getting the care you need, are being billed or harassed for payments, or otherwise have a problem with your medical benefits, speak to a Workers' compensation attorney right away.

Vocational Rehabilitation

In some jurisdictions, workers' compensation benefits include vocational rehabilitation, or training and placement assistance for a new job. Vocational rehabilitation is valuable for an employee who will not be able to return to his or her pre-injury job because of the lasting effects of the illness or injury. Examples of vocational rehabilitation include:

  • Resume building
  • Job application assistance
  • On-the-job training
  • Vocational testing
  • Interview skills training
  • Tuition/education assistance
  • Labor market surveys (identifying a job(s) the employee can do)

In some cases, employers have used vocational rehabilitation as an excuse to reduce or terminate other workers' compensation benefits. An experienced workers' compensation attorney will protect and preserve your rightful benefits unless and until they are no longer needed.

Income/Disability Benefits

Disability payments are a key component of workers' compensation. These payments recompense employees for a portion of wages that are lost due to work-related injury or illness. Disability benefits are typically classified as temporary or permanent and partial or total. Employees may receive more than one type of disability (but not at the same time) during the recovery process.

Temporary Disability
Generally, temporary disability benefits begin to accrue when an employee misses more than a few days of work (typically 3-7 days). If an employee is partially disabled (i.e., able to return to work part-time or in a limited capacity) he or she may be eligible for temporary partial disability. Though the amount varies, it is sometimes calculated as two-thirds of the weekly wage times the percentage of disability or half of the difference between the average weekly wage before the injury and the average weekly wage after. Temporary total disability is paid when an injured worker is unable to work at all during the recovery period. Typically, this benefit equals two-thirds of the employee's average weekly pay (with some limits on the total benefit).

There are usually time limits for temporary disability benefits but generally it is intended to last until the employee has reached "maximum medical improvement" and can return to work, or the employee becomes eligible for permanent disability.

Permanent Disability
If a physician determines that an employee will never fully recover from his or her on-the-job injury or illness and will always be limited in his or her ability to return to work (sometimes called "permanent and stationary") he/she may be eligible for partial or total permanent disability benefits. Typically, permanent disability is seen with a chronic condition such as asthma and back pain or a catastrophic injury such as traumatic brain injury. Permanent disability is complicated and is based on many factors besides wages such as:

  • Which body part(s) are affected
  • Degree of injury
  • Level of pain
  • Future work restrictions
  • Expected future medical care

Permanent disability may continue in weekly installments, as a lump sum or a combination thereof. Often there is a hearing to determine the settlement. It is important to have an experienced workers' compensation lawyer advocate on your behalf to ensure you receive the full benefits you are due.

Social Security & Other Public Disability Benefits

Workers' compensation benefits are limited to workplace illness and injuries only. If a worker also has a disabling medical condition that is not job-related, he/she might be collecting public (federal, state and local) disability benefits related to that condition, including Social Security, temporary disability, civil service disability, and government retirement. However, your combined total public benefits (private insurance benefits do not count) may not exceed 80 percent of your average wages before you became disabled (unless you were a high-wage earner). If your benefits exceed this threshold, your Social Security benefits will probably be reduced. To learn more about disability benefits, speak to an employment lawyer.

Death Benefits

According to the Bureau of Labor Statistics, in years 2008 and 2009 alone there was a combined total of almost 10,000 work-related fatalities. Though no amount of money can compensate for the loss of a loved one, workers' compensation death benefits can provide financial assistance to dependent family members. This generally includes the surviving spouse and children (where applicable) but may also be extended to parents, grandparents, siblings and other relatives if it can be proved that they are financially dependent. Death benefits usually include burial expenses and a portion of lost wages (e.g., 70 percent) but will vary in every circumstance, so it is best to speak with a knowledgeable workers' compensation attorney to learn more.

Workers' Compensation Attorney

The exact nature and amount of workers' compensation benefits vary depending on the case and the state where the workers' compensation injury occurred. To learn more about the workers' compensation benefits you are legally entitled to, contact a workers' compensation lawyer.