Q: What are the benefits paid in a Workers' Compensation claim?
It never ceases to amaze me how many people won’t file Workers’ Compensation claims because they think they are “suing” their employer. They are not. The Workers' Compensation Act came about in the early 1900’s. Under the Act, generally speaking, an employee usually can’t sue their employer for an industrial injury (there are exceptions). In return, the Workers’ Compensation System basically functions as a no fault benefit system that can help an injured worker to get back on their feet by providing:
a) Medical Treatment
b) Money to replace wages or temporary disability - (“TD”)
c) Money for your permanent disability - (“PD”)
d) Future medical treatment
e) A “Job Displacement Voucher”
A) Medical Treatment:
Under the Workers’ Compensation System you are entitled to medical treatment to “cure or relieve the effects of an industrial injury.” This includes not only doctor bills, but also medicines, hospital costs, fees for lab tests, x-rays, MRIs and other diagnostic procedures. You also are entitled to costs of mileage going to and from your medical appointments and the pharmacy.
B) Temporary disability:
If an individual injured on the job is unable to work, they are entitled to temporary disability (TD). This is two-thirds of your normal salary subject to maximum and minimum dollar amounts.
No TD is due to you the first three days off work unless your injury requires hospitalization or lasts more than 14 days. Your first payment of TD must be made no later than 14 days after your employer learns of your injury and TD Status. On that date, all TD is due and must be paid unless your employer denies liability for your injury.
I would heartily recommend that you file for State Disability (“SDI”) concurrent with the receipt of TD. Normally you can’t get TD and SDI at the same time. But, by filing for state disability as soon as possible, (and informing them that you are currently receiving TD) you “lock in” the date you applied. Later on, if you need to re-apply because your workers’ compensation benefits terminate, your qualification will be determined by the date you applied for SDI. Remember, your eligibility for SDI is determined from your previous work history. While you are receiving TD you could fall out of your “insured status” period for SDI. Then you are out of luck—no benefits to fall back on. Very bad news. If you timely file for SDI, you can preserve your rights to collect it when the workers' compensation benefits run dry.
Temporary disability will continue until you reach “Maximum Medical Improvement.” Heads up, if you are unable go back to work when you are there! Your temporary disability will shut down and the carrier will start paying you advance on your permanent disability (PDA).
C) Permanent disability:
Permanent disability (PD) is compensation for your “diminished future earning capacity.” There are no payments for “pain and suffering” as there is in civil litigation.
How much money you will get for PD depends on the percentage level, determined by a doctor to be adjusted for your age and occupation.
The percentages a doctor will award for PD vary wildly from doctor to doctor. Some doctors are very conservative. Some are very liberal. Sadly, medical evaluations for workers’ compensation claims have become big business in this state. There have been huge reductions in the amount of PD that gets paid on a claim thanks to “workers’ compensation reform.” What doctors to pick, how your injury is described in the “pleadings,” and developing PD through current case law can make a big difference in the dollars you put in your pocket.
D) Future medical treatment:
If you settle your case via “stipulation” you can keep your rights to future medical treatment open for life. There is a catch here, what treatment you get will be based on what your treating physician’s recommendation is, or what is recommended by an Agreed Medical Evaluator or a Panel Qualified Medical Evaluator. Workers’ compensation carriers have some fairly significant tools to reduce or eliminate future medical treatment all together: Utilization Review, ACEOM Guidelines, and “Second Opinion on Back Surgery” procedures. It is a nasty business, I advise clients that stipulate these days that it means that they have the right to fight for medical treatment. There is “service after settlement” in our office. In other words, if a client settles their case by way of stipulation, we will retain their file and help them get future medical treatment if the insurance carrier wants to be difficult. We do this free of charge.
E) Job Displacement Voucher:
If you are unable to return to your old job because of limitations caused by your work related injury you will be entitled to a Job Displacement Voucher. This is not money in your pocket. It is rather, payment to institutions or vendors for educational needs if you can’t return to your old job. The voucher is between $4,000.00 and $10,000.00 depending on your level of disability.