Most states have a schedule of injuries in their workers’ compensation laws. This is a chart that lists and values injuries that involve the loss of use of a body part or sense (such as hearing or vision).
When you lose the use of a listed body part, workers’ comp refers to this as a scheduled or specific loss. Most states’ schedules include the loss of vision or hearing or the loss of use of an arm, leg, hand, foot, finger, and toe.
However, some states include other types of injuries. For example, New York includes scarring and disfigurement on its schedule, and Connecticut includes various organs, such as the lungs, heart, and liver.
In most states, a scheduled or specific loss can occur with or without a work-related amputation. For example, a crush injury may not result in your hand’s amputation, but may prevent you from gripping, grasping, and holding items. In most states, this inability to use your hand will qualify you for scheduled loss benefits.
In general, you must reach maximum medical improvement (MMI) before you are eligible for a scheduled loss award. You reach MMI once your medical condition has stabilized and your doctors do not believe there will be any additional improvement.
Once you reach MMI, your doctor will assign you a permanent disability rating. If your injury appears on the state schedule, you will receive a scheduled loss award.
Workers’ compensation is state-based, meaning that your benefits will vary depending on where you live. However, you typically will receive a set weekly amount for the number of weeks set out in the schedule of injuries. In many states, this amount is two-thirds of your average weekly wage. Scheduled loss awards are usually paid even if you’re able to return to work immediately.
The value of a scheduled loss varies from state-to-state. For example, the award for the loss of an arm is as follows:
In several states, you can receive compensation for a partial loss. If you suffer a partial loss of a scheduled body part, you will receive that percentage of the listed award. For example, if your doctor assigns a 25 percent loss of use of your arm in New York, you would receive 78 weeks of scheduled loss benefits.
A minority of states, including Washington, list specific dollar amounts for scheduled losses instead of weeks of payment. In these states, you will receive a lump sum award according to the amount listed in the schedule.
In some states, your scheduled award may be reduced by the number of weeks (or amounts) that you have already received temporary total disability benefits.
The majority of states offer scheduled loss awards to eligible workers. A small number of states do not have a schedule of injuries—including California, Florida, Nevada, and Texas.
However, this doesn’t mean you won’t receive compensation for the loss of use of a body part in these states: You may still be eligible for an unscheduled award (described below). In some states, you may be eligible for an unscheduled award if you’re still unable to earn your normal wages after your scheduled loss award runs out.
Not all injuries are listed on a state’s schedule. For example, if you have a work-related back, lung, or brain injury, you are not eligible for a scheduled loss award in most states. However, you may still be entitled to other workers’ comp benefits, sometimes called “wage loss benefits” and “permanent disability benefits.”
Your right to benefits may depend on whether your state bases eligibility on your level of impairment or wage loss.
These two systems can lead to different results. For example, suppose a worker suffers a head injury, causing memory and concentration problems. However, her employer has simple work that she is capable of performing. In an impairment-based state, she may be eligible for PPD benefits if her doctor assigns an impairment rating (regardless of her ability to work). In a wage-loss state, she will only be eligible for a wage loss benefits if she earns less at the new job or is expected to suffer a decrease in earning capacity in the future.
Whether your workplace injury is classified as a scheduled loss or an unscheduled loss, you'll benefit from hiring a workers' comp lawyer to handle your claim. An attorney can explain the process, file your claim, and if necessary represent you at a workers' comp hearing.
]]>This article explains the basics.
In California, you may be able to go to your personal primary care physician right after you’re injured at work, but only if:
You may also predesignate a qualified medical group. You can use a form provided by the California Department of Workers’ Compensation (DWC Form 9783) to make your predesignation.
The rules are somewhat different if your employer or its insurer has contracted with a health care organization (HCO) to provide managed care for work-related injuries and illnesses.
When that’s the case, you may predesignate your personal physician, chiropractor, or acupuncturist; your employer must give you the proper predesignation form when you’re hired and once a year after that. (Cal. Labor Code §§ 4600, 4600.3 (2024).)
If you didn’t predesignate your personal doctor, you probably won’t be able to choose the initial physician you see for treatment. When your employer or its insurance company has established a medical provider network (MPN) you’ll generally have to choose a doctor in that network. However, there are some exceptions to this rule, including when:
Similarly, if the insurer has contracted with an HCO, you’ll generally be treated in the HCO immediately after your injury. If there’s no MPN or HCO contract, the claims administrator usually has the right to choose your treating doctor for the first 30 days after your injury. (Cal. Labor Code §§ 4600, 4600.3, 4616.3 (2024).)
It’s important that you feel comfortable with your treating physician, both in terms of the care you’re receiving and the decisions the doctor is making about your ability to work. If at any point you strongly disagree with your doctor’s opinions, you may want to switch treating physicians. The process for doing that depends on whether your employer has an MPN or HCO.
If your employer or its insurer hasn’t established an MPN or contracted with an HCO, you may switch to a new treating doctor once during the first 30 days after you reported your injury or illness.
However, unless you’ve given your employer the name of your personal chiropractor or acupuncturist before you were hurt, the claims administrator may generally choose the new doctor (if it does so within five days of your request).
After 30 days, you may choose your own new treating doctor within a reasonable distance from your home. You can switch doctors again if it’s reasonable. (Cal. Labor Code §§ 4600(c), 4601 (2024).)
If your employer has an MPN, you can ask to switch doctors at least twice, but the second and third doctors must be from the MPN. This is true even if you’ve been seeing your predesignated personal physician.
If you still disagree with the third doctor’s opinion, you can submit an application for an “independent medical review” with an impartial medical professional. Depending on the outcome of that review, you may then be able to select a doctor outside of the MPN. (Cal. Labor Code §§ 4616.3, 4616.4 (2024).)
If you’ve been seeing a treating doctor within an HCO, you can switch at least once to another doctor within the HCO. You may switch to a new medical provider (including a chiropractor or acupuncturist) after a waiting period: 180 days if you have employer-provided health insurance; 90 days if aren’t covered.
The new treating doctor must be within a reasonable distance from your home. The same rules for switching doctors apply if you’ve been seeing your predesignated personal physician, but your employer or insurer has contracted with an HCO. (Cal. Labor Code § 4600.3 (2024).)
If you’re having problems with medical issues in your workers' comp case—whether you're not satisfied with the care you've been receiving, you disagree with your doctor’s opinions about your diagnosis or work limitations, or the insurance company is dragging its heels on approving recommended treatment—it would be smart to speak with a workers’ comp lawyer.
Attorneys who are experienced in workers’ comp can help you navigate the complicated process of changing doctors and getting approval for needed medical care.
They may also be able to recommend good treating doctors who understand the complex workers’ comp system.
]]>Workers’ comp provides benefits to people who suffer a a work-related injury or illness, regardless of who was at fault. When the injury or illness is emotional or psychological, rather than physical, most states—including New York—have rules that make it hard to qualify for benefits.
Read on to learn more about claiming workers’ comp benefits for mental health conditions in New York.
The basic requirements for workers’ comp benefits in New York are as follows:
Since workers’ comp in New York is a no-fault system, you do not have to prove that anyone caused your injury or illness. You only have to show that it resulted from your job and that it is keeping you from working.
Workers’ comp is a type of insurance. Your employer pays into a fund managed by the WCB. If an employee receives benefits, the employer’s contribution to the workers’ comp fund could go up. This gives employers a reason to dispute claims that aren't clear-cut, particularly mental health-related claims
In New York, virtually any mental health condition—including depression, anxiety, and PTSD—can lead to a successful workers' comp claim if you can demonstrate that the condition was directly related to your job.
However, the law makes a specific exception regarding mental health conditions that are caused by “lawful personnel decision[s]” that an employer makes “in good faith,” including “disciplinary action, work evaluation, job transfer, demotion, or termination.” N.Y. Workers’ Comp. L. § 2(7) (2024).
In other words, you cannot get workers’ comp benefits for stress or other conditions that result from employment decisions that do not go your way. Getting transferred to a new job, demoted, or fired is stressful. As long as your employer was following the law, though, a workers’ comp claim will have no chance of success in New York.
A mental health condition can develop as a result of an injury, accident, or other traumatic event in the workplace. It can also build over time because of a person’s job duties or their working conditions. A person could manifest a mental health condition for the first time in connection with their job, or something could happen that makes an existing condition much worse.
The following scenarios could result in a viable workers’ comp claim involving a mental health condition:
Workplace accidents can cause harm far beyond physical injuries. The pain of an injury and the difficulty of recovery can lead to mental health problems.
A person who suffers injuries on the job can develop PTSD, depression, or other conditions that affect their mental well-being. They might make a full physical recovery but still be unable to return to work because of anxiety, panic attacks, or phobias.
A person can develop mental health concerns because of something that happened to someone else in the workplace. A serious incident, such as an industrial accident that causes dismemberment, can traumatize other people who witness it. A first responder who discovers a particularly grisly accident or crime scene could develop significant PTSD symptoms.
A person who is the victim of workplace violence could suffer both physical and psychological injuries that prevent them from returning to work. PTSD, anxiety, or depression could result from an assault or other violent acts.
Ordinary job stress generally does not entitle you to workers’ comp benefits. But some jobs or workplaces might be so stressful that significant mental health problems could develop over time. This could apply to jobs with high levels of stress, such as police officers, healthcare workers, or air traffic controllers. It could also apply to difficult workplaces or hostile working conditions.
The impact of a mental health condition can be invisible to others. Unlike a broken bone, sprain, or other physical injury, there might be no obvious signs of a problem. Yet anxiety, PTSD, depression, and other conditions can cause difficulty concentrating, panic attacks, and other symptoms that make work impossible.
As with any claim, you need medical evidence to prove the extent of your injury or illness. For a claim based on a mental health condition, your evidence might include the following:
Workers' compensation claims based on mental health conditions are some of the hardest to win. For that reason, you'll want an experienced workers' comp attorney on your side to give yourself the best possible chance of success. Most workers' comp lawyers don't charge a fee up-front and are paid only if you win your case.
]]>Workers' comp provides benefits to people who suffer a a work-related injury or illness, regardless of who was at fault. When the injury or illness is emotional or psychological, rather than physical, most states—including Florida—have rules that make it harder to qualify for benefits.
In Florida, you must demonstrate a direct connection between a mental health condition and a work-related physical injury to qualify for workers' comp. The law makes an exception for first responders suffering from work-related PTSD in certain situations.
Read on to learn more about how Florida’s workers’ comp laws apply to mental health issues.
The Florida Division of Workers’ Compensation (DWC) handles workers’ comp claims. To qualify for benefits, all of the following must be true:
Florida workers' comp law covers physical injuries and, in some cases, mental or nervous injuries.
Florida law requires most employers to carry workers’ comp insurance. This applies to public employers, construction companies with at least one employee, and all other private employers with at least four employees. (Fla. Stat. § 440.02(19)(b) (2024).)
If you can prove that a work-related physical injury was “the major contributing cause” of your mental health condition, you can qualify for benefits. This requires that a doctor has determined with “reasonable medical certainty” that the injury is at least 50% responsible when compared to any other cause. (Fla. Stat. §§ 440.093(2) (2024).)
If your mental health condition wasn't the result of a work-related physical injury, your claim will be denied.
Workers’ comp benefits are not available for the following mental health conditions, according to Florida law:
You can only claim benefits for mental health conditions that arise directly from your injuries. If you are experiencing anxiety or depression because your injuries prevent you from working, that does not qualify for benefits. The mental health issues must be directly related to the injury itself.
Individuals with preexisting mental health conditions will likely face an uphill battle in receiving benefits, though it's not impossible. If, for example, you suffered from anxiety before experiencing an injury at work, it might be difficult to claim workers’ comp benefits for anxiety symptoms related to your injury.
The law allows you to make a claim for a mental health condition that became significantly worse after an on-the-job injury, but you'll need to present solid evidence. Hiring a lawyer in this situation is essential.
Sometimes mental health issues can contribute to the development of physical conditions. For example, anxiety and PTSD can cause increased blood pressure, which can lead to heart attack or stroke.
Florida law states that you cannot claim workers’ comp benefits for this type of physical injury unless it is serious enough to require medical attention. If work-related stress or anxiety take such a toll on a person that they suffer a heart attack, that person could be eligible for benefits if their claim meets the state’s legal requirements.
Finally, state law sets limits on the amount of benefits you can recover for some mental health conditions. If you can prove that you suffer from “permanent psychiatric impairment,” state law limits the psychiatric portion of your impairment rating to one percent. (Fla. Stat. § 440.15(3)(c) (2024).)
The Florida legislature passed a bill in 2018 that allows first responders to obtain workers’ comp benefits for certain mental health conditions without a related physical injury. They are also not subject to the one-percent impairment limit.
This provision of Florida law applies to police officers and other law enforcement officers, firefighters, emergency medical technicians, and paramedics. It allows first responders to recover workers’ comp benefits if they develop PTSD as a result of their employment.
In order to receive benefits, they must have a diagnosis from a licensed psychiatrist based on certain events, including the following:
State law sets out specific criteria for proving that your mental health condition should qualify for workers’ comp benefits:
Such evidence might include treatment notes, a psychiatric evaluation, records from an in-patient hospital stay, a letter from your psychiatrist, or all of the above.
Witness statements from coworkers, supervisors, and others can also be useful in proving the cause of your condition—and how it limits your ability to work.
In addition to limiting the circumstances in which someone may claim workers’ comp for mental health issues, Florida also limits the amount of time they may receive benefits.
Under Florida law, you cannot receive benefits for a mental health condition for more than six months after your physical injury reaches maximum medical improvement. (Fla. Stat. § 440.093(3) (2024).)
Workers' comp claims based on mental health conditions are some of the hardest to win, no matter where you live. That's why hiring an experienced workers' comp attorney to represent you is essential. An attorney will know how to develop the evidence in your case to give you the best chance of success.
]]>An employee making a claim must demonstrate that their injury occurred in the course of their employment and that they are unable to return to work either temporarily or permanently.
Some injuries have a clear connection to one’s work, such as broken bones suffered in a fall at a construction site or injuries sustained by a delivery driver in an accident while out on a route.
The modern workplace can also cause people to suffer from mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD).
Texas workers’ comp law allows claims for certain types of mental health issues. Read on to learn more about what kinds of mental health conditions might qualify for workers’ comp in Texas.
Before you can claim workers’ comp benefits for a mental health condition, you must determine whether your employer has workers’ comp coverage. Workers’ comp is a type of insurance. Every state except one requires most or all private employers to have workers’ comp insurance policies. Texas is the lone exception.
Texas only requires public employers to have workers’ comp insurance. Coverage is optional for most private employers. (Tex. Lab. Code § 406.002 (2024).) An employer that chooses not to carry workers’ comp insurance must provide written notice to its employees and the state. (Tex. Lab. Code §§ 406.004, 406.005 (2024).)
Workers’ comp benefits are available for some mental health conditions in Texas. As a general rule, this applies to mental health conditions that arise from a specific incident in the workplace.
Example. Two window washers fall from a scaffold in windy conditions. The first man's fall is broken by a support cable and he suffers only minor injuries. However, he watches the other man fall eight stories to his death. If the first man suffers PTSD or depression as a result of the incident, he would likely have a claim for workers' comp benefits. (The other man's next of kin would receive workers' comp death benefits.)
In addition, some mental health conditions, such as stress or anxiety, can have significant physical effects. Workers’ comp in Texas would cover a heart attack that results from “a specific event occurring in the course and scope of the employee's employment.”
This does not apply to heart attacks that result from “emotional or mental stress factors” unless you can prove that a “sudden stimulus” was the cause. (Tex. Lab. Code § 408.008 (2024).)
Conditions that develop over time, such as depression resulting from workplace stress, are not covered by workers’ comp, with an important exception for first responders discussed below.
Mental trauma injuries mainly resulting from “a legitimate personnel action” are likewise not covered by workers' comp. (Tex. Lab. Code § 408.006 (2024).) For example, if you've suffered depression or anxiety after being disciplined, demoted, or fired—assuming these actions were legitimate and not discriminatory or otherwise unlawful—your condition won't entitle you to workers' comp benefits.
Workers comp benefits are typically not available for mental health conditions that develop over time, rather than in response to a single incident. A stressful or dangerous workplace can take a mental health toll over time, but this is not an “injury” for workers’ comp purposes in Texas.
An important exception applies to first responders, whom most would agree have a uniquely difficult and stressful job. The term “first responder” includes:
A first responder must have a diagnosis of PTSD that meets the standards of the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which is currently the DSM-5. The diagnosis must also state that:
State law does not limit the availability of benefits to PTSD arising from certain types of incidents. Some states require evidence that a first responder developed PTSD because they witnessed a death while on the job or provided care to someone who suffered an injury that would prove fatal. Texas requires only proof that the condition developed because of the job.
Texas first responders are also not limited to PTSD that arises from a single traumatic incident. By specifying “one or more events,” the statute makes it clear that they may claim benefits for a condition that develops over time.
If you're filing a claim for workers' comp benefits in Texas based on depression, anxiety, or PTSD, you likely face an uphill battle. Contact a workers' comp attorney to give yourself the best chance of receiving benefits.
]]>While all work-related mental health issues deserve to be taken seriously, not all are covered by workers’ compensation laws. As a general rule, workers’ comp allows employees to recover lost income and medical expenses when they suffer an injury or illness stemming from their job. Unlike workplace physical injuries, however, mental health conditions such as depression or anxiety can be harder to measure objectively, and it can be difficult to prove that they are work-related.
For these reasons, some states do not allow workers’ comp coverage for purely psychological injuries in the absence of any physical harm. Ohio has traditionally been one of those states.
If you suffer from a mental health condition caused by work stress—but you haven’t sustained any physical injuries—you’re generally not entitled to recover workers’ comp benefits in Ohio.
Let’s take a closer look at the law governing benefits for workers’ mental health conditions in Ohio.
While Ohio workers generally can't receive workers' comp for mental health conditions resulting from workplace stress, they can receive benefits for psychological conditions from certain other causes.
Ohio law gives workers the right to seek benefits for a psychological injury in two specific circumstances:
While you can’t seek benefits for purely psychological injuries in Ohio unless you’re a first responder, you can seek workers’ comp when your mental health condition stems from a work-related physical injury.
Here are a few examples of this type of injury:
To prove this type of claim, you need to show that your mental health condition stems from your work-related physical injury, rather than from some other cause. In the above car accident example, you’d need to show that your PTSD was caused by your physical injuries themselves and not simply by your involvement in the accident.
All Ohio employers with more than one employee are required to purchase workers’ comp coverage from a state insurance fund administered by the Ohio Bureau of Workers’ Compensation (BWC). The BWC is responsible for investigating and deciding all workers’ comp claims except those involving first responder PTSD.
Recognizing that first responders often are involved in extremely traumatic events in the course of serving the public, Ohio passed a law in 2021 to provide compensation for public safety officers who’ve suffered work-related PTSD without any accompanying physical injuries.
To recover under this law, workers such as police officers and firefighters need only show that they’ve been diagnosed with PTSD and that their PTSD arises out of or was sustained in the course of their employment. Employers are prohibited from retaliating against an employee for filing or pursuing a PTSD claim.
Claims under this law are not overseen by the BWC, but instead are administered by a separate fund created specifically for first responder PTSD claims. As such, these are technically not “workers’ comp” claims, but they provide similar benefits. Public entities that employ first responders are required to pay into this fund; private employers are not.
Because workers’ comp claims are often contested, they can be lengthy and complex. This is especially true for cases involving psychological injuries, as they are less straightforward than on-the-job physical injuries.
A workers’ comp lawyer can help you evaluate your claim, navigate the various stages of the process, and recover the benefits to which you’re entitled. Most workers’ comp attorneys charge a fee only if you win your case, and don’t require any money up front.
]]>While all work-related mental health issues deserve to be taken seriously, not all are covered by workers’ compensation laws. As a general rule, workers’ comp laws allow employees to recover lost income and medical expenses when they suffer an injury or illness stemming from their job. Unlike physical workplace injuries, however, mental health conditions can be harder to measure objectively, and it can be difficult to prove that they are work related.
For these reasons, some states do not allow workers’ comp coverage for psychological injuries. Pennsylvania does offer mental health coverage—but the law imposes limits on when you’re entitled to recover benefits.
In Pennsylvania, employees are entitled to workers’ comp benefits for psychological injuries, but only in certain circumstances. Pennsylvania workers’ comp law recognizes three types of workplace psychological injuries:
If your claim falls into one of these categories, you’re entitled to seek workers’ comp benefits. But whether your workers’ comp claim is successful depends heavily on the type of psychological injury you’ve sustained and the specific facts of your case. Mental/mental injuries are the hardest to prove, followed by mental/physical, and finally physical/mental.
Regardless of which category your case falls into, you’re more likely to recover workers’ comp benefits for a mental health condition in Pennsylvania if:
Let’s take a closer look at each of the types of psychological injuries for which you can seek workers’ comp benefits in Pennsylvania.
Pennsylvania workers’ comp law allows you to seek benefits when you suffer a psychological injury stemming from a work-related physical injury. You’re entitled to these benefits regardless of whether your mental health condition occurred during or after the physical injury.
An example of this type of injury would be an employee who falls off a ladder at work, sustains serious back injuries, and develops severe depression as a result. Another example would be an employee who is involved in a car accident while driving for work and, as a result, suffers both physical injuries and post-traumatic stress disorder (PTSD).
Proving this type of physical/mental claim is generally no more difficult than proving a claim for a purely physical injury. One caveat is that the physical injury that causes your psychological condition must be significant enough to require medical treatment.
You’re also entitled to workers’ comp benefits when you suffer work-related psychological stress that results in a physical injury. An example of this type of injury would be severe work stress that results in a heart attack, migraines, or ulcers.
This type of mental/physical claim is harder to prove than a physical/mental claim. To do so successfully, you need to show that:
Expert medical testimony is particularly useful in this type of case to help prove that your physical injury was caused by work stress, rather than by a preexisting condition such as cardiovascular disease.
Workers in Pennsylvania are also entitled to benefits when they suffer purely psychological injuries with no physical component. These mental/mental injuries occur when a work-related psychological stimulus causes a psychological injury.
Examples of this type of injury include mental health conditions that result from extraordinary situations such as workplace robberies, shootings, or prolonged sexual harassment.
Workers’ comp claims for purely psychological injuries are especially challenging to prove. To prevail on your claim, you need to demonstrate that your psychological injury was caused by an “abnormal working condition.”
Generally speaking, normal work stress—such as added responsibilities or difficult supervisors—doesn’t constitute an abnormal working condition. Instead, you need to prove that one of two things caused your psychological injury:
In the past, Pennsylvania courts were reluctant to find that abnormal working conditions existed in cases involving first responders. Judges reasoned that extremely stressful and traumatic events were a “normal” part of the job for workers such as police personnel, who knew the risks inherent in their profession.
More recently, however, courts have relaxed their requirements for first responders and for evaluating abnormal working conditions in general. They recognize that even in professions with high levels of stress, workers can experience very unusual or unpredictable events that cause them psychological injuries.
What’s important is that the psychological injury be objectively verifiable and traceable to an identifiable source, and that the claim of abnormal working conditions be evaluated based on the facts of a particular case, rather than by comparison to other, similar cases.
Because workers’ comp claims are often contested, they can be lengthy and complex. This is especially true for cases involving psychological injuries, as they are less straightforward than on-the-job physical injuries.
A workers’ comp lawyer can help you evaluate your claim, navigate the various stages of the process, and recover the benefits to which you’re entitled. Most workers’ comp attorneys charge a fee only if you win your case, and don’t require any money up front.
]]>Workers’ compensation is a system created by state law to provide benefits to employees who sustain on-the-job injuries, while also protecting employers from the liability of employee lawsuits. Under the workers’ comp system, employees are entitled to lost income and medical expenses when they suffer a work-related injury or illness, regardless of who was at fault. In return for these benefits, employees give up the right to sue their employers in court for workplace injuries.
Workers’ comp laws can differ substantially from state to state, so it’s important to be familiar with the laws in your particular area. But there are many similarities among the states as far as who is eligible for workers’ comp, what injuries are covered, the types of benefits available, and the process for making a workers’ comp claim.
Benefit amounts vary from state to state, but it's fairly typical for states to provide two-thirds of your previous wages in benefits, subject to a weekly cap. In addition, workers' comp benefits can cover the cost of your medical care.
A number of factors determine exactly how much you'll receive in workers' comp, and for how long. They include:
As you'd expect, temporary injuries are typically worth less than permanent ones. Likewise, if your injuries have left you "totally disabled" (that is, completely unable to work), you'll receive more than if you're only "partially disabled" (still able to perform a less demanding job).
To be eligible for workers’ comp, you must meet your state’s deadlines for reporting your injury and filing a workers’ comp claim. In addition, all of the following must be true:
Below we'll discuss these criteria in more detail.
The workers’ comp system is designed to protect employees who suffer work-related injuries. It does not protect workers who are not employees, such as independent contractors and volunteers.
However, just because you are called an independent contractor doesn’t mean you are one. Whether workers are employees or independent contractors in the eyes of the law typically depends not on what they are called or how they are classified for tax purposes, but on how much control they have over their work.
Volunteers generally aren’t entitled to workers’ comp coverage, but some states make exceptions for certain volunteers, such as volunteer firefighters or police officers.
To recover workers’ comp benefits, you need to show that your injury or illness is "work-related." An injury generally is considered work-related if you were doing something for the benefit of your employer, and you were injured or became ill as a result. The injury need not take place at the worksite, but must take place during the course of your employment.
An injury typically is not considered work-related if:
Example. James, a salesperson, suffers an injury from a car accident while driving from his office to his client’s place of business. James will likely be covered by workers’ comp because his trip was business-related and occurred during the workday. However, if James was injured while driving home in his car after his workday was over, he probably wouldn't be entitled to workers' comp.
The vast majority of employers are required by state law to carry workers’ comp insurance, but there are exceptions. For example, very small employers (between two to five employees, depending on the state) are not required to offer workers’ comp coverage in some states. A few states don’t require charities to purchase workers’ comp insurance. Texas is the only state that does not require private employers to purchase workers’ comp insurance.
If you are injured on the job and your employer doesn’t have workers’ comp insurance despite a state requirement, you can file a personal injury lawsuit against your employer in civil court. Some states have an uninsured employers fund, and in those states, you can make a claim against the state fund instead.
Certain types of workers are exempt from or otherwise not covered by state workers’ comp coverage. While these job categories vary from state to state, the most common exceptions to state workers’ comp include:
When people think of a workers’ comp injury, they often picture a one-time, traumatic injury, like a fall from a ladder. But in many states, workers’ comp coverage extends to the following types of injury and illness as well:
Finally, depending on your occupation and the rules in your state, you might also be eligible for workers' comp benefits if you get COVID-19 as a result of your job.
Workers’ comp coverage generally does not extend to the following types of injuries:
A workers’ comp case can be broken down into four steps:
Appealing a workers’ comp denial can be complicated and time-consuming. It often involves a medical exam and several legal proceedings.
If your employer's insurance company disagrees with a decision by your treating doctor about your medical treatment, the insurer usually has the right to demand that you be evaluated by a doctor of its choice at an Independent Medical Examination (IME). After the IME, the doctor will prepare a report, which you can dispute if it contains any factual inaccuracies.
A workers' comp judge will often require you to participate in a settlement conference or mediation. At the mediation, a neutral third party will help you and the insurer attempt to resolve your claim informally.
The workers' comp hearing is your opportunity to make your case to a judge if you are unable to settle your claim. The hearing usually involves arguments by the lawyers, testimony by witnesses (including your own testimony), and presentation of evidence such as medical records, documents showing lost wages, and doctors’ reports. The judge will then make a decision. You have the right to appeal the decision if the judge rules against you.
Workers’ comp typically pays for a number of different types of benefits:
Some workers’ comp claims are straightforward, but many are contested, lengthy, and complex. An experienced workers’ comp lawyer can walk you through the process, keep track of deadlines, and represent you during your appeal.
Hiring a workers' comp lawyer won't cost you anything out of pocket. In most states, workers' comp attorneys charge a percentage of your benefits if you win your case, and nothing (or only case-related expenses) if you lose.
The benefits you might receive will depend on your individual situation, including your medical condition and how much you earned before your injury. This article explains how the most important workers’ comp benefits are calculated in Illinois.
You may receive temporary total disability (TTD) benefits if you can't work while you're recovering from your work-related injury or illness, or if your employer can't give you modified light-duty work that accommodates your physical limitations.
You won't receive these benefits for the first three lost work days unless you need at least 14 days off work. TTD benefits continue until your doctor says that your condition has improved as much as it's going to with treatment (known as "maximum medical improvement," or MMI).
The amount of your TTD benefits will be two-thirds of your pre-injury average weekly wage, up to a maximum amount that changes every six months. The maximum for the first half of 2023 was ​$1,848.20. (For different dates, you can find the maximum and minimum amounts of TTD, and other benefits on the Illinois benefit rates table.)
If you are able to return to light-duty or part-time work while you're recovering, you may receive temporary partial disability (TPD) benefits, which are calculated as two-thirds of the difference between what you would be earning at your pre-injury job and your current wages.
Example: You earned $950 per week before your injury and would have received a scheduled $50 raise while you were off work. You are now working part-time and earning $400 per week. You would take the difference between $1,000 (what you would have been making) and $400, which is $600. You would then receive two-thirds of that amount in PTD benefits, which is $400 per week.
Once you've reached MMI, your doctor will evaluate you to determine if your injury or occupational illness has left you with any permanent physical loss or disability—and if so, to what extent.
You'll be considered permanently and totally disabled if you're unable to do any kind of work or if you've lost the use of both eyes, hands, arms, feet, or legs (or any two of those limbs). When that's the case, you will receive permanent total disability benefits for life, at the same rate as your TTD benefits.
If you've lost the use of some part of your body—which generally means you can't do some things you were able to do before your injury—you may receive one of the four types of permanent partial disability benefits available in Illinois: wage differential benefits, scheduled loss-of-use awards, unscheduled awards, or disfigurement benefits.
If you've been able to return to work but are earning less than you were before your injury because of your permanent partial disability, you might be entitled to a wage differential award.
These benefits are two-thirds of the difference between what you're earning in your new job and what you would be earning at your pre-injury job. The payments will stop after five years or when you turn 67, whichever happens later.
If you've lost the use of certain parts of your body (such as your eyes, ears, and extremities), you may receive an award equal to 60% of your pre-injury average weekly wages, multiplied by a number of weeks shown in a schedule in Illinois law.
For example, the schedule lists a total loss of use of a hand at 190 weeks. If you've lost 50% of the use of your hand, the multiplier would be 95 weeks. And if your pre-injury wages were $1,000 a week, you would receive a total of $57,000 ($600 x 95).
If you have a physical impairment that isn't listed on the schedule (such as an injury to your head, spine, or internal organs), you may receive a nonscheduled award equal to 60% of your pre-injury average weekly wage for a percentage of 500 weeks, based on the disability rating that your doctor has assigned to your condition.
For example, say you have a permanent impairment resulting from a back injury, rated as a 25% impairment to the body as a whole, and your average weekly wage was $1,000. Your nonscheduled award would be $600 multiplied by 125 weeks (25% of 500 weeks), for a total of $75,000.
If you have a serious and permanent disfigurement to an area of your body that's commonly visible to the public—such as your face, head, neck, upper chest, arms, or lower legs—you may be entitled to receive an award equal to 60% of your pre-injury average weekly wage for up to 162 weeks, depending on the severity of the disfigurement.
Illinois workers’ compensation also provides other benefits, including:
As you can see, workers’ compensation only pays of a portion of your lost wages. Workers’ comp also does not pay anything for the pain and suffering caused by your injury. While this may seem unfair, it's part of the trade-off that is the workers’ comp system.
The advantage of workers’ comp is that you can get benefits relatively quickly without needing to file a lawsuit or prove that your employer was at fault for causing your injury. The downside is that you can’t get compensated for the full value of your losses. (However, in some limited situations, you may be able to file a lawsuit outside of the workers' comp system.)
]]>Under Florida workers’ comp, you’ll be eligible for temporary total disability benefits if you need time away from work to recover from your work-related injury or illness. You won’t get these benefits for the first seven days off, unless your injury keeps you from working for more than 21 days.
Temporary total disability benefits are two-thirds of your average weekly wage just before the injury, up to a legal maximum that's adjusted annually. For injuries in 2023, the maximum is $1,197 per week. (To see the caps for other years, check out this table of maximum benefits amounts on the website for Florida’s Division of Workers’ Compensation.)
For some severe injuries like paralysis or blindness, the benefit rate is higher: 80% of the employee’s pre-injury wages for the first six months, without a maximum. The legal minimum is $20 per week.
Temporary total disability benefits will continue until the earliest of three events:
Florida law says that temporarily disabled workers may not receive these benefits for more than two years (Fla. Stat. Ann. § 440.14).
You may receive temporary partial disability benefits if your condition hasn’t reached MMI but your doctor has said that you can return to work with some restrictions (such as not lifting heavy objects or using a keyboard for limited periods).
If you earn less when working with these restrictions than you did before, these benefits will be 80% of the difference between your current earnings and 80% of your pre-injury wages. For example, suppose you used to earn $1,000 a week but now earn $600. You would subtract $600 from 80% of $1,000 (or $800), to get $200. You would then receive 80% of $200, or $160 per week.
Once your medical treatment is complete (or six weeks before your temporary total disability benefits are set to expire if you haven’t yet reached the MMI stage), your doctor will evaluate you to determine whether you have any lasting medical condition or lost function (called an “impairment”) as a result of your injury.
If you can work to some extent, the doctor will use a schedule to assign you an impairment rating, expressed as a percentage. This rating will then be used to calculate how long your permanent impairment benefits will last, according to a formula in Florida law.
The amount of the weekly benefits will be 75% of your temporary total disability rate (up to the same legal maximum), but that amount will be cut in half if you’re earning at least as much as you did before your injury.
If you know your impairment rating, you can use Florida’s handy impairment benefits calculator to figure out how much you’ll receive each week and for how long.
If your doctor finds you have a permanent disability that keeps you from doing any work (even a sedentary job), you will be eligible to receive permanent total disability benefits at the same rate as your temporary total disability benefits. These benefits will continue until you’re 75 years old (or for the rest of your life if you don’t qualify for Social Security benefits).
Certain severe injuries—such as amputation of an arm or leg or severe brain injury—are automatically considered to cause permanent total disability.
Florida workers’ compensation also provides additional benefits, including:
As you can see, workers’ comp pays only a portion of your lost wages (although it helps that workers' comp benefits are generally tax-free). In addition, you can’t receive any compensation for the pain and suffering caused by your injury.
While this may seem unfair, it’s part of the trade-off in the workers’ comp system. The advantage is that you can get benefits relatively quickly without needing to file a lawsuit or prove that your employer was at fault for causing your injury.
The downside is that you can’t get the full value of your losses. (In some limited situations, however, you may be able to file a lawsuit outside of the workers’ comp system to seek compensation for your losses, including pain and suffering.)
Because you’re almost always limited to workers’ comp for an on-the-job injury, it’s important to make sure that you get all of the benefits you deserve. An experienced workers’ comp lawyer can help you do that. To learn more, see our article on when you may need to hire a workers’ comp attorney.
]]>Your eligibility for specific benefits will depend on the nature of your injuries, the extent of your permanent limitations, and your ability to return to work.
This article explains how the most important workers’ comp benefits are calculated in Indiana. (To get these benefits, you’ll need to file a workers’ comp claim and show that your injury or illness is work related.)
If you aren’t able to return to your regular job duties—or you can’t work at all—while you’re recovering from your injuries, you may be eligible for temporary disability benefits. In Indiana, these benefits aren’t paid for the first seven days of your disability unless it lasts for more than 21 days.
You may receive temporary total disability (TTD) benefits when you’re unable to do any kind of work as a result of your work-related injury or illness.
In Indiana, these benefits are calculated as two-thirds of your average weekly wage during the year before your injury, up to a legal maximum. Indiana has kept that cap quite low compared to other states.
For injuries that occurred on or after July 1, 2023, the maximum average weekly wage, for purposes of determining benefits, is $1,205. That translates to a maximum TTD benefit of $804 per week. (Benefit amounts for past and future years are available on the Indiana Workers' Compensation Board website.)
TTD benefits will continue until you:
(Ind. Code §§ 22-3-3-7, 22-3-3-8, 22-3-3-22, 22-3-6-1 (2023).)
If you can return to work in some capacity while you’re still recovering, but your injuries prevent you from earning as much as you did before you were hurt, you may receive temporary partial disability benefits equal to two-thirds of the difference between your pre-injury wages (up to the legal maximum, discussed above) and what you’re actually earning now.
For example, if you used to earn $900 per week but now are making $600 in a light-duty job that accommodates your limitations from the injury, you would receive $200 per week in benefits.
Temporary partial disability benefits continue for a maximum of 300 weeks. If you received TTD benefits before switching to temporary partial disability, the period of time when you collected TTD payments will count against the 300-week limit. (Ind. Code § 22-3-3-9 (2023).)
Once your doctor has said that you’ve reached MMI, you will be evaluated to determine whether you have any permanent impairment as a result of your injury—and if so, to what extent. The doctor will give you what’s known in Indiana as a permanent partial impairment (PPI) rating, expressed as a percentage of the loss or lost use of a body part or function.
The PPI rating will then be converted into a dollar amount of benefits, based on a complicated formula set out in a statute. First, your rating will be translated into a number of degrees, based on which parts of your body are affected and the extent of your impairment.
Certain listed body parts (mostly the extremities) and senses (hearing and vision) are assigned values expressed as degrees—such as 40 degrees for loss of a hand or loss of hearing in both ears. Other impairments that aren’t listed—such as a back injury or damaged kidneys—are considered impairments to the whole body, which has a value of 100 degrees.
The percentage of your impairment rating will be multiplied by the assigned degrees for the affected body part. For example, if you lost 50% of the use of your hand, your PPI would be worth 20 degrees (40 X .5). If you had a 15% PPI rating for the whole body based on a back injury, your PPI would be worth 15 degrees (100 X .15). Loss of both hands, both feet, sight in both eyes, or a combination of two of those losses would be worth 100 degrees.
Then, your PPI award will be calculated by multiplying each degree of impairment by a certain dollar amount that goes up in increments. For injuries that happened on or after July 1, 2023, those values are:
To continue the example of 50% lost use of a hand (worth 20 degrees), the total PPI award would be calculated as follows:
The dollar value per degree is doubled if one of the listed body parts was amputated. (You can find a PPI calculation worksheet on the “Injuries” section of the Indiana WCB website.)
If you received TTD benefits for more than 125 weeks, the amount you received beyond that time will be taken out of your total PPI award.
You may agree to receive the award in a lump sum as part of your workers’ comp settlement. Otherwise, PPI awards are usually paid in weekly installments, at the same rate as TTD. (Ind. Code §§ 22-3-3-10, 22.3-3-10.5 (2023).)
If your injury or occupational illness prevents you from performing any reasonable work, you will be entitled to receive either a permanent total disability award (500 weeks at the TTD rate) or the amount that would result from a PPI calculation, whichever is greater. (Ind. Code § 22-3-3-10 (2023).)
Indiana sets an overall cap on the amount of workers’ compensation benefits you may receive—including temporary disability, permanent partial impairment, and permanent total disability. However, medical benefits (discussed below) don’t count toward that limit. For injuries that happened after June 2023, the maximum is $402,000. (Ind. Code § 22-3-3-22(t) (2023).)
Indiana workers’ compensation also provides additional benefits, including:
If your employer’s insurance company has denied your workers’ comp claim, is holding back benefits, or won’t authorize needed medical treatment, it would be wise to speak with a workers’ comp lawyer.
You should also consider consulting with an attorney before you sign any workers’ comp settlement. An Indiana attorney who's experienced in this area can evaluate your case, give you advice as to whether it’s worth filing an appeal, make sure your rights are protected in an agreement, and help you get all of the benefits you deserve. (Learn more about how a good workers’ comp lawyer can help.)
In Indiana, as in most states, workers' comp attorneys can't charge a fee unless you win your case. Indiana workers' comp attorneys are limited to charging no more than 20 percent of your benefits up to $50,000 and no more than 15 percent of your benefits over $50,000.
You might also be responsible for reimbursing your attorney for case-related expenses, such as postage, copy expenses, medical records requests, and more.
Be sure you understand and are comfortable with the fee agreement before signing it.
]]>The benefits you might receive will depend on your individual circumstances, including your medical condition and how much you earned before you were hurt. This article explains how the most important kinds of workers’ comp benefits are calculated in Minnesota.
Temporary disability benefits cover part of your lost wages while you’re recovering from your work-related injury or illness. There’s a three-day waiting period before benefits start, unless you’re off work for at least ten days.
If you’re completely unable to work because of your injury, you may receive temporary total disability (TTD) benefits. The amount of these benefits will be two-thirds of your average weekly wage before you were hurt or became ill, up to a maximum that changes each October, based on the statewide average weekly wage.
For injuries that happened in the year beginning October 1, 2023, the cap is $1,363.74 per week. There’s also a minimum weekly payment of either 20% of the maximum payment or the employee's weekly wage, whichever is less.
TTD benefits will stop:
You may receive temporary partial disability benefits if you’re able to do some work but are earning less than your pre-injury wages because of the limitations caused by your injury.
In Minnesota, TPD benefits are two-thirds of the difference between your pre-injury and post-injury wages (up to the same maximum amount as for TTD). For example, if you used to earn $1,200 in weekly wages, but you now can only earn $600, you would get $400 in TPD benefits ($1,000-$600 = $600; 0.66 x $600 = $400).
Even if you still aren’t able to work at your pre-injury wages, TPD benefits will stop once you’ve received these payments for 250 weeks or when 450 weeks have passed since your injury, whichever comes first.
If you have some level of ongoing impairment after you’ve reached MMI, you may be eligible for permanent partial or total disability benefits, depending on the extent of that impairment.
Once you reach MMI, your doctor will give you a total body impairment rating, expressed as a percentage. Unless you're permanently and totally disabled (more on that below), the rating will determine the amount of permanent partial disability (PPD) benefits you’ll receive. In Minnesota, PPD benefits are calculated by multiplying the impairment rating by a dollar amount shown in a compensation schedule in Minnesota law.
For example, under the schedule effective in 2023:
PPD benefits may be paid in installments or in a lump sum (reduced by up to 5%). You can find the full compensation schedule in the current Minnesota statute.
You may receive permanent total disability (PTD) benefits in Minnesota if your injury has left you completely and permanently unable to work at anything more than sporadic employment, as long as you have a certain level of whole body impairment (with the threshold depending on your age and education). However, the law presumes that you qualify for PTD if, as a result of your injury, you permanently:
If you meet any of these criteria, you’ll continue to receive PTD benefits even if you return to work. Otherwise, PTD benefits continue as long as you’re totally disabled.
The amount of these benefits will be two-thirds of your pre-injury wages, up to the same maximum as for TTD benefits (with a minimum based on 65% of the statewide average weekly wage). However, once you’ve received a total of $25,000, the amount of your weekly payments may be reduced to offset any government disability benefits you receive based on the same injuries.
Minnesota workers’ compensation also provides other benefits, including:
If your workers’ comp claim is denied, or if you disagree with the impairment rating assigned to you, you should speak with an experienced Minnesota workers’ comp lawyer who can evaluate your claim and help you get the benefits you deserve.
If you’re worried about the cost, it may help to know Minnesota generally limits the amount of fees that workers’ comp attorneys may charge: a maximum 20% of the first $130,000 in benefits that the lawyer helps you collect after the insurance company refused to pay, not including benefits for medical treatment or vocational services.
]]>These benefits are intended to help you get proper medical care, compensate you for some of your financial losses, and help you get back to work. Below is a summary of the benefits provided under Texas law. (To get these benefits, you’ll first need to file a Texas workers’ compensation claim.)
Workers’ comp pays for all necessary medical treatment for a work injury, as long as it’s been recommended or approved by your treating doctor. (For more information, see our article on how to get medical treatment through workers’ comp.)
If you have to miss work while recovering from your injury, or your injury keeps you from earning your usual wages, you may be able to collect temporary income benefits.
Texas calculates these benefits under a formula: 70% of the difference between your average weekly wages and the wages you are able to earn after your injury, or 75% of the difference if you earned less than $10 an hour.
Example: If you earned $15 an hour before your injury ($600 per week) and you aren’t able to work at all, the difference between your pre- and post-injury wages is $600; you would receive $420 per week (70% of $600) in temporary income benefits.
State law sets upper and lower limits on these benefits. The maximum and minimum amounts depend on when you were injured (or, for occupational illnesses, when you started receiving benefits). For injuries taking place between October 2023 and September 2024, the maximum is $1,174 per week and the minimum is $176.
Temporary income benefits won’t kick in until after the first week of missed work, unless you ultimately have to miss two weeks or more. These benefits last until the earliest of the following events:
Texas allows an extension of the 104-week limit if you have (or will have) spinal surgery within 12 weeks before the deadline.
Once you have reached maximum medical improvement, your doctor will evaluate you to determine whether your work injury has left you with a permanent loss of function or limitation (called an “impairment”).
If so, the doctor will rate the severity your impairment from 1% to 99%. You’ll be eligible to receive benefits for a period of time determined by your impairment rating: three weeks for each percentage point. In Texas, these payments are called impairment income benefits (commonly known as partial permanent disability benefits in many other states).
The weekly benefit amount will be 70% of your average weekly wage before the injury. Here again, there are limits. For injuries that happened in fiscal year 2024, the upper limit for impairment income benefits is $822.
Example: You earned $600 per week before your injury and receive a 20% impairment rating. You will receive $420 per week (70% of $600) for 60 weeks (3 weeks x 20).
After your impairment income benefits have run out, you may be able to receive supplemental income benefits if you meet all of the qualifications:
As long as you qualify, you can receive supplemental income benefits for up to 401 weeks. To calculate the weekly benefit amount, take the difference between 80% of your pre-injury wage before your injury and your post-injury wages. You will receive 80% of that amount, subject to the same maximum and minimum as impairment income benefits.
Example: Suppose you have a permanent impairment rating of 30%. You used to earn $600 per week before your injury, but now you earn $200 per week. Subtract $200 from $480 (80% of your pre-injury wage) to get $280; you will receive 80% of $280, or $244 per week.
Texas also allows lifetime income benefits, but only for a few very severe types of impairments:
Lifetime income benefits are 75% of your pre-injury average weekly wage, with the same maximum and minimum as temporary income benefits. Unlike other types of benefits, however, lifetime income benefits are increased 3% every year, regardless of the maximum.
In addition to compensation for medical treatment and part of your wage loss, Texas also provides other types of workers’ comp benefits, including:
As you can see, there are limits to workers’ comp benefits: you’ll receive only a portion of your lost wages (although it may help to learn that workers’ comp benefits are generally tax-free). In addition, you can’t receive any payment for the pain and suffering related to your injury.
This is part of the trade-off of the workers’ comp system: You can receive benefits relatively quickly without having to prove that your employer was at fault for your injury, but you won’t be fully compensated for all of your losses.
Texas is one of the only states that don’t require private employers to participate in the workers’ compensation system. If your employer opted out by not carrying workers’ comp insurance, you can sue for your injury in court.
While this is usually a longer and more involved process, you can receive the full value of your wage loss and pain and suffering. To learn more, see our personal injury page. And if your employer has chosen to participate in the Texas workers’ comp system, an experienced workers’ comp lawyer can help make sure that you get all of the benefits you deserve.
To learn more, see our article on when you may need to hire a workers’ comp attorney.
]]>To get these benefits, you’ll need to report your injury to your employer, tell the doctor you first see about the injury or illness that it’s work related, and then make sure that the doctor or your employer has filed the proper report to the Ohio Bureau of Workers’ Compensation (BWC).
If you’re completely unable to work after you’ve had an on-the-job injury or contracted an occupational disease, you’re entitled to temporary total disability benefits. You won’t receive these benefits for the first week unless you’re out of work for at least two weeks straight.
The amount of benefits is based on your average earnings before you were injured or became ill, with maximum and minimum amounts determined by the statewide average weekly wage (SAWW) at the time of your injury. There are also limits on how long you can receive these benefits.
Ohio pays different rates of benefits at two different stages of your temporary total disability, with slightly different caps on the amount:
For injuries that happened in 2024, the maximum weekly benefit is $1,195. (For other years, you can find a list of the maximums at the BWC website.)
If you’re also receiving Social Security retirement benefits, the maximum is lowered to two-thirds of the SAWW (or $796.67 for 2024 injuries).
The minimum for temporary total disability benefits is generally one-third of the SAWW. However, if you earned less than that before your injury, you’ll receive the actual amount of your wages.
In Ohio, you can continue to receive temporary total disability benefits until:
Ohio pays “wage loss” benefits if you have temporary partial disability, meaning that if you can’t do your normal job because of your workplace injury or occupational disease, but you are able to work in some capacity.
These benefits are calculated at two-thirds of the difference between your pre-injury weekly wages and your current earnings, up to the amount of the SAWW. For instance, if you previously earned $1,000 a week but now earn $400 a week, you’ll receive two-thirds of $600, or $400 per week in benefits.
If your employer has offered you light-duty work, or you’ve found a new, lower-paying job, you can receive these benefits for up to 200 weeks. You’re also entitled to wage loss benefits while you’re looking for work that accommodates your partial disability; these benefits can last up to 52 weeks; half of that time could be added to the 200-week limit for benefits once you’ve found a new job, for a total maximum of 226 weeks.
Once you’ve reached maximum medical improvement—or you’re still receiving temporary total disability benefits at the 200-week point—you’ll be scheduled for a medical exam to determine if you have any permanent limitations as a result of your workplace injury or occupational disease.
You’ll be considered permanently and totally disabled if:
With permanent total disability, you’ll continue to receive weekly payments at your temporary total disability rate for the rest of your life.
If your doctor finds you have a permanent impairment, but your disability isn’t total, you may still be eligible for permanent partial disability benefits. Ohio workers’ comp calculates these benefits in three different ways: for the loss of certain parts of your body, by a percentage of overall disability, or an award for serious disfigurement.
If you’ve suffered an amputation or have completely lost the use of an eye or an extremity (such as fingers, toes, hands, feet, arms, and legs), you’ll receive permanent partial disability benefits for the number of weeks listed in a state schedule for that body part. The weekly amount will be equal to the current SAWW. For example, for the total loss of a foot, you would receive benefits for 150 weeks. For an accident that happened in 2024, the total benefits would be $179,250 ($1,195 per week for 150 weeks).
If you have a permanent impairment other than the loss of one of the scheduled body parts, the doctor will assign a percentage for your permanent partial disability. Your benefits will then be calculated at two-thirds of your average weekly wage, up to a maximum equal to one-third of the current SAWW.
Those benefits will continue for a number of weeks equivalent to your percentage of disability times 200 weeks. For example, if you have a 50% permanent disability, you’ll receive the payments for 100 weeks. However, if your disability is 90% or more, you’ll receive the checks for the full 200 weeks.
If you have a serious disfigurement to the face or head that would impact your ability to find work, the BWC may award you an amount of compensation that’s considered fair under the circumstances, up to a maximum of $10,000.
Under special circumstances, in order to give you immediate financial relief or help you rehabilitate, the BWC may pay your permanent partial disability benefits in a lump sum rather than in weekly payments.
Ohio workers’ comp also provides other benefits to injured workers and their survivors, including:
As you can see by now, workers’ comp benefits only cover a portion of you’re the wages you lose because of a workplace injury or illness—and you won’t receive any money for your pain and suffering. This might not seem fair, but it’s part of the trade-off inherent in the workers’ comp system.
The advantage of workers’ comp is that you can receive your benefits relatively quickly without having to file a lawsuit and prove that your employer was to blame for your injury. The disadvantage is that you won’t receive compensation for the full value of your losses. (In a few limited circumstances, however, you might be able to sue outside of the workers’ comp system to recover pain and suffering and other losses from a workplace injury.)
]]>This article explains how the most important workers’ comp benefits are calculated in Washington and how much you might receive. (To get these benefits, you will need to file a workers’ compensation claim and show that your injury or illness is work related.)
You're entitled to benefits meant to replace part of your lost earnings if you can't work at all while you're recovering from your injury or illness, or you can only work with restrictions that limit your earning power. These payments, known in Washington as "time-loss compensation," don't begin until the fourth day after your injury, unless your temporary disability lasts for at least 14 days.
Time-loss benefits will continue until your pre-injury earning power is restored, or your doctor determines that your condition isn't likely to improve, even with further medical treatment.
If you’re completely unable to work, time-loss benefits are based on your average monthly gross income at the time of your injury, including wages, health benefits, bonuses, and tips. You'll receive 60% to 75% of that income, depending on your marital status and number of dependents.
However, there's a minimum and maximum for time-loss benefits that changes annually, based on a percentage of the statewide average monthly wages for the previous calendar year. For the 12-month span beginning July 1, 2023, the maximum monthly wage-loss payment is $8,416.70 (120% of the statewide average), and the minimum is $1,052.09 (15% of the statewide average).
If you can return to work but aren't able to earn as much as you could before your injury, you may receive a partial wage-loss benefit equal to 80% of the difference between your present wages and your pre-injury earning power.
These payments are subject to the same maximum and minimum as for total temporary disability; there's also a limit on the total you can receive in wages plus partial wage-loss benefits (based on 150% of the statewide average monthly wages).
Once your medical condition has stabilized, you will be evaluated to see if your injury or illness has left you with any permanent disability and, if so, to what extent. Depending on the severity of your disability, you may be eligible for a permanent partial disability award or a permanent total disability pension.
If you have some permanent limitations because of your injury or illness, you'll be eligible for a permanent partial disability (PPD) award. L&I publishes an annual schedule that sets the amount of awards for impairment to certain body parts, organs, and bodily systems, depending on the level of impairment and the date of your injury.
For impairments to eyes, hearing, and limbs, the schedule lists the amount of an award for complete lost function or an amputation of that body part; awards for partial loss will be a percentage of that amount, in proportion to the level of lost function.
Typically, you'll receive your PPD award in a lump sum, but awards over a certain amount will be spread out over time in monthly payments.
Even if you're able to return to work, you may receive a permanent and total disability pension for the following injuries:
Other severe impairments may also qualify as a permanent and total disability, but only if they prevent you from performing any type of work.
The amount of your monthly pension benefit will be based on the amount of time-loss compensation you would receive for total temporary disability. You can choose a reduced pension in order to ensure that your designated beneficiary would continue receiving pension payments if you die of causes unrelated to your work injury or illness.
Washington also provides other workers' compensation benefits, including:
If you had to miss to work due to injury or illness, whether or not your condition was work-related, you might be eligible for benefits under Washington's new Paid Family and Medical Leave (PFML) program. Under PFML, you can receive up to 12 weeks of benefits of as much as 90 percent of your income, up to $1,456 per week (in 2024).
Find more information at Washington's Paid Leave website.
If L&I disputes your workers' comp claim or isn't paying all of the benefits you deserve, you should speak with a Washington workers’ comp lawyer as soon as possible. A lawyer can evaluate your claim and help ensure that you receive the proper compensation.
And if you're worried about paying a lawyer, it may help to know that workers' comp attorneys are only allowed to collect reasonable fees on benefits they help you get. In Washington, the fees can't be more than 15% of what you receive in a structured settlement agreement, or 30% of the increase in your award when you resolve your claim any other way.
]]>This article explains the types and amounts of benefits that are available through workers’ comp. (To get these benefits, you will need to report your injury as soon as possible, file a workers’ comp claim on time—usually within a year—and prove that your injury or illness is work related.)
If you’re unable to work because of a work-related injury or illness—or you can’t work at the same level as before—Georgia workers’ comp will pay you temporary total or partial disability benefits to replace part of your lost income.
You’re entitled to receive temporary total disability benefits if you can’t work because of your injury for at least seven days. The benefits usually don’t start until you’ve been out of work for that amount of time, but you can receive payment for the first seven days if you’re incapacitated for 21 straight days following the injury.
The amount of temporary total disability benefits will be equal to two-thirds of your average weekly wage before the injury, up to a maximum ($800 per week, as of 2023). There’s also a minimum payment of $50 per week unless you earned less than that.
These benefits will generally continue until you’ve reached what’s known as “maximum medical improvement”—meaning that your condition has improved as much it’s going to with treatment.
However, you can’t receive temporary disability payments for more than 400 weeks from the date of your injury, unless you’ve had a catastrophic injury like a severe head injury, severe burns, amputation of a limb, or paralysis from a spinal cord injury. (The maximum amount and duration of benefits do change periodically; you can check the current numbers on the "Benefits Information" section of the Georgia State Board of Workers’ Compensation website.)
If you’re able to work but are earning less than before because of your injury, you can receive temporary partial disability benefits. The benefit amount is two-thirds of the difference between your average weekly earnings before and after your injury. For example, if you previously earned $1,100 per week but are now earning $500 for light-duty work, you can receive two-thirds of the difference ($600), or $400. There’s also a cap on these benefits—$533 per week (in 2023) for no more than 350 weeks from the injury date.
Once you’ve reached maximum medical improvement, your doctor will evaluate you to determine if you have any permanent disability and, if so, how much (expressed in a percentage of disability for each affected body part or for the whole body).
If you have a permanent and total disability, you could continue to receive weekly payments for life at the temporary total disability rate—or you might be able to receive a lump sum for the amount of your future payments (reduced to the present value of those benefits). Some severe injuries, such as blindness in both eyes or the loss of two limbs, are presumed to be permanent total disability.
If your permanent disability is partial, the amount of your income benefits will be the same as for temporary total disability—but only for a limited time. The duration of benefits is determined by the percentage of disability for each affected part of the body multiplied by the maximum number of weeks listed in a state schedule for body parts such as eyes, ears, and various extremities. For example, the schedule lists a total loss of use of a hand at 160 weeks. If you’ve only lost 50% of the use of a hand, you would receive benefits for 80 weeks.
If you have a permanent disability to part of your body that’s not listed—such as your head, spine, or organs—the duration of your permanent disability benefits will be based on the percentage of disability multiplied by 300 weeks, the maximum for disability “to the body as a whole.” (Although this is listed in Georgia’s schedule for permanent disability benefits, awards for the whole body are usually referred to as “unscheduled awards.”) For example, if your doctor gives you a 50% disability rating for a back injury, you will receive 150 weeks’ worth of benefits.
The same rules apply for permanent partial disability related to an occupational disease, except that there won’t be any compensation for partial loss of use of a listed body part or partial vision loss.
Workers’ comp pays for all reasonable and necessary medical treatment related to a work-related injury or illness, as long as it’s prescribed by your authorized treating physician. However, there’s a 400-week limit on most medical benefits unless your injury is considered catastrophic under Georgia law.
Other exceptions to the time limit include replacing prosthetic devices or durable medical equipment that was originally provided within the 400 weeks.
Georgia workers’ compensation also provides additional benefits, including:
As you can see, workers’ compensation only pays of a portion of your lost wages, and it doesn’t pay anything for the pain and suffering caused by your injury. While this may seem unfair, it is part of the trade-off that’s inherent in the workers’ comp system.
The advantage of workers’ comp is that you can get benefits relatively quickly without needing to file a lawsuit or prove that your employer was at fault for causing your injury. The downside is that you can’t get the full value of your losses. (However, in some limited situations, you may be able to sue outside of the workers’ comp system to recover pain and suffering and other losses from a workplace injury.)
]]>This article explains how the most important workers’ comp benefits are calculated in Oklahoma. (To get these benefits, you’ll need to file a workers’ comp claim and show that your injury or illness is work related.)
If you aren’t able to return to your regular job duties—or you can’t work at all—while you’re recovering from your injuries, you may be eligible for temporary disability benefits. In Oklahoma, these benefits aren’t paid for the first three days that you’re out of work. (Okla. Stat. tit. 85a, § 45(A) (2023).)
You’ll be entitled to receive temporary total disability (TTD) benefits if your injury or illness prevents you from performing your job or any alternate work that your employer offers you. TTD benefits are calculated as 70% of your average weekly wage (AWW) in the year preceding your injury, up to a maximum based on average statewide wages. For injuries that happened in 2024, the maximum TTD benefit is $1,038.31. (That amount is adjusted annually for inflation; see the "Benefit Charts" section on the Oklahoma Workers' Compensation Commission (WCC) website for updated figures.)
Even though these benefits are lower than your normal earnings, it’s worth pointing out that workers’ comp benefits are generally not taxable.
You will continue to receive TTD benefits until you:
The time limit on TTD benefits is generally 156 weeks. There are much shorter limits for soft tissue injuries (eight weeks), hernias (six weeks), and psychological problems resulting from the original physical injury (26 weeks). All of these limits may be extended under certain circumstances. (Okla. Stat. tit. 85a, §§ 13, 61, 62, 45(A) (2023).)
If you can’t perform your normal job duties while you’re recovering from your injuries, but you’re able to do any alternative work that your employer has offered, you’ll be entitled to receive temporary partial disability (TPD) benefits—unless you refuse that alternative work offer. These benefits are calculated as 70% of the difference between your pre-injury average weekly wages and your current earnings. However, the combination of your actual earnings and your TPD benefits may not add up to more than the TTD rate.
For example, say you earned $900 per week before your injury, and you’re now working at a light-duty job that pays $500. The basic calculation of TPD benefits would come to $280 ($900 – $500 = $400 X .7). However, $280 plus your actual earnings would total $780 per week, which is higher than the TTD rate for your pre-injury wages ($900 X .7 = $630). So as not to exceed that TTD rate, your TPD benefits would only be $130 a week ($500 + $130 = $630).
You may continue receiving TPD benefits until you reach MMI or return to work at your pre-injury wages, or for a maximum of 52 weeks. (Okla. Stat. tit. 85a, § 45(B) (2023).)
Once you reach MMI, a doctor will evaluate you to see if your work-related injury or illness has left you with any permanent limitations and, if so, to what extent.
If you have permanent limitations that don’t completely prevent you from working, the doctor will give you a permanent partial disability (PPD) rating, expressed in a percentage. PPD benefits will be 70% of your pre-injury wages, up to a maximum of $360 per week, multiplied by a number of weeks that depends on the percentage of your disability rating and the affected parts of your body.
A schedule in Oklahoma law lists the number of weeks for amputation or total lost use of certain body parts (mostly the extremities, ears, and eyes). For less than total loss of use, the PPD formula will use a number of weeks proportional to the percentage of impairment. For example, the schedule shows 220 weeks for loss of a hand. If you lost 50% of the use of a hand, you would receive 70% of your pre-injury wages or $360 (whichever is less) for 110 weeks—or a total maximum benefit for that impairment of $39,600.
Permanent impairments to other parts of the body—such as a back injury, head injury, or damaged kidney—are compensated as a percentage of the whole body, which is worth a total of 360 weeks. So if the doctor gave you a whole body PPI rating of 25% for a back injury, you would receive benefits for 90 weeks (25% of 360), for total maximum benefits of $32,400 ($360 X 90). (In the “Benefits Charts” section on the WCC website, referenced above, you can find “PPD Rate Charts” that show estimated benefit calculations for percentages of disability to the whole body and to scheduled body parts.)
If your injury has left you with serious and permanent disfigurement, and you haven’t received other PPD benefits for the affected part of your body, you may receive an award for the disfigurement, up to a maximum of $50,000.
PPD benefits are paid regardless of whether you return to your pre-injury job. Instead of getting these benefits in weekly payments, you may agree to receive a lump sum for the total amount as part of a workers’ comp settlement. (Okla. Stat. tit. 38a, §§ 45(C), 45(F), 46 (2023).)
If your injury or illness has left you completely unable to earn wages doing any kind of suitable work, given your experience and training (including training you received through vocational rehabilitation), you’ll be entitled to receive permanent total disability benefits at the same rate as TTD benefits.
These payments will continue for 15 years or until you reach the full Social Security retirement age, whichever happens later. To keep receiving the payments, however, you must file an affidavit every year confirming that you still aren’t capable of gainful employment. (Okla. Stat. tit. 85a, § 45(D) (2023).)
Oklahoma workers’ compensation also provides additional benefits, including:
If your employer’s insurance company has denied your workers’ comp claim, is holding back benefits, or won’t authorize needed medical treatment, you should consider speaking with a workers’ comp lawyer. A local attorney who's experienced in this area can evaluate your case, discuss the advisability of filing an appeal, make sure your rights are protected in a settlement agreement, and help you get all of the benefits you deserve. (Learn more about how a good workers’ comp lawyer can help.)
]]>You may be able to receive temporary disability benefits if you can’t work or earn as much as you used to while you’re recovering from your injury or illness. Connecticut has a three-day waiting period before these benefits begin, unless you’re completely or partially unable to work for more than seven days.
Temporary disability benefits continue until either you can return to work at your full wages, or your doctor has determined that you’ve reached “maximum medical improvement” (MMI)—which means your condition has stabilized, and you aren’t likely to improve even with further medical treatment. (Conn. Gen. Stat. §§ 301-295, 301-307 (2023).)
While you’re unable to perform any type of work during your recovery, you’re entitled to receive temporary total disability (TTD) benefits equal to 75% of your pre-injury average weekly wages (after taxes are taken out), up to a maximum that’s based on the statewide average weekly wages during the year when you were injured or became ill. For injuries occurring after October 1, 2023, the maximum is $1,575. There’s also a minimum: 20% of the maximum benefit, as long as it’s no more than 75% of your pre-injury wages. (Conn. Gen. Stat. §§ 301-307(a), 301-309 (2023).)
You may also receive some benefits if you’re partially incapacitated during your recovery—for instance, if you can only work part time, or you can’t do the same type of work as before your injury. Temporary partial disability benefits are equal to 75% of the difference between the current after-tax wages for the kind of work you did before your injury and your actual take-home pay, up to a maximum that’s based on the statewide average for manufacturing workers ($1,154 for injuries after October 1, 2023). (Conn. Gen. Stat. § 3-308(a) (2023).)
For example, if you used to take home $750 a week but now can earn only $350 after taxes, you would receive $300 per week in temporary partial disability benefits ($750 - $350 = $400 x .75 = $300).
Once you’ve reached the MMI stage, your doctor will determine whether you have any permanent disability as a result of your injury or illness—and if so, to what extent.
You may be eligible for permanent partial disability (PPD) benefits if, as a result of your work-related injury or illness, you‘ve lost some use of a part of your body that’s listed a schedule in Connecticut law. The schedule is very comprehensive, covering a wide variety of body parts (including organs) and sensory functions (like vision and hearing).
The amount of PPD benefits will depend on how much function you’ve lost, as well as your pre-injury wages. The weekly rate is the same as for TTD (75% of your after-tax, pre-injury earnings), but the maximum is the same as for partial temporary disability. There’s also a $50 minimum for PPD benefits.
If you’ve lost all use of the body part (or had an amputation), these PPD benefits will last for the number of weeks shown in the schedule. For partial loss of use, the benefits will last for a number of weeks that’s proportional to the percentage of your disability. For instance, if you’ve completely lost the use of your dominant hand, you’ll receive the weekly benefits for 168 weeks. But if you’ve lost 50% of that hand’s function, the benefits will last for 84 weeks. (As part of a workers’ comp settlement, you could agree to receive the total amount of these benefits in a lump sum, minus a small discount.)
You may also receive up to 208 weeks of compensation (at the same rate) if your injury left you with permanent disfigurement or significant scarring on your face, head, neck, or any part of your body that would hinder your ability to find work. (Conn. Gen. Stat. § 31-308(b), (c) (2023).)
Once your PPD payments end, you might be eligible for additional discretionary benefits if that’s warranted, given the nature of your injury and its effect on your earning capacity. These benefits are equal to 75% of the difference between the current after-tax pay for the type of job you held before your injury and what you’re probably able to earn now. The amount of your current earning capacity will be based on various factors, including your education, training, and experience, as well as the availability of work for people of your physical condition and age.
The duration of these additional discretionary benefits will be based on those same factors, but they may not last longer 520 weeks or the duration of your regular PPD benefits, whichever is less. (Conn. Gen. Stat. § 31-308a (2023).)
If your injury or illness has left you completely unable to do any type of work, even after you’ve reached MMI, you may continue to receive benefits at the same level as TTD benefits, subject to the same maximum and minimum. These benefits will last as long as you’re totally disabled—potentially for life—and will include annual cost-of-living adjustments.
Connecticut workers’ comp law will consider you to be permanently and totally disabled if you have certain kinds of injuries, such as total blindness and amputation or paralysis in two extremities. (Conn. Gen. Stat. §§ 31-307, 31-307a (2023).)
Connecticut workers’ compensation also pays other benefits, including :
You might be able to handle your own workers’ comp claim if you have a minor injury and your employer’s insurance company promptly pays your benefits. Otherwise, you should speak with a workers’ compensation lawyer who can evaluate your claim and protect your right to all of the benefits you deserve. (Learn more about when you need a workers’ comp attorney.)
]]>This article explains how the most important workers’ comp benefits are calculated in South Carolina, including temporary disability and permanent disability benefits. (To get these benefits, you’ll need to file a workers’ comp claim within the state’s time limits and show that your injury or illness is work related.)
Temporary disability benefits cover a portion of your lost wages if you’re unable to return to your regular job while you’re recovering from your work-related injury or occupational disease. In South Carolina, you won’t receive these benefits for the first seven calendar days of your disability, unless you’re off work for more than 14 days. (S.C. Code § 42-9-200 (2023).)
If you’re completely unable to work because of your injury, you’re entitled to receive benefits equal to two-thirds of your average weekly wage before the injury, up to the legal maximum. For injuries that happen in 2023, the maximum is $1,035.78. (The South Carolina Workers’ Compensation Commission website publishes a list of the maximum compensation rate for other years.) There’s also a minimum of $75 per week, unless you earned less than that before your injury. (S.C. Code § 42-9-10 (2023).)
Temporary total disability benefits will continue until you’re able to return to work or your doctor says that you’ve reached maximum medical improvement (MMI), which basically means that your condition has stabilized and isn’t expected to improve any further.
You may receive temporary partial disability benefits if you’re able to work but you aren’t able to earn as much as you did before your injury while you’re still recovering from your injury. This typically happens when your doctor has placed restrictions on your ability to work—such as limits on how long you can stand, how much you can lift, or how many hours you can handle in a day—and the light-duty job your employer has offered pays less than your normal wages.
Partial disability benefits are calculated as two-thirds of the difference between your pre-injury wages and what you’re able to earn now (subject to the same maximum amount as for total disability benefits). For example, suppose you normally earn $900 a week but now can only earn $600 at a light-duty job. You would receive two-thirds of $300 ($900 - $600), or $200 per week.
South Carolina places a 340-week limit on receiving partial disability benefits based on reduced earning capacity. If you begin receiving these benefits after being temporarily totally disabled, the time period in which you received total disability benefits won’t be deducted from the 340-week cap. (S.C. Code § 42-9-20 (2023).)
Once you’ve reached MMI, your doctor will evaluate you to determine if your injury has left you with any lasting disability—and if so, to what extent.
In South Carolina, there are generally two different ways of qualifying for permanent disability benefits:
You will automatically be considered permanently and totally disabled if, as a result of your injury, you lost both hands, arms, shoulders, feet, legs, or hips; the vision in both eyes; or a combination of two of those. In addition, if you’ve lost at least 50% of the use of your back, workers’ comp will presume that you’re permanently and totally disabled unless your employer or the insurance company proves otherwise.
Permanent total disability benefits are paid at the same rate as temporary total disability benefits, with the same maximum and minimum. South Carolina generally places a 500-week limit on total disability benefits. However, benefits will continue for life for those who are permanently, totally disabled and are paraplegic, quadriplegic, or have physical brain injuries.
The 500-week cap applies to both temporary and permanent total disability; that means that any time you received temporary disability could be deducted from the 500 weeks. (S.C. Code §§ 42-9-10, 42-9-30(21) (2023).)
If your injury has led to the permanent loss or lost use of part of your body, you may receive partial disability benefits according to a schedule in South Carolina law. These benefits are paid at the same weekly rate as temporary total disability (two-thirds of your pre-injury wages, with the same maximum and minimum). The payments will continue for a set period of time, depending on the affected body part and the extent of your lost use (expressed in a percentage).
For certain body parts—mostly the extremities, shoulders, hips, and eyes, as well as hearing—the schedule gives a corresponding number of weeks that benefits would continue for 100% lost use. For less than complete loss, benefits would continue for a period of time in proportion to the percentage of loss. For example, the schedule lists 140 weeks for loss of a foot. If you’ve lost 50% of the use of your foot, you would receive 70 weeks’ worth of benefits.
The schedule treats lost use of the back somewhat differently, with a maximum 300 weeks for lost use of 49% or less and 500 weeks for 50% or more lost use. (As discussed above, the state will presume that you’re permanently and totally disabled if you have 50% or more lost use of your back.)
For lost use of other parts of your body not included in the list (such as a neck injury, damage to your kidneys, or neurological damage), you will be assigned what’s known as a “whole person impairment rating,” expressed in a percentage. That rating will then determine the duration of your benefits, as a proportion of 500 weeks. For example, for a 10% permanent disability to the body as a whole, you will receive payments for 50 weeks.
The South Carolina law on scheduled loss also allows workers’ comp judges to award up to 50 weeks’ worth of benefits for a serious disfigurement to any part of the body that’s normally exposed at work. (S.C. Code § 42-9-30 (2023).)
South Carolina courts have consistently ruled that employees who have permanent disability to more than one body part may choose to collect benefits under either the “medical model” (that is, based on specific injuries or scheduled losses to the affected body parts) or under the “economic model” (that is, based on their loss of earning capacity, just as for temporary disability).
For instance, if you have permanent impairments to both your back and a leg, you could decide to seek benefits based on your reduced ability to earn as a result of those impairments, if that would result in higher compensation. Under this economic model, if you’re completely unable to work, you would receive two-thirds of your pre-injury wages; otherwise, you would receive two-thirds of the difference between your pre-injury wages and what you can earn now. The same maximum and minimum weekly amounts for temporary disability will apply to permanent disability based on income loss, as will the same maximum number of weeks you can receive benefits (500 weeks for total disability or 340 weeks for partial disability).
The flip side of this rule is that even if experts have said that you’re completely unable to work as a result of a permanent disability that affects only one scheduled body part, you may only receive partial disability benefits under the South Carolina schedule.
South Carolina workers’ compensation also provides additional benefits, including:
If you’re having trouble getting the workers’ comp benefits you deserve in South Carolina, you would be wise to talk to a workers’ compensation attorney. A lawyer who’s experienced with South Carolina’s workers’ compensation system can evaluate your claim, advocate for your rights with the insurance company (and workers’ comp judge, if need be), and ensure that any settlement agreement is fair. (Learn more about how a good workers’ comp lawyer can help.)
]]>This article explains how the most important workers’ comp benefits are calculated in Massachusetts and how much you might receive. (To get these benefits, you’ll need to file a Massachusetts workers’ comp claim and show that your injury or illness is work related.)
If you’re completely unable to work while you’re recovering from your work-related injury or illness, you may receive temporary total incapacity (TTI) benefits in Massachusetts (usually known elsewhere as temporary total disability). These benefits don’t start until you’ve been away from work for five days, unless you’re unable to work for at least 21 days. TTI benefits continue until the soonest of the following:
Weekly TTI payments are calculated as 60% of your average weekly wage before your injury or illness, subject to a maximum and minimum based on the statewide average weekly wage (SAWW) at the time of your injury. You’ll receive the full amount of your pre-injury wages if they were less than the minimum. (Mass. Gen. Laws ch. 152, §§ 29, 34 (2023).)
For injuries that happened in the year between October 2023 and September 2024, the maximum TTI benefits are $1,796.72, and the minimum rate is $359.34. (For other years, see the chart of maximum and minimum TTI rates in Massachusetts.)
Massachusetts pays partial incapacity benefits if you’re able to return to work, but your injury or illness prevents you from earning as much as you did previously. These weekly payments will amount to 60% of the difference between your pre-injury wages and the amount you’re capable of earning now, but no more than 75% of what you’d receive for TTI benefits. Also, if your actual earnings plus your partial incapacity benefits add up to more than twice the SAWW amount, the insurance company may reduce your benefits to bring the earnings-plus-benefits total down to that point.
Generally, partial incapacity benefits continue until you are able to earn your normal wage or you’ve received the payments for five years. However, the payments may be extended up to ten years if your injury has left you with certain types permanent disability, such as:
(Mass. Gen. Laws ch. 152, §§ 35, 35d (2023).)
In addition to any other workers’ comp benefits, you may receive an award for the permanent loss, or lost function, of certain senses and body parts. The amount of the award is calculated by multiplying the SAWW by a certain number listed in a schedule, depending on the extent of your loss and the specific body part.
For example, for the total lost use of a leg, the schedule lists a multiplier of 39. If your leg was amputated because of an injury during the year before October 2023, you would receive an amount equal to 39 multiplied by $1,796.72 (the statewide wage for that year), for a total of $70,072.08. If you lost 50% of your leg or its function, you would receive half that amount.
For permanent loss of bodily functions or senses not listed in the schedule, you would receive an amount that’s considered fair, up to a maximum of 32 times the SAWW. You may also receive up to $15,000 if your injury has left you with permanent disfigurement, including disfiguring scars on your face, neck, or hands. (Mass. Gen. Laws ch. 152, § 36 (2023).)
If doctors determine that you are permanently and totally incapable of working as a result of your injury or illness, you may receive weekly payments for as long as your disability continues. These benefits will be equal to two-thirds of your average weekly wage, subject to the same maximum and minimum as for temporary total benefits. (Mass. Gen. Laws ch. 152, § 34a (2023).)
Massachusetts workers’ compensation also provides additional benefits, including:
If your employer’s insurance company has denied your workers’ comp claim or is balking at paying any benefits, it’s time to speak with a workers’ comp lawyer who can evaluate your case and help you get all of the benefits you deserve. (Learn more about how a good workers’ comp lawyer can help.)
If you’re worried about the expense, it may help to know that under Massachusetts law, workers’ comp attorneys are paid only if they win benefits for you. If you settle your case, the lawyer will receive 15% to 20% of the settlement, depending on the timing. But the insurance company has to pay your attorney’s fee if you win benefits another way—through an award after a court hearing or because the insurer changed its position after initially denying your claim.
]]>Temporary disability benefits cover a portion of your lost wages if you’re unable to return to your regular job while you’re recovering from your on-the-job injury or illness. These benefits will continue as long as you’re temporarily disabled.
If you’re completely unable to work during your recovery, you’ll be eligible to receive temporary total disability (TTD) benefits. There’s a three-day waiting period before these benefits kick in, unless you’re off work for more than 14 days. TTD benefits are calculated as two-thirds of your average weekly wage at the time of your injury, up to the statewide average wage. For 2023, the maximum is $1,402. There’s also a $50 minimum for weekly TTD benefits unless you were earning less than that at the time of your injury. (Md. Code, Lab. & Emp. § 9-620 (2023).)
If you can return to work but aren’t able to earn your normal wages due to the temporary limitations caused by your injury or illness, you’ll receive temporary partial disability benefits equal to 50% of the difference between your pre-injury wages and your current earning capacity. For example, say your weekly wages were $1,000 at the time of your injury, but now you can earn only $600 because your doctor has limited you to light-duty or part-time work. Your temporary partial disability benefits would be $200 per week ($1,000 - $600 = $400 x .5 = $200).
The legal maximum for temporary partial disability benefits is 50% of the statewide average weekly wage ($701 for 2023). (Md. Code, Lab. & Emp. § 9-615 (2023).)
Once your treating doctor has determined that you’ve reached maximum medical improvement (meaning that your condition isn’t expected to improve, even with further treatment), you’ll be evaluated to see if your injury or illness has left you with lasting impairments—and, if so, to what extent.
If you have permanent impairments that don’t completely prevent you from working, the doctor will give you a permanent partial disability (PPD) rating, expressed in a percentage. The duration of PPD benefits will depend on the affected part or parts of your body, as well as the extent of the impairment. Here’s the basic outline of how this part of the PPD calculation works:
If you’ve received an award for less than 75 weeks, the duration of your award might be increased for up to 75 additional weeks if your impairment affects your ability to perform job duties (what’s known as “industrial loss”).
There’s a $50 minimum for the weekly amount of PPD benefits (unless you earned less than that before your injury). Otherwise, the amount varies depending on the number of weeks in your award. There are exceptions for certain injuries and for public safety employees, but the general calculation of the weekly amount is as follows:
If you’ve received more than one award for the same injury (for instance, if your injury resulted in a permanent impairment to both your neck and an arm), your weekly benefit amount will be calculated based on the total number of weeks for the combined awards.
Example: If you sustained 30% lost use of an arm plus 15% whole body impairment for a neck injury, you would receive a combined award for 165 weeks. If your pre-injury wages were $900 a week, you would receive benefits at the maximum rate for a 2023 injury ($468 per week), because two-thirds of $900 is over the limit. So your total PPD benefits would be $468 x 165, or $77,220.
Although PPD benefits are generally paid in addition to TTD benefits, Maryland law authorizes a workers’ comp judge to order an offset or credit against your PPD award for TTD or vocational rehabilitation benefits that you’ve received. (Md. Code, Lab. & Emp. §§ 9-610.1, 9-626, 9-627, 9-628, 9-629, 9-630, 9-631 (2023).)
If your injury or occupational disease has left you permanently and totally disabled, you’ll be entitled to benefits at the TTD rate, subject to the same maximum. However, these payments will be adjusted every year to reflect changes in the cost of living.
Maryland law presumes that you’re totally and permanently disabled when you’ve completely lost the use of both hands, arms, feet, legs, or eyes, or any two of those body parts. Other permanent impairments may also qualify, but only if they prevent you from performing any type of work. Permanent total disability benefits will continue as long as you are totally disabled—potentially for life. (Md. Code, Lab. & Emp. §§ 9-636, 9-637, 9-638 (2023).)
When an employee dies as a result of a work injury or illness, surviving family members who were financially dependent on the deceased worker may receive death benefits. If the deceased worker provided 100% of the family’s income, the dependents will receive weekly benefits at the full TTD rate, subject to the same maximum.
However, if the deceased employee contributed only part of the family income, the amount will be reduced accordingly. For example, suppose the deceased employee had been earning $600 a week at the time of the injury, and that amount contributed 50% of the combined family income. The death benefit would be 50% of $400 (two-thirds of $600), or $200 a week. Death benefits are adjusted annually to reflect changes in the cost of living.
As a general rule, death benefits in Maryland continue for 12 years. Among the exceptions to this time limit, the payments may stop earlier when the surviving spouse remarries or children turn 18 (or 23 if they’re still full-time students). (Md. Code, Lab. & Emp. § 9-683.3 (2023).)
Maryland has separate rules for death benefits paid to surviving dependents of certain county and municipal employees.
In addition to the payments meant to cover part of lost wages, Maryland workers’ compensation pays other benefits, including:
If your employer’s insurance company has denied your workers’ comp claim, isn’t paying benefits you’re entitled to receive, or won’t authorize needed medical treatment, you should consider speaking with a Maryland workers’ compensation lawyer. A local attorney who's experienced in this area can evaluate your case, discuss whether it makes sense to file an appeal, make sure any settlement agreement is fair, and help you get all of the benefits you deserve. (Learn more about how a good workers’ comp lawyer can help.)
]]>Unless your employer (or its insurance company) pays benefits voluntarily after you report your injury or illness, you’ll need to file a workers’ comp claim to receive these benefits. In Hawaii, the law presumes that your injury or illness is work related when you file a claim, unless your employer provides substantial evidence to the contrary. (Haw. Rev. Stat. §§ 386-82, 386-83, 386-85 (2023).)
If your doctor says that you need to be off work while recovering from your injury, you should receive temporary total disability (TTD) benefits to replace part of your lost income. In Hawaii, these benefits don’t start until your fourth day of missed work. To ensure that you get TTD benefits on time, it’s very important to get a note from your treating physician verifying that you can’t work.
TTD benefits are calculated as two-thirds of your average weekly wage before your injury (usually determined based on your earnings during the previous 12 months). Like other states, however, Hawaii law sets a maximum weekly rate for TTD benefits, based on a percentage of statewide average wages. For 2023, the maximum is $1,090 per week. (Like most workers’ comp benefits, TTD benefits are not taxed.)
You’ll continue receiving TTD benefits as long as you are unable to return to work, until you reach maximum medical improvement (MMI)—meaning your medical condition has stabilized and isn’t likely to improve any more. (Haw. Rev. Stat. §§ 386-31(b), 386-51 (2023).)
You’re entitled to receive temporary partial disability benefits if you can return to work in some capacity after your injury, but you can’t perform your normal job duties while you’re recovering from your injuries. (For instance, your doctor may temporarily restrict you to sedentary or part-time work.) The benefits will continue until you’re able to return to your normal, full-duty job or you’ve reached MMI.
In Hawaii, temporary partial disability benefits are calculated as two-thirds of the difference between your pre-injury average weekly wages and what you’re currently earning, subject to the same maximum and minimum rates as for TTD benefits. For example, if your pre-injury wages were $900 a week but you’re currently earning $600 at a light-duty job, you would receive two-thirds of $300, or $200 a week in benefits. (Haw. Rev. Stat. § 386-32(b) (2023).)
Once you’ve reached MMI, a doctor will evaluate you to determine if your injury or illness has left you with any permanent impairment and, if so, to what extent. In most cases with any lasting impairment, you’ll receive permanent partial disability (PPD) benefits. Except for awards based on disfigurement, the total amount of a PPD award is calculated by multiplying the maximum TTD rate by a certain number of weeks, depending on the affected part(s) of your body and the extent of your impairment, expressed as a percentage.
In Hawaii, your eligibility for PPD benefits isn’t dependent on your ability to work. You may receive these benefits regardless of your current earnings. (Haw. Rev. Stat. § 386-32(a) (2023).)
A schedule in Hawaii law lists a number of weeks for the loss or lost use of certain body parts—basically the extremities, eyes, and ears. For example, complete loss of a hand is worth 244 weeks. If you’ve lost partial use of a hand, the number of weeks would a proportion of that total based on the percentage of your impairment. For instance, 25% lost use of a hand would be worth 61 weeks (25% of 244). The PPD award for that impairment would be 61 multiplied by the maximum weekly benefit ($1,090 in 2023), for a total of $66,490.
If you have a permanent impairment to a part of your body not listed in the schedule—such as your back, neck, or head—or a loss of any physical or mental function, the doctor will give you a PPD rating expressed as a percentage of impairment to the “whole person.” That percentage will be multiplied by 312; the resulting number will then be multiplied by the maximum PPD rate to come up with the total award.
For instance, if you had a back injury that resulted in a 5% whole person impairment, your PPD award would be calculated by multiplying 15.6 (5% of 312) by the maximum weekly benefit ($1,090 in 2023), for a total of $17,004.
If your injury (including the medical treatment for the injury) resulted in permanent scarring or another kind of disfigurement, you may also receive a separate disfigurement award. The amount will depend on what’s considered fair under the circumstances, up to a maximum of $30,000.
Even though the maximum TTD rate is used in calculating the total amount of PPD awards, your actual pre-injury wages will determine the weekly rate at which you’ll receive the award. The weekly installments will be two-thirds of your average weekly wage. For example, if your pre-injury earnings were $900 a week, you would get PPD benefits at the rate of $600 a week until you received the full amount of your award. However, you may apply to receive your award in a lump sum. (Haw. Rev. Stat. §§ 386-32, 386-54 (2023).)
If you’re permanently and totally disabled, you may receive weekly benefits at the same rate as TTD benefits, subject to the same maximum and minimum. However, these benefits are adjusted annually, in proportion to changes in the maximum weekly benefit amount. Hawaii doesn’t set a time limit or maximum amount for permanent total disability benefits.
Hawaii will presume that you’re permanently and totally disabled if you have any of the following injuries:
For other injuries, disability will be determined on a case-by-case basis. (Haw. Rev. Stat. § 386-31, 386-35 (2023).)
The following benefits are also available through workers’ comp in Hawaii:
Navigating the worker’s compensation system can feel overwhelming, especially when you’re dealing with the effects of your injuries and getting medical treatment. In order to receive the benefits you deserve, it’s important to obtain quality medical care, follow your doctor’s orders, and show that you’re eager to return to work when you can do so. But if the insurance company is denying treatment or benefits, you should consider getting help from a qualified workers’ comp attorney. (Learn more about when you need a lawyer for your workers’ comp case.)
]]>(To get these benefits, you’ll need to report your injury to your employer promptly, tell the doctor that your medical problem is related to your work, and sign the form you’ll receive. Although the medical provider should turn in the form—which constitutes your workers’ comp claim—it’s your responsibility to make sure that your claim has been filed within a year.)
If your doctor says that you can’t work at your normal job while recovering from your workplace injury or occupational disease, you’re entitled to temporary disability benefits to make up for some of your lost earnings. You won’t receive these benefits for the first week you’re off work unless you’re out for two consecutive weeks. Unlike many states, Arizona doesn’t have a set time limit for these benefits. The payments will last until you can return to your regular work or your medical condition has stabilized (more on that below).
If you’re unable to work at all during your recovery, you’ll receive temporary total disability (TTD) benefits equal to two-thirds of your average monthly wage before you were injured or became ill, up to a maximum that changes every year. For injuries that happened in 2023, the maximum wage for purposes of calculating the benefit amount is $5,393.37, which translates into maximum monthly benefits of about $3,596. (See Arizona’s list of the maximum wages for injuries in other years.)
If you have anyone who depends on your financial support, you can also receive an additional monthly allowance of $25 (in total, not per dependent).
If you can return to work but you aren’t able to earn as much while you’re recovering, Arizona workers’ comp pays temporary partial disability benefits. The benefit amount will be two-thirds of the difference between your pre-injury monthly wages (subject to the same maximum as for TTD benefits) and what you’re earning while you’re still recovering. For example, if you used to earn $3,200 a month but now can only earn $1,700, you’ll get $1,000 in benefits (two-thirds of $1,500).
Once it appears your condition is stationary—meaning that it won’t improve any more, even with further treatment—your doctor will evaluate you to see if you have any permanent disability as a result of your workplace injury or occupational disease. Arizona has different ways of calculating permanent disability benefits, depending on the affected part of your body and the extent of your impairment.
Arizona law sets out a schedule for the amount and duration of PPD benefits when you’ve lost the functional use of an extremity (including a finger, toe, arm, hand, foot, or leg) or you suffered loss of hearing or eyesight. The amount of the benefits will be based on a percentage your pre-injury wages (up to the current maximum), as follows:
You’ll receive those benefits for a period of time listed in the schedule for each affected part of the body. For example, the payments will last 15 months for total lost use of a thumb, 20 months for complete hearing loss in one ear, 25 months for lost sight in one eye, and 50 months for loss of your dominant hand.
If your disability to any of the listed body parts is partial, the payments will last for a number of months proportional to the percentage of disability. For example, if your doctor determines that you’ve lost 50% of the use of your dominant hand, you’ll receive benefits for 25 months (50% of 50 months).
If you have a permanent impairment to your organs or other parts of your body that aren’t listed in the schedule—such as the hips, shoulders, lungs, spine, or digestive tract—you may receive PPD benefits only if the disability causes a reduction in your earning capacity. The amount of these benefits will be 55% of the difference between your pre-injury wages and the amount you’re able to earn now.
After you’ve received a workers’ comp award for unscheduled PPD, your benefits may be adjusted up or down if your earning capacity changes as a result of your work injury or illness (not, for instance, because of age or another unrelated injury or illness).
When your injury has caused a permanent disfigurement to your head and face (including lost teeth), the Industrial Commission of Arizona (ICA) will decide on a fair amount of PPD benefits for a period of time up to 18 months.
If you’re permanently and totally disabled as a result of your work-related injury or illness, you may receive benefits for the rest of your life at the same rate as temporary total disability. Certain impairments are presumed to be permanent total disability, including:
Other types of impairments may also qualify if medical evidence shows that you’re completely disabled and unable to work.
The ICA may allow an award or settlement for permanent disability benefits over time to be converted to a lump sum. However, there are dollar limits on these lump-sum awards (depending on the type of disability).
The Arizona workers’ comp system also provides other types of benefits for employees who are injured or become ill because of their work, including
If your employer’s insurance company has denied your workers’ comp claim or is balking at paying benefits on time or in the right amount, you should strongly consider contacting an Arizona workers’ comp lawyer. A local attorney who’s experienced in this legal area can evaluate your claim and work to ensure that you receive all of the compensation you deserve under Arizona law. Learn more about what a good workers' comp lawyer can do for you and what to look for in a workers' comp attorney.
]]>The actual amount you ultimately receive will depend on circumstances unique to your case, including the nature and extent of your injuries, whether you’re able to return to your normal job, and how much you were earning at the time of your injury. (To get these benefits, you will need to file a workers’ comp claim and show that your injury or illness is work related.)
If your doctor says that you can’t work at your normal job while you’re recovering from your injury or occupational disease, you will be eligible for temporary disability benefits. Alabama has a three-day waiting period before temporary disability benefits begin, unless you’re disabled for 21 days or more. (Ala. Code § 25-5-59 (2023).)
You will receive temporary total disability (TTD) benefits when your injuries prevent you from doing any work during your recovery. In Alabama, TTD benefits are generally two-thirds of your average weekly wages (typically based on your earnings over the year before your injury).
However, the state sets maximum and minimum amounts for these payments based on average statewide earnings.
For injuries that happen between July 2023 and June 2024, the maximum TTD benefit is $1,084 per week, and the minimum is $298 unless your pre-injury wages were lower than that. (The Alabama Department of Labor’s website publishes a list of maximum and minimum benefits for other years.)
You should continue receiving TTD benefits until you’re able to return to work or your doctor says that you’ve reached “maximum medical improvement” (MMI), which means that your condition has stabilized and isn’t likely to improve any further. (Ala. Code §§ 25-5-57(a)(1), (b), 25-5-68 (2023).)
Alabama pays temporary partial disability benefits when you are able to do some work after your injury but can’t earn as much as usual—typically because your doctor has restricted you to light-duty or part-time work. These benefits are two-thirds of the difference between your pre-injury earnings and what you’re able to earn now. For example, suppose you normally earn $800 a week, but now you can only handle a light-duty job that pays $500 per week. You would receive $200 in weekly benefits (two-thirds of $300).
Alabama sets a 300-week limit on temporary partial disability benefits. (Ala. Code § 25-5-57 (2023).)
Once you’ve reached MMI, your doctor will evaluate you to determine if you have any permanent physical impairment as a result of your injury and, if so, to what extent. You’ll receive a permanent disability rating in the form of a percentage of disability. Most of the time, your permanent disability will be partial.
Alabama has different ways of calculating permanent partial disability (PPD) benefits, depending on the nature of your disability: scheduled awards based on impairments to certain body parts, awards for disfigurement, and unscheduled awards for other injuries.
A schedule in Alabama law lists a number of weeks for the loss or lost use of certain body parts—basically the extremities, eyes, and hearing loss. For example, amputation or complete lost use of an arm is worth 222 weeks. If you’ve lost partial use of an arm, you’d receive TTD benefits for a number of weeks in proportion to the percentage of your impairment. For instance, if you lost 50% of the use of an arm, you would receive payments for 111 weeks.
The weekly amount of these benefits is $220 per week or two-thirds of your pre-injury wages, whichever is less. You may ask to receive the total amount of your scheduled award in a lump sum rather than in weekly installments, but your request will be approved only if the workers’ comp judge believes that would be in your best interest. (Ala. Code §§ 25-5-57(3), 25-5-68, 25-5-83 (2023).)
If your injury has resulted in a serious disfigurement that limits your ability to find work (and isn’t already covered by a scheduled loss of use), you might be awarded PPD benefits up to 100 weeks.
Disfigurement awards have the same $220-per-week maximum as scheduled awards, and you may request to receive the benefits in a lump sum. (Ala. Code §§ 25-5-57(3), 25-5-68, 25-5-83 (2023).)
If you have an impairment to a part of your body that’s not included in the schedule—such as your back, neck, head, or internal organs—your weekly PPD benefit will be based on the difference between your pre-injury injury wages and what you’re able to earn in your current condition, up to a maximum of $220 a week.
These benefits will last for a maximum of 300 weeks, minus the number of weeks that you already received TTD benefits. Here again, you may ask to receive these benefits in a lump sum. (Ala. Code §§ 25-5-57(3)(g), 25-5-68, 25-5-83 (2023).)
If you’re permanently and totally disabled as a result of your injuries—meaning that you’re completely unable to work or to be retrained for any gainful employment—you will continue to receive weekly benefits at the PPD rate (subject to the same maximum and minimum), potentially for the rest of your life.
However, your employer may ask the court to end these benefits if it claims that you’re able to do some work as a result of physical or vocational rehabilitation.
You may not receive these benefits if you’ve refused to accept reasonable work accommodations offered by your employer or to participate in physical or vocational rehabilitation. (Ala. Code § 25-5-57(4) (2023).)
Alabama workers’ compensation also provides additional benefits, including:
If you’re having trouble collecting all of the workers’ comp benefits you deserve, a qualified workers’ comp attorney may be able to help. And before you sign a workers’ comp settlement, you should have a lawyer review the agreement to make sure that your rights are fully protected. (Learn more about when you need a lawyer for your workers’ comp case.)
]]>This article explains the most important workers’ comp benefits available in the state.
If you aren’t able to work at all while you’re recovering from your work-related injury or illness, you’ll be entitled to temporary total disability (TTD) benefits. However, these benefits aren’t paid for the first seven days of disability, unless you end up being away from work more than 21 days.
TTD benefits amount to two-thirds of your average weekly wages at the time of your injury, up to the legal maximum for the year when you were hurt or became disabled. For injuries that happened in 2023, the maximum benefit is $1,254 per week. (You can find a list of the maximum weekly rates for other years at the website of the North Carolina Industrial Commission.) There’s also a minimum amount: $30 per week.
You may receive temporary partial disability benefits if you’re able to return to work in some capacity, but not at the same level as before your injury. Except for injuries to one of the body parts in North Carolina’s schedule of injuries for permanent partial disability (discussed below), temporary partial disability benefits are equal to two-thirds of the difference between your pre-injury wages and what you’re able to earn now.
For example, if you earned $1,200 a week before your injury but are currently earning $600 on light duty, you would receive $400 a week in benefits. If you have a scheduled injury, you may receive benefits at the full TTD rate during your healing period.
Generally, there’s a 500-week limit on how long you can receive total and/or partial temporary disability benefits. You may apply for an extension of TTD benefits, but you will have to prove that you’re still completely unable to work.
If you’re getting full Social Security retirement benefits, your TTD benefits will be reduced by the amount of the Social Security payments. (N.C. Gen. Stat. §§ 97-28, 97-29, 97-30, 97-31 (2023).)
After your doctor finds that you’ve reached “maximum medical improvement” (meaning that you aren’t likely to get better, even with further medical treatment), you’ll be evaluated to see whether your work-related injury or illness has caused long-lasting limitations.
The type and amount of permanent disability benefits will depend on the part of your body that’s affected, as well as your impairment rating (generally expressed in a percentage).
If you’ve permanently lost vision, hearing, or the use of certain body parts (fingers, hands, arms, toes, feet, legs, or back), your permanent partial disability benefit will be based on a schedule that lists the maximum number of weeks for each of these body parts or senses.
The award is calculated as two-thirds of your average weekly wages multiplied by the appropriate number of weeks in proportion to your impairment rating. For example, the schedule in North Carolina law lists 200 weeks for the total loss of a hand.
If you’ve lost 50% of the use of your hand as a result of your injury, you would receive 100 weeks’ worth of payments. In the case of a back injury, however, partial loss of 75% or more will be compensated at the same level as total lost use.
These weekly payments are subject to the same maximum and minimum as TTD benefits. (N.C. Gen. Stat. § 97-31 (2023).)
As part of a settlement of your workers’ comp case in North Carolina, you may agree to receive these permanent disability benefits in a lump sum rather than in weekly payments.
If you still have reduced earning capacity after you’ve been assigned a permanent partial impairment rating for a scheduled loss of use, you may opt to continue receiving temporary partial disability benefits (based on the difference between your pre-injury wages and current earning capacity).
North Carolina law also allows lump-sum awards for other types of partial disability:
You may be eligible to receive permanent total disability benefits for the rest of your life—at the same rate as TTD benefits—if you have one or more of the following serious injuries:
(N.C. Gen. Stat. § 97-29(d) (2023).)
North Carolina workers’ compensation also provides additional benefits, including:
If your employer’s insurance company has denied your workers’ comp claim, is holding back benefits, or won’t authorize needed medical treatment, you should probably speak with a workers’ comp lawyer.
A North Carolina attorney who's experienced in this area can evaluate your case, give you advice as to whether it’s worth filing an appeal, and help you get all of the benefits you deserve. (Learn more about how a good workers’ comp lawyer can help.)
]]>This article explains how the most important workers’ comp benefits are calculated in Nevada and how much you might receive. (To get these benefits, you will need to file a workers’ compensation claim and show that your injury or illness is work-related.)
In Nevada, temporary disability benefits are paid to workers who need to take more than five days off work due to their injuries. (Nev. Rev. Stat. § 616C.400 (2023).)
Temporary total disability (TTD) benefits are two-thirds of your average monthly wage, up to maximum amount that's adjusted every year. For injuries that happen during the year beginning July 1, 2023, the maximum benefit is $5,101.95 per month.
You'll continue to receive TTD benefits until you're able to return to work, your employer has offered you modified work that accommodates any restrictions you have, or your condition has stabilized to the point that you aren't likely to improve even with further medical treatment. (Nev. Rev. Stat. §§ 616A.065, 616C.475 (2020).)
You may receive temporary partial disability benefits if you’re able to work but are earning significantly less than usual due to your injury. In Nevada, these benefits amount to the difference between what you would receive for TTD and what you're actually earning.
For example, suppose you normally earn $3,000 per month, but after your injury, you’re earning only $1,500 a month. If you weren’t able to work at all, your TTD rate would be $2,000 (two-thirds of $3,000), so your temporary partial disability benefits would be $500 per month ($2,000–$1,500).
Nevada places a 24-month cap on temporary partial disability benefits. (Nev. Rev. Stat. § 616C.500 (2023).)
Once your medical treatment is complete, a doctor will evaluate you to determine if your work-related injury or illness has left you with any permanent impairment and, if so, to what extent.
If the doctor finds that you have a permanent partial disability, you will be assigned a permanent impairment rating, stated as a percentage. For each percent of impairment, you will receive 0.6% of your average monthly wage at the time of your injury. For example, suppose you have 10% impairment, and your average monthly wage is $2,400. Your permanent partial disability award would be calculated as follows: (.006) x $2,400 x 10 = $144 per month.
Permanent partial benefits start once TTD benefits end, and they will continue for five years or until you turn 70, whichever happens later. (Nev. Rev. Stat. § 616C.490 (2023).)
If the doctor determines that you are permanently and totally disabled, you will continue to receive monthly payments at your TTD rate for as long as the disability continues. Certain injuries—such as total loss of sight and amputation or permanent paralysis of two limbs—are automatically considered to be permanently and totally disabling, unless proven otherwise. (Nev. Rev. Stat. §§ 616.435, 616.440 (2023).)
Nevada workers’ compensation also provides additional benefits, including:
If your Nevada workers' comp claim is denied or the insurance company isn't promptly paying all of the benefits you deserve, it would be a good idea to contact a Nevada workers' comp lawyer. An attorney who's experienced in this area can evaluate your claim and help ensure that you receive the proper compensation. To learn more, see our page on hiring a workers' comp lawyer.
]]>This article explains the types and amounts of benefits that are available through workers’ comp. (To get these benefits, you will need to file a workers’ compensation claim and show that you have a work-related injury or illness.)
In Louisiana, you may receive temporary total disability (TTD) benefits if you’re physically unable to do any kind of work while you’re recovering from your work-related injury or illness. Unless your disability lasts at least two weeks, you won’t receive these benefits for the first week off work.
The weekly TTD benefit amount is two-thirds of your average weekly wage at the time of your injury, but there’s both a cap and a floor on these benefits. The maximum is 75% of the statewide average weekly wage at the time of your injury, while the minimum is 20% of that wage. For injuries that happen between September 1, 2023, and August 31, 2024, the maximum TTD benefit is $816 a week, and the minimum is $218.
As long as you’re still unable to work, TTD benefits continue until you no longer need regular medical treatment, and doctors can determine whether and to what extent you have any permanent disability as a result of your work-related injury or illness. (La. Rev. Stat. §§ 23:1202, 23:1221(1), 23:1224 (2023).)
Although you can’t get temporary disability benefits in Louisiana if you’re able to work at all (including self-employment), you may receive “supplemental earnings benefits” if your injury keeps you from being able to earn at least 90% of your pre-injury wages.
These benefits are calculated at two-thirds of the difference between what you earned before and what you’re capable of earning now in any type of work. For example, if you earned $3,000 a month before your injury, but you can only do light-duty work that pays $1,800 a month, you would receive two-thirds of the $1,200 difference, or $800 a month.
As long as you still qualify for supplemental earnings benefits, you can receive these payments for up to 520 weeks, unless you retire before then. (La. Rev. Stat. § 23:1221(3) (2023).)
Once your medical treatment is complete, your doctor will examine you and determine whether your injury or illness has left you with any permanent disability—and if so, to what extent.
In order to be considered permanently and totally disabled in Louisiana, you must prove that you’re physically unable to do any type of gainful work, including self-employment—regardless of whether the work matches your education, training, and other qualifications, and even if you have to work in some pain.
If you meet this narrow definition, you may continue to receive weekly payments at your TTD rate for as long as the disability continues. (La. Rev. Stat. § 23:1221(2) (2023).)
If your injury or illness has left you with a permanent impairment that doesn’t completely prevent you from working, you may receive permanent partial disability (PPD) benefits.
These benefits are two-thirds of your pre-injury average weekly wages, but Louisiana has two different methods for calculating how long those payments last—and therefore the total amount you’ll receive. (As part of a settlement of your Louisiana workers’ comp case, you may agree to receive the total amount of these benefits in a lump sum.)
If you’ve had an amputation or what Louisiana calls an “anatomical loss of use” of certain body parts—the extremities or an eye—your PPD benefits will last a certain number of weeks according to a schedule in Louisiana law.
For example, the schedule lists 150 weeks for the total loss of a hand. If you’ve lost only 10% of your hand, you would receive 15 weeks of payments. (La. Rev. Stat. § 23:1221(4)(a)–(o) (2023).)
You may receive PPD benefits for up to 100 weeks if you have any of the following permanent impairments as a result of your injury or illness:
(La. Rev. Stat. § 23:1221(4)(p) (2023).)
In addition to other benefits, Louisiana pays a one-time award of $50,000 for certain types of catastrophic injuries that result from on-the-job accidents, such as third-degree burns over at least 40% of the body, quadriplegia, paraplegia, or the total loss of two extremities or both eyes. (La. Rev. Stat. § 23:1221(s) (2023).)
Louisiana workers’ compensation also provides additional benefits, including:
(La. Rev. Stat. §§ 23:1203, 23:1210, 23:1226, 23:1231–1236 (2023).
If you have a minor on-the-job injury and you have no trouble getting benefits from the insurance company, you might be able to handle your workers’ comp claim on your own. In most cases, however—especially if your claim has been denied—you’d be wise to speak with a workers’ compensation lawyer who can evaluate your claim and protect your right to all of the benefits you deserve.
In Louisiana, workers’ comp lawyers are only paid a percentage of benefits that they win for their clients. (Learn more about when you need a workers’ comp attorney and what a good workers’ comp lawyer can do for you.)
]]>This article explains how the most important workers’ comp benefits are calculated in Tennessee, including temporary disability and permanent disability benefits.
To get these benefits, you’ll need to promptly notify your employer about your injury (at least within 15 days after the injury), file a workers’ comp claim within a year if the insurance company hasn’t voluntarily paid benefits, and prove that your injury or illness is work related. (Tenn. Code §§ 50-6-201, 50-6-203 (2023).)
Temporary disability benefits cover a portion of your lost wages when you can’t return to your regular job—or can’t work at all—while you’re recovering from your work-related injury or illness. In Tennessee, you won’t receive these benefits for the first seven days that you’re disabled unless your temporary disability lasts at least 14 days.
If your doctor says that you are completely unable to work during your recovery, you should be eligible to receive temporary total disability (TTD) benefits. The weekly amount of these benefits will be two-thirds of your average weekly wage before you were injured, up to a legal maximum that’s tied to Tennessee's statewide average weekly wage in the year of your injury.
For injuries that happen from July 2023 through June 2024, the maximum is $1,313.40 per week. There’s also a minimum: $179.10 for that same year. (For injuries in other years, see the list of workers’ compensation rates published by the Tennessee Department of Labor and Workforce Development.)
You may continue to receive TTD benefits until you are able to return to work or have reached what’s known as “maximum medical improvement” (MMI), which basically means that either you've completely recovered or your condition isn’t likely to improve any further. (Tenn. Code §§ 50-6-205, 50-6-207 (2023).)
You may receive temporary partial disability benefits if you can do some work during your recovery period, but your injuries prevent you from earning as much as you did before. Typically, this happens when your doctor has set restrictions on what you can do—such as no heavy lifting, limited standing, or part-time work only.
Temporary partial disability benefits are calculated as two-thirds of the difference between your pre-injury wages and what you’re currently able to earn. For instance, if you earned $900 before your injury but are now only able to earn $600 at a light-duty job, you would receive $200 per week (two-thirds of the $300 difference). These benefits are subject to the same weekly maximum and minimum as TTD benefits. (Tenn. Code § 50-6-207 (2023).)
Once you have reached MMI, you will be evaluated to determine whether you have any lasting impairments as a result of your workplace injury or illness. If you do, you may be eligible for permanent disability benefits. The amount of these benefits will depend on the extent of your impairments.
If your permanent impairments are so severe that you are unable to perform any type of paying work, you will be eligible for permanent total disability benefits at the same weekly rate as TTD benefits (with the same maximum and minimum amounts).
These benefits will continue as long as you are still incapacitated from working, until you’re eligible to receive full Social Security retirement benefits. (Tenn. Code § 50-6-207(4) (2023).)
If your permanent impairments don’t completely prevent you from working, you should be eligible to receive permanent partial disability (PPD) benefits. The amount of these benefits will be calculated based on the permanent impairment rating that your doctor has assigned to you. This rating reflects the percentage of total body function that you lost due to your injuries or illness.
You will generally receive two-thirds of your pre-injury wage for a number of weeks that is determined by multiplying 450 by the percentage of your impairment rating. For example, if your injuries resulted in a 20% impairment rating, and your pre-injury average weekly wage was $900, you would receive $600 (two-thirds of $900) a week for 90 weeks (20% of 450), or a total of $54,000.
The minimum weekly PPD benefit is the same as for TTD, but the maximum is somewhat lower ($1,194 for injuries in the year beginning July 2023).
Tennessee law allows for the possibility of increased PPD benefits if you still haven’t returned to work or are earning less than your pre-injury wages when the period of your original PPD award runs out (or 180 days after you reached MMI, if that comes later).
You must file a new petition for benefit determination. If it’s approved, your original award may be increased by a factor of 1.35, as well as certain additional factors based on your age, education, and the unemployment rate in the county where you worked.
There’s a cap on the total amount of benefits you may receive for temporary and permanent partial disability in Tennessee. The maximum total benefit is calculated by multiplying 450 by the maximum weekly amount for the year of your injury. (TTD benefits that you received before reaching MMI won’t count toward this maximum total benefit, and the cap doesn’t apply in cases of permanent total disability.)
You may be able to receive your PPD award in a lump sum, if the workers’ comp judge approves it as being in your best interest. (Tenn. Code §§ 50-6-102, 50-6-207(3), 50-6-229 (2023).)
In addition to temporary and permanent disability benefits, workers’ compensation in Tennessee provides other benefits, including:
If your employer’s insurance company denies your workers’ comp claim or isn’t paying the benefits you deserve, you would be wise to speak with a workers’ comp lawyer.
A local attorney who’s experienced in this area should be able to evaluate your claim and help ensure that you get the compensation you’re entitled to receive under Tennessee law.
To learn more, see our page on working with a workers' comp lawyer.
]]>This article explains the most important benefits available to injured employees and the basic rules for determining compensation.
The actual amount of money you may receive will depend on your medical condition, your ability to return to work, how much you earned before your injury, and how state workers’ comp laws apply to your claim.
If you can’t return to your job (or the same type of work) while you’re recovering from your injury, you may receive temporary total disability (TTD) income benefits to help make up for part of your loss in earnings.
These benefits are calculated as two-thirds of the average weekly wage you were receiving at the time you were injured or became ill because of your work, subject to maximum and minimum amounts that change annually, depending on the date of your injury.
For injuries in 2023, the weekly maximum is $1,118.43, and the minimum is $203.35. (To find the maximum and minimum amounts for other injury dates, go to the Kentucky Department of Workers’ Claims site and scroll down to the “Workers’ Compensation Benefit Schedule” for the current year.)
Kentucky doesn’t pay TTD income benefits for the first seven days off work, unless your temporary disability last more than two weeks. The payments will continue until you can return to your normal job or you reach a point known as “maximum medical improvement” (MMI)—which means that your condition has stabilized and isn’t expect to improve, even with further medical treatment.
Although Kentucky workers’ comp doesn’t explicitly provide what many states call temporary partial disability, you may still receive some income benefits if you’re able to do light-duty or other alternative work while you’re still recovering. In that situation, the amount of TTD benefits will be offset by your actual after-tax earnings.
Once you’ve reached MMI, your doctor will evaluate your condition to see if you have any permanent disability. If so, you may receive income benefits for total or partial permanent disability.
If your injury or occupational illness prevents you from performing any type of work, you’ll be entitled to receive permanent total disability income benefits at the same rate as TTD benefits. These benefits will continue as long as you’re completely disabled, until you turn 70.
If you’re still able to do some kind of work but your work-related injury or illness has left you with some permanent disability, your doctor will give you what’s known as a “permanent impairment rating.”
This rating—which is a percentage representing the extent to which you’ve lost overall bodily function—will then go into a formula to determine how much you may receive in permanent partial disability (PPD) income benefits.
Kentucky’s rules for PPD are complicated, but here are the basics for determining the amount of benefits:
If all this sounds complicated, that’s one reason most injured employees hire a workers’ comp lawyer to help them through the process. But if you’ve already been assigned an impairment rating, you can get an estimate of your benefit amount by using Kentucky’s PPD Benefit Calculator.
Regardless of the multipliers discussed above, there’s a time limit on how long you can receive PPD income benefits in Kentucky. If you have a rating of 50% or less, you’ll receive PDD benefits for 425 weeks; if your rating is 51% or higher, the benefits will last for 520 weeks from the time when you first had impairment over 50%.
In addition to the income benefits for temporary and permanent disability, Kentucky workers’ comp provides other types of benefits, including:
The workers’ comp system has pluses and minuses. On the minus side, income benefits cover only part of your lost wages, and you won’t receive any compensation for your pain and suffering—the physical and emotional distress your injury has caused. (There are only a few limited situations when you may sue outside of the workers’ comp system to recover all of your losses from a workplace injury, including pain and suffering.)
On the plus side, however, you can receive benefits relatively quickly without having to file a lawsuit, prove that your employer was to blame for your injury, and find a way to cover your medical expenses and lost income while you wait for the outcome.
]]>The benefits you actually receive will depend on the nature of your injuries, your ability to return to work, how much you normally earn, and other factors unique to your case.
This article explains how the most important workers’ comp benefits are calculated in Colorado. (To get these benefits, you’ll need to file a workers’ comp claim and show that your injury or illness is work related.)
You may be eligible for benefits meant to replace part of your lost wages if you can’t work at all or can’t perform your regular job duties while you’re recovering from your injuries. In Colorado, temporary disability benefits aren’t paid for your first three days off work, unless your disability lasts more than two weeks. (Colo. Rev. Stat. § 8-42-103 (2023).)
If you’re unable to perform any type of work due to your injury, you’ll receive temporary total disability (TTD) benefits equal to two-thirds of your average weekly wages when you were hurt or got sick. However, there’s a cap on these benefits that’s based on a percentage of statewide average wages at the time of your injury. For injuries between July 1, 2023, and June 30, 2024, the maximum TTD benefit is $1,293.25 per week. To hit that cap, your pre-injury weekly wages would have be to at least $1,939.88. (The Colorado Workers’ Compensation Benefits Calculator will show the maximum benefit rate for other years.)
Unless you’re receiving vocational rehabilitation services, TTD benefits will stop when the earliest of the following events happens:
(Colo. Rev. Stat. §§ 8-42-102, 8-42-105 (2023).)
If you’re working during your recovery but aren’t earning as much as you used to because of your injuries, you may receive temporary partial disability benefits. These benefits are calculated as two-thirds of the difference between your pre-injury wages and what you’re currently earning. For example, if you used to earn $900 a week but are now earning $600 for light-duty or part-time work, you would receive $200 in benefits. These benefits have the same maximum as for TTD, and they end when you’ve reached MMI or have refused a modified work offer. (Colo. Rev. Stat. § 8-42-106 (2023).)
Once you’ve reached MMI, a doctor will evaluate you to determine if your work injury or illness has left you with any permanent lost function or impairment to part of your body—and if so, to what extent. In most cases with any lasting impairment, you’ll receive permanent partial disability benefits. Depending on the affected part or parts of your body, you’ll receive a scheduled loss award and/or an award for nonscheduled whole person impairment.
You may ask to receive up to $10,000 of your permanent partial disability benefits in a lump sum (less a discount). If you’re owed any remaining benefits, you’ll get that money in periodic payments. (Colo. Rev. Stat. § 8-42-107 (2023).)
You’ll receive a scheduled loss award if you’ve permanently lost any use of a body part included in a schedule in Colorado law (mostly covering the extremities, eyes, and ears). The schedule shows how many weeks of compensation you would receive for an amputation or complete loss of use for each of the listed body parts.
For less than total loss of use, you’d receive compensation for a number of weeks proportional to the percentage of your impairment. For example, the schedule lists 208 weeks for the total loss of an arm. If you’ve lost 50% of the use of an arm, you would receive compensation for 104 weeks.
For scheduled injuries, the weekly amount of compensation is a set amount—not based on your pre-injury earnings—that changes every year. For injuries in the year beginning July 1, 2023, the scheduled impairment rate is $405.84 per week. (Colo. Rev. Stat. § 8-42-107 (2023).)
The Colorado benefits calculator, mentioned above, will show you the impairment rate for your date of injury, as well as the appropriate number of weeks for the scheduled body part and the percentage of your impairment.
If you have a permanent impairment to a part of your body not listed in the schedule—such as your back, neck, or an internal organ—you’ll receive nonscheduled whole person impairment benefits.
A number of factors go into the calculation of these benefits. First, your doctor will assign you an impairment rating, expressed as a percentage. Next, you will be assigned an age factor, based on how old you were when you reached MMI.
Your benefit will be calculated by multiplying your impairment rating by your age factor and then by 400 weeks. You will receive benefits for the resulting number of weeks at the TTD rate. (Here again, the online benefits calculator will show the amount and duration of your benefits after you fill in the appropriate information.) (Colo. Rev. Stat. § 8-42-107 (2023).)
If your injury left you with a serious, permanent disfigurement on a part of your body that’s normally exposed to the public, you may receive an additional award. The maximum amount of this award also changes each year. (Colo. Rev. Stat. § 8-42-108 (2023).)
Colorado also places a limit on how much you can receive in combined temporary disability benefits and permanent partial disability benefits.
This cap changes each year. For injuries occurring in the year beginning on July 1, 2023, the maximum is $119,299.72 if you have a whole person impairment rating of 19% or less, or $238,596.43 with a whole person impairment rating of 20% or more. (Colo. Rev. Stat. § 8-42-107.5 (2023).)
If your injury or occupational illness permanently prevents you from performing any type of work, you will be entitled to permanent total disability benefits at your TTD rate for as long as you’re completely disabled—potentially for life. (Colo. Rev. Stat. § 8-42-111 (2023).)
Colorado workers’ compensation also provides additional benefits, including:
If your employer’s insurance company has denied your workers’ comp claim, is delaying or refusing to pay benefits, or won’t authorize needed medical treatment, you should consider speaking with a workers’ comp lawyer.
A local attorney who's experienced in this area can evaluate your case, discuss whether it makes sense to file an appeal, make sure your rights are protected in a settlement agreement, and help you get all of the benefits you deserve. (Learn more about how a good workers’ comp lawyer can help.)
]]>This article explains how the most important workers’ comp benefits are calculated in Michigan and how much you might receive.
You may receive benefits that cover a portion of your lost wages if you have a disability as a result of your work-related injury or illness. In Michigan, a disability is any limitation in your “wage earning capacity” in work that’s suitable for your qualifications and training (more on that below).
Wage-loss benefits will begin after you’ve been unable to work for seven days. But if your disability lasts for at least 14 days, you’ll receive retroactive benefits for the first seven days. You may continue to receive the payments as long as your wage earning capacity is reduced because of your disability, unless you’ve turned down a reasonable job offer.
If you’re unable to work at all and are entitled to wage-loss benefits, you’ll generally receive 80% of your pre-injury wages (based on the after-tax value of the average weekly wages in the 39 highest-paid weeks out of the 52 weeks before you were injured or became ill). However, there’s a cap on these benefits that depends on when you were injured. For 2023, the maximum wage loss benefit is $1,095 per week. (You can find the maximum rates for injuries that happened in other years on the Michigan State Average Weekly Wage Chart.)
If you can return to work in a limited capacity, you may receive 80% of the difference between your pre-injury wages and your current wage earning capacity. For example, if you took home $800 a week in after-tax wages before your injury, but now you can only earn $500, your wage-loss benefits would be $240 (80% of $300).
The Michigan Workers’ Disability Compensation Agency offers an online calculation tool to help you determine your wage-loss benefit amount.
Under Michigan workers’ comp law, your wage earning capacity is the amount you earn or are able to earn at a job that’s reasonably available and suitable to your education, training, experience, and skills.
Your wage-loss benefits will be calculated based on any reduction in actual earnings if your doctor has released you to work with restrictions (such as limits on how much you can lift or how long you stand) and your employer has provided you with modified work. Otherwise, you’ll be expected to look for another job. If you’ve made a good-faith effort but haven’t been able to find work that you’re qualified to do and that accommodates your restrictions, you may receive the full amount of wage-loss benefits.
Benefits are treated differently if, as a result of your injury, you’ve lost (or lost the functional use of) an eye, arm, leg, hand, finger, foot, or toe. In this case, you will receive “specific loss benefits” equal to 80% of your after-tax average weekly wage (subject to a minimum and maximum) for a certain number of weeks, depending on which body part you've lost.
You’ll continue to receive these benefits for the scheduled number of weeks even if you’re able to work during that time. However, if you still have wage loss after the specific loss benefits run out, you may then receive wage-loss benefits.
You may qualify for a total and permanent disability benefits if your work-related injury or illness has caused total blindness, incurable mental illness, the loss of two limbs, or the complete and permanent lost use of two limbs.
The amount of benefits for total and permanent disability begin at the same rate as wage loss for total incapacity; however, if you’re receiving the maximum amount, you’ll be able to take advantage of increases in the maximum rates (rather than being stuck with the cap in effect at the time of your injury). You’ll also be entitled to a minimum payment, and your workers’ comp benefits won’t be offset by any other benefits you're receiving, such as short-term disability or a pension.
You will continue to be considered totally and permanently disabled for the first 800 weeks that you’re receiving benefits, whether or not you’re working; after that, your benefits may be stopped or reduced if you are actually earning wages.
Michigan workers’ compensation also provides other types of benefits, including:
If your employer’s insurance company has disputed your claim or isn’t paying the amount of benefits that you believe you’re entitled to receive, you should speak with a workers’ compensation attorney. A local lawyer who’s experienced in this field can help you in many ways, including finding a vocational expert to help establish the proper amount of your wage earning capacity and wage loss.
]]>If you are unhappy with your treating doctor, you may be able to change physicians. However, workers’ compensation laws vary from state to state. Make sure you understand the rules and procedures in your state before changing workers’ comp doctors. If you fail to follow the correct process, the insurance company may refuse to pay your medical bills.
In an emergency, you have the right to seek treatment from any doctor or hospital. However, for non-emergency treatment, you will need to follow your state’s workers’ compensation rules.
In many states, your employer or its insurance company has the right to select the treating doctor who will provide your ongoing medical care. In other states, you can pick your own doctor from the very beginning.
And, in still other states, the rules are more complicated—for example, you might need to select a doctor from an approved panel or network from your employer. (To learn more, see our article on who selects your initial treating physician.)
Sometimes, you may feel that your occupational doctor is more concerned about your employer’s financial well-being than your full recovery. If your condition is not improving or you are dissatisfied with the doctor’s medical care, you may be able to change doctors.
Every state’s workers’ comp system is different. In most states, you can change doctors at least once. However, depending on where you live, there may be other limitations on your ability to change medical providers.
Some states allow the insurance company to control all medical treatment in a workers’ comp case. In these states—such as Florida, New Jersey, North Carolina, and Virginia—you may ask for a new doctor, but the insurance company will typically select the new doctor for you.
If the insurance company denies your request, you can usually appeal the decision to your state’s workers’ compensation agency. However, appeals regarding medical treatment can be tricky, so you may want to consider hiring an experienced workers’ comp lawyer for help.
Other states, including Pennsylvania and Michigan, allow workers to switch physicians after a waiting period. The length of the waiting period varies from state to state (ranging from one appointment to 90 days). However, after that time period, you may treat with a doctor of your own choosing.
You should not start treating with a new doctor until you give the insurance company adequate notice. Otherwise, you may be billed for treatment received before you gave notice.
Another group of states allows you to change physicians but limits the number of times you can do so. For example, in Illinois, you can change doctors twice without the insurance company’s permission. (After your second change, you must get either the insurance company’s approval or a court order before switching doctors.) Georgia allows a one-time change of physician.
If you’ve used up your automatic changes and are still unhappy with your treatment, a workers’ compensation lawyer can help you request approval for an additional change.
Some states, including New York and Washington, allow workers to choose their treating doctors. However, they have a directory of medical providers who are authorized by the state to treat injured workers.
If you treat with an unauthorized doctor, the insurance company may not pay the doctor’s bills. These states typically have an online directory of authorized doctors. While you may be able to change physicians, you must treat with an authorized provider.
A managed care organization (MCO) is a network of physicians that treat injured workers. MCO’s are an increasingly popular way to reduce workers’ comp expenses for employers. If your employer provides treatment through an MCO or provider network, you typically may change physicians, but your new doctor must also be within the network.
If you’re not able to change doctors, you may still be able to get a second opinion in some states. In general, a second opinion doctor does not provide ongoing treatment. Instead, the doctor will perform a one-time examination, review your medical records, and give recommendations on your treatment, work restrictions, and limitations.
The insurance company will consider the second opinion report and findings when assessing your workers’ comp claim. A second opinion can also be used as evidence at a workers’ compensation hearing if your benefits are denied.
Second opinions are usually available when the insurance company has control over your medical care and selects your treating doctor. The process for requesting a second opinion varies from state to state. Typically, if your claim has been denied, the insurance company will not pay for a second opinion.
Instead, your workers’ compensation lawyer may send you to an independent medical examination with a doctor of his or her choosing.
Contact a workers’ comp lawyer or your state’s workers’ compensation agency for more information and assistance.
When you choose a new doctor, you should consider a series of factors, including:
It is important that you trust the provider and feel comfortable with his or her treatment recommendations. If you need help finding a doctor, a workers’ compensation lawyer may be able to recommend a physician, especially if you need to select one from your employer’s network. Workers’ comp lawyers are often familiar with occupational doctors and can tell you which ones are likely to be open-minded and fair.
]]>To get these benefits, you’ll need to report your injury to your employer within 30 days after your injury (or after you know or should have known that your disability is related to your work) and file a workers’ comp claim.
Temporary disability benefits are paid while you are recovering from your injuries. You may be eligible for either temporary total disability (TTD) or temporary partial disability (TPD). In Wisconsin, these benefits are not paid for your first three days off work, unless your disability lasts more than seven days.
You may receive temporary total disability (TTD) benefits while you:
These benefits are calculated at two-thirds of your average weekly wage before your injury, up to a maximum that changes annually. For 2023, the maximum TTD benefit is $1,247 (two-thirds of the maximum weekly wage of $1,870.50 for that year, which is 110% of the statewide average weekly wage).
TTD payments continue until you return to work or your doctor says that you’ve reached “maximum medical improvement” (MMI), which means that your condition won’t improve any further with medical treatment.
If you can return to work, but you aren’t able to earn as much as you were before the injury or illness, you may receive temporary partial disability (TPD) benefits.
The amount of these benefits will be two-thirds of the difference between your pre-injury and post-injury wages; however, the pre-injury wages are subject to the same maximum as for TTD benefits. For example, if you used to earn $1,000 a week but now can earn only $700, you would get $200 in TPD benefits (two-thirds of $300).
Once you’ve reached MMI, your doctor will evaluate you and decide whether you have any permanent limitations as a result of your work injury or occupational disease. In most cases where there’s some permanent disability, it will be partial. In that case, you’ll receive a permanent impairment rating (expressed as a percentage of lost body function).
Although the amount of permanent partial disability (PPD) benefits in Wisconsin is also calculated as two-thirds of your average weekly earnings, the maximum is much lower than for temporary disability, and it isn’t raised every year. For injuries that happened on or after January 1, 2023, the state’s maximum compensation rate for PPD is $430 a week.
If you’ve returned to work, you’ll still receive PPD benefits based on your physical limitations. If you’re unable to earn at least 85% of your pre-injury wages, however, your award may be adjusted upward to take into account your lost earning capacity.
The length of time you receive TTD benefits will be determined in one of two ways: (1) according to a schedule for the lost use of certain body parts (scheduled loss), or (2) based on a permanent impairment rating for other lost body function.
If you’ve completely lost the use of a body part included in Wisconsin’s PPD schedule, you’ll receive benefits for the number of weeks listed in that schedule. The schedule mostly covers extremities (arms, legs, hands, feet, fingers, and toes), but it also includes removal of an eye or lost vision, as well as deafness. The number of weeks will be multiplied by a certain amount if you have an impairment to your dominant hand or to multiple body parts listed on the schedule.
If you suffer a partial loss of a listed body part, benefits will last for a proportional length of time. For example, if you lost 50% of the use of your hand, the benefits will last for half of the maximum in 200 weeks in the schedule, or 200 weeks. If it was your dominant hand, that period will be increased by 25%, for a total of 250 weeks.
For permanent partial disability that isn’t listed on Wisconsin’s schedule (such as to your lungs or back), the duration of your benefits will be a percentage of 1,000 weeks, based on your permanent impairment rating. For example, if you had a back injury that resulted in a 15% permanent impairment rating, you will receive PPD benefits for 150 weeks (1,000 x 0.15).
If your injury left you with a permanent disfigurement to a part of your body that would be visible at work and could potentially result in wage loss, Wisconsin’s Workers’ Compensation Division may award you any amount of permanent disability that it considers fair, considering several factors such as your age, education, training, previous experience, and occupation.
You are entitled to permanent total disability benefits if your workplace injury or occupational illness prevents you from performing any type of work. Certain injuries (including the loss of both eyes, arms, or legs) are presumed to be totally and permanently disabling. Other serious injuries may also qualify. The benefits as long as you continue to be totally disabled (potentially for life), at the same rate as TTD benefits.
In addition to temporary and permanent disability benefits, Wisconsin workers’ compensation provides other benefits, including:
If an injury or illness results in death, the worker’s dependents may receive death benefits. Death benefits can be up to four times the worker’s annual wages (subject to a maximum benefit). Additionally, the insurance company must pay up to $10,000 for the worker’s reasonable funeral and burial expenses.
If your employer’s insurance company has disputed your workers’ comp claim or is balking at paying the benefits you think you deserve, you should contact qualified workers’ comp lawyer.
A local attorney who’s experienced in this area should be able to evaluate your claim and ensure that you receive all of the benefits you’re owed under Wisconsin law. A lawyer can also explain any potential reduction in your benefits if you’re also receiving Social Security disability benefits. (Learn more about finding and hiring a workers’ compensation lawyer.)
]]>This article explains the types and amounts of benefits that you may receive after you file a workers’ compensation claim.
If you can’t work for more than seven days because of your on-the-job injury or illness, you will be entitled to receive temporary total disability (TTD) benefits. In New Jersey, these benefits are 70% of your average weekly wages before the injury, but there is a maximum and minimum that changes every year.
For injuries that happen in 2023, the weekly maximum benefit is $1,099, and the minimum is $293.
TTD benefits continue until you:
(N.J. Stat. §§ 34:15-12(a), 34:15-14 (2023).)
Once you've reached maximum medical improvement, your doctor will evaluate you to determine if you have any lasting disability as a result of your injury and, if so, to what extent.
If you're permanently and totally disabled—meaning that you can’t work at all because of your injury—you will continue to receive weekly payments at your temporary total rate.
However, once you’ve received these benefits for 450 weeks, you’ll have to go through an evaluation and prove that you underwent physical or educational rehabilitation (if ordered to do so) but are still unable to earn at your pre-injury level. If you can show that, your benefits will be extended as long as you’re still disabled, with the amount of your payments reduced in proportion to any wages that you’re actually able to earn.
Certain severe injuries—such as the loss of both eyes, hands, arms, feet, or legs, or a combination of any two—are automatically considered to result in permanent and total disability. (N.J. Stat. § 34:15-12 (2023).)
If your work-related injury or illness has left you with a lasting medical condition or lost function (often called an impairment) but you’re still able to work in some capacity, you may be eligible for permanent partial disability benefits. The amount you’ll receive will depend on the extent of your impairment and the affected part of your body, as well as on your pre-injury wages.
New Jersey provides a schedule of disabilities listing the maximum benefits for impairments to certain body parts—such as a hand, arm, foot, leg, or eye—at different levels (expressed in terms of a percentage of lost function). For example, if your leg was amputated as a result of your injury, you would receive 315 weeks' worth of benefits, at 70% of your pre-injury wages.
But if you only lost 50% of the use of a leg, you’d receive 157.5 weeks' worth of benefits. (You can find New Jersey’s current schedule of disabilities, as well as the current maximum and minimum disability rates, on the state’s Department of Labor and Workforce Development site.)
For permanent impairments to other body parts (such as your head, spine, or organs), you may receive a “nonscheduled award” for a portion of the maximum time period (600 weeks) that corresponds to the level of your disability. For example, if your doctor assigns you a 10% disability rating to the body as a whole, you can receive 60 weeks’ worth of payments. Here again, the weekly amount will be based on 70% of your pre-injury wages, up to the dollar limit. (N.J. Stat. § 34:15-12 (2023).)
You may receive other types of workers’ comp benefits in New Jersey, including:
(N.J. Stat. §§ 34:15-12(e), 34:15-13, 34:15-15 (2021).)
As you can see, workers’ comp benefits cover only a portion of your lost wages and don’t include anything for the pain and suffering caused by your injury. While this may seem unfair, it is part of the trade-off inherent in the workers’ comp system. The advantage of workers’ comp is that you can get benefits relatively quickly without filing a lawsuit and proving that your employer was at fault for causing your injury. The downside is that you can’t get the full value of your losses. (However, you may be able to sue outside of the worker’s comp system in certain limited situations.)
]]>This article explains the types of workers’ comp benefits available in the state, as well as how they’re calculated. (To get these benefits, you must promptly report your injury to your employer and file a workers' compensation claim.)
Workers’ comp pays for all reasonable and necessary medical treatment related to a work injury, as long as the health care provider is authorized. (Learn how to get medical treatment through workers’ comp.)
When it’s appropriate, you may also receive mileage reimbursement for travel to and from doctors’ appointments.
If you need to take more than seven days off work to recover from your work-related injury, you may receive cash benefits intended to replace part of your lost wages. You won’t receive these benefits for the first seven days, unless you ultimately are off work more than 14 days.
The amount of temporary disability benefits depends on your average weekly earnings during the year before your injury, as well as the extent of your temporary disability. Your treating doctor will assign you a disability percentage, ranging from 0% to 100%.
If your doctor says that you’re 100% disabled on a temporary basis, your temporary disability benefits will be two-thirds of your average weekly wage, up to a maximum amount.
The legal maximum depends on the date of your injury. For injuries that happened between July 1, 2023 and June 30, 2024, the maximum is $1,145.43.78 per week. (For other injury dates, the New York Workers' Compensation Board (WCB) keeps an updated list of the maximums on its website.)
If you aren't able to return to your full pre-injury job (and the wages that come with that) but can do some level of work while you're recovering from your injury, you will be entitled to partial temporary disability benefits. These benefits will amount to two-thirds of the difference between your average weekly wage and your current earning capacity (up to the same cap mentioned above).
For this purpose, your earning capacity is generally measured by what you're actually making. For example, if your average weekly wage was $900, but you’re working a light-duty job earning $300 per week, you could receive two-thirds of the difference ($600), or $400 per week.
However, if you aren't working at all—for instance, because your employer hasn't offered you a light-duty position that accommodates your partial disability—the WCB may assign you a level of earning capacity that's reasonable under the circumstances (but no more than 75% of your pre-injury wages).
Once your medical condition has stabilized to the point where it wouldn’t improve even with further treatment (a stage known as “maximum medical improvement”), your doctor will evaluate you to decide if your injury has left you with permanent limitations. If the doctor says that you’re 100% disabled, you’ll receive two-thirds of your average weekly wage as long as you continue to be disabled.
Generally, permanent total disability means that you can’t work at all because of your limitations, but injured employees with certain types of disabilities (such as the loss of both eyes, legs, or arms) may be able to earn a limited amount of money without losing their disability benefits.
New York has three different ways of awarding benefits for permanent partial disability, depending on the parts of the body that are affected.
New York law includes a schedule to determine permanent partial disability benefits for injured employees who’ve lost the ability to use certain parts of their body (eyes, ears, and parts of the upper and lower limbs).
If you’ve permanently lost some use of one of these body parts, you’ll receive two-thirds of your average weekly wage (up to the legal maximum) for the number of weeks listed in the schedule, multiplied by the percentage of your lost use. For example, the schedule lists a total loss of use of a hand at 244 weeks. If you have only 50% lost use, you would receive 122 weeks of payments.
You may request a lump-sum payout instead of weekly payments. Cash benefits that you have already received are deducted from your award.
If you have a permanent disability to your spine, head, organs, or another part of the body not listed on the schedule, you may receive permanent partial disability benefits. The amount of the payments will be two-thirds of the difference between your pre-injury average weekly wage and your current earning capacity (as determined based on your specific disability and state guidelines).
The maximum number of weeks you’ll receive these benefits will depend on the percentage of your lost earning capacity, according to a formula in New York law. For example, you’ll receive benefits for no more than 500 weeks if you’ve lost 91% of your earning capacity, while a 15% loss of earning capacity will result in benefits for no more than 225 weeks.
You may be able to receive an additional award of up to $20,000 if your injury has left you with a permanent, serious disfigurement to your face, head, or neck, or if a workers’ comp judge has decided that disfigurement to certain other parts of your body could hurt your earning capacity.
New York workers’ compensation also provides additional benefits, including:
You can see by now that you won’t receive compensation for all of your losses through workers’ compensation. This may seem unfair, but it’s part of the workers’ comp trade-off: You can receive benefits relatively quickly without having to prove that your employer was at fault for the injury. At the same time, you generally aren’t allowed to sue your employer in an effort to receive the full value of your lost earnings, as well as damages like pain and suffering.
However, there are limited circumstances when you may be able to sue outside of the workers’ comp system for a workplace injury. If you believe your case may qualify for one of these exceptions, or you’re having trouble collecting workers’ comp benefits, consider speaking with a workers’ comp lawyer.
An attorney who’s experienced in this area can explain how the law applies to your situation and make sure you get the compensation you deserve.
]]>In general, it’s not illegal for private investigators to observe you in public places and take photos or videos of you. They can also gather evidence from:
This doesn’t mean they may go to any lengths to get incriminating evidence against you.
Private investigators aren’t allowed to do anything illegal, which could include:
Despite these limitations, private investigators may gather valuable ammunition against you simply by following you around in public while you run errands, attend doctors’ appointments, or mow your front lawn.
In some states, they may be allowed to take photos or videos of you inside your home, as long as they can see you from public property through a window.
Even in states with laws against secretly photographing or recording through the window of a house, such as Minnesota, it’s generally only a crime if the person being recorded reasonably expected privacy (Minn. Stat. Ann. § 609.746(b) (2022)).
It would be hard to argue that it was reasonable to expect privacy when you’re walking in front of the living room window with the curtains open, visible from the street.
Fortunately, you can take steps to prevent a private investigator from jeopardizing your workers’ comp case. Even if the insurance company hasn’t disputed your claim, make sure that your public activities are consistent with your injuries.
And be careful not to put yourself in situations that could look bad if taken out of context. For example, if you injured your back in the fall at work, don’t allow yourself to be photographed or video recorded lifting heavy boxes, gardening, or horsing around with your kids.
You might think it’s OK to try these activities and stop as soon as you feel pain. But a photograph of a single instant (or a brief video clip) could make it look like you’re physically able to perform these tasks.
Finally, don't forget that private investigators have telephoto lenses and are trained to get quality photographs from over a hundred feet away. So just because you don’t see photographers nearby doesn’t mean they’re not there.
If the insurance company disputes any part of your claim—especially if it has photos or videos that show you in a bad light—you should speak with a workers’ comp lawyer.
An attorney who’s experienced in this area of the law can help counter that evidence, put it in context, and gather other evidence that can support your claim. (Learn more about what a good workers’ comp lawyer should do for you.)
See our article on filing a workers’ compensation claim to learn how to start the process for getting benefits, including payment for your medical care.
You should seek treatment right away for any injury, even if it seems minor. This means seeing a doctor immediately after a work-related accident or at the first sign of any symptoms that might be due to your work duties or to toxic exposure on the job.
Getting prompt treatment serves two important purposes: First, early treatment makes it more likely that you’ll recover from your injuries faster. Second, the closer in time to your accident that you receive treatment, the less room it gives your employer (or its insurance company) to argue that your medical condition isn’t related to your work.
No matter what, you should resist the urge to “tough it out” or downplay the seriousness of your injuries. This can delay or impede your recovery, and it can affect the scope of treatment authorized by workers’ comp or the amount of benefits you ultimately receive.
If you need immediate medical attention, you should go to the nearest emergency room. If it’s not an emergency, however, you’ll need to follow your state’s rules for getting medical care.
Some states give you the right to choose the doctor who will treat you for your injuries (called your "treating doctor" in workers' comp lingo), while others give that right to your employer or its insurer.
Still other states have more complicated rules for selecting a treating doctor. For example, in California, you can choose your treating doctor only if you officially designated your personal primary physician for that purpose before the accident, and you have health care coverage (see details on selecting treating doctors in California workers’ comp cases).
And in Massachusetts, your employer can require you to see a health care provider within its preferred provider arrangement (if it has one), but only for the first visit; after that, you can switch to your choice of treating doctor (Mass. Gen. Laws ch. 152, § 30 (2018)).
To learn more, see our articles on how to find a treating doctor and changing doctors in your workers’ comp case.
Although doctors hired by employers or insurance companies are supposed to be objective, they often have close and financially rewarding relationships with the employers and insurers that refer cases to them. Because of this, it’s in your best interest—whenever possible—to receive treatment from a doctor you know and trust.
When you have a choice, make sure you select a doctor who’s both experienced and articulate. Your treating physician will play an essential role in your workers’ compensation case.
In addition to making decisions about your diagnosis and the treatment you should receive, the doctor will often have to write reports (and sometimes give testimony) that will affect when you can return to work and the benefits you’ll receive, including payments for temporary disability and permanent disability.
So it’s important that the treating physician can clearly and convincingly explain the reasons behind his or her decisions. (Learn more about the role of the treating doctor in your workers’ comp case.)
In any case, make sure that you obtain treatment through the correct avenues and from a properly licensed or credentialed doctor. Otherwise, you run the risk that your medical bills will not be covered.
Even with the advancement of medical technology, doctors still rely on patients to report symptoms, severity of pain, and activities that are difficult or impossible to perform.
This is especially true for soft tissue injuries; these injuries don’t involve bones and often cannot be verified through medical imaging like x-rays. Because some injuries can be more subjective in nature, it’s especially important for you to communicate with your doctor about what you’re feeling. In doing so, you should follow these guidelines:
In most states, your employer is required to pay for your medical bills until a decision has been made to accept or deny your claim, at least up to a certain amount. If your claim is approved, your employer will continue to pay for your medical bills for approved treatment.
If your workers’ comp claim is denied, you can pay for your own bills and seek reimbursement from the insurance company if and when the denial is overturned on appeal.
Some doctors might agree to treat you on what’s called a “lien basis,” meaning that payment for your bills will come out of any recovery you get through workers’ comp. In the meantime, if your state has a temporary disability insurance program, you may be eligible to apply for these short-term benefits to make up for some of your out-of-pocket costs.
Workers’ comp cases can be difficult to navigate, especially if your employer’s insurance company is fighting your claim or refusing to authorize medical treatment (like surgery or other expensive procedures) that your treating doctor has recommended.
Getting the help of an experienced workers’ compensation attorney can be invaluable in making sure you’re fully compensated for your loss and able to get all the medical treatment that you need. A local lawyer with workers’ comp expertise may also be able to refer you to doctors who can provide proper care as well as strong medical evidence to support your case. (Learn more about what a good workers’ comp lawyer should do for you.)
]]>Here are some practical tips on how to get the most out of your workers’ comp claim.
The first thing you should do after a work injury is immediately report it to your boss. Every state requires workers to give notice of their injuries by a certain deadline, which varies significantly by state. If you miss the deadline, you might lose your right to collect workers’ comp benefits. In some states, you’ll also need to file a workers’ compensation claim form by a certain date in order to officially start your claim. To learn more about these requirements, read our article on filing workers’ comp claims.
You should seek medical treatment as soon as possible after your injury. Prompt medical care can lead to a quicker, fuller recovery. It also serves as important medical evidence in your workers’ comp claim by documenting your accident and describing your injuries and physical restrictions. If you delay in getting treatment, the insurance company could argue that you weren’t as seriously injured as you say you were—or that your injury never happened at all.
In many states, workers must initially treat with a doctor chosen by the insurance company. When you treat with the insurance company’s doctor, there is a potential conflict of interest. These doctors are paid primarily by insurance companies and may not always have your best interests in mind. For example, the doctor might minimize your injuries and treatment so that the insurance company won’t have to pay you as much. (If you’re lucky enough to live in a state that lets you choose your own doctor, this usually won’t be a problem.)
Because your treating doctor will play an essential role in your workers’ compensation case, you should switch doctors if you think you’re not getting the best treatment. Each state has its own rules and procedures for changing doctors, which vary significantly. For example, there might be a waiting period before you can switch, or you might be limited to only one change during the course of your workers’ comp claim. And, in some states, the insurance company will select your new physician or you’ll be required to choose from a network of approved doctors.
Injured workers should understand the available benefits through the workers’ comp system. While each state has its own rules for eligibility and amounts, the following benefits are typically available:
Because insurance companies are for-profit businesses, you shouldn’t rely on the adjuster to fully explain your state’s benefit system or all of the available benefits. If you have questions, contact your state workers’ compensation agency or a workers’ comp lawyer for help.
Unlike a regular doctor’s appointment, an independent medical examination (IME) does not focus on treating your injury. Instead, the insurance company hires a doctor to perform an examination, review your medical records, and issue a report. This report summarizes the doctor’s opinion on your diagnoses, work restrictions, and the relationship between your injury and your work. Frequently, insurance companies schedule IME’s when they want to terminate or reduce your workers’ comp benefits.
If you are scheduled for an IME, you must attend the appointment (or risk termination of your workers’ comp benefits). It’s important to prepare for the IME by reviewing your medical records and anticipating tricky questions from the IME doctor. See our article on how to prepare for your IME to learn more.
If the insurance company questions your credibility, it might hire a private investigator to follow you around. The investigator will watch you at home and in public places—hoping to catch you doing something that contradicts your workers’ comp claim. For example, suppose you tell your doctor that you can’t lift more than five pounds. If surveillance footage shows you carrying boxes into your house, the insurance company will use it to argue that you’re lying about your symptoms. However, the footage can easily be misinterpreted—the boxes might be lighter than they appear or you might have experienced a serious increase in pain afterward. If you think you are under surveillance, talk to a workers’ comp lawyer about how you can minimize the impact of surveillance footage.
It’s always in your best interest to keep copies of paperwork concerning your workers’ comp claim, including work restrictions, letters from your employer or the insurance company, and completed forms (such as an accident report). While your doctors will create medical records documenting your treatment, work restriction slips are not always put in your medical records. Many of these records are essential for getting your workers’ comp claim approved and paid.
Insurance companies are for-profit businesses. They frequently deny legitimate workers’ compensation claims in an attempt to save money. However, you have the right to appeal the insurance company’s denial. Many workers who received initial denials end up receiving at least some workers’ comp benefits after filing an appeal.
While every state has a different process and requirements, an appeal typically requires filing a written form with the state agency by a certain deadline. Once the state agency processes your appeal, a judge will typically schedule one or more hearings to assess and resolve your dispute. Because workers’ comp appeals are complicated and require extensive legal and technical knowledge, you should seriously consider hiring a workers’ comp lawyer at this point. (For more information, read our article on workers’ comp appeals.)
Unless you have a workers’ comp lawyer, you must attend every legal meeting or court date during an appeal (such as mediation, scheduling conferences, and hearings). If you do not appear at a scheduled legal appointment, you risk losing some or all of your benefits. Even if you have a lawyer, you will need to show up for some key events (such as your deposition or an independent medical examination). If you have to miss an appointment, it should be for a good reason and you should notify the insurance company and the state agency beforehand.
You might not need a lawyer if your workers’ comp claim is very simple or if the insurance company voluntarily pays your claim. However, consider hiring an experienced lawyer if the insurance company:
It can be difficult to navigate the workers’ comp system, including when to accept a settlement offer and for how much. A lawyer can properly value your claim, negotiate with the insurance company, and represent you in an appeal, if necessary.
]]>If a work-related injury or illness prevents you from working for a period of time while you recover, you may be entitled to receive money to help replace your lost income.
To qualify for these payments—usually called temporary total disability (TTD), wage loss, or income loss benefits—you first must be eligible for workers’ compensation, file a workers’ comp claim, and seek medical treatment under your state’s rules. If your treating doctor says that you can’t go back to work right away because of your injury or illness, your employer’s insurance company should begin paying you TTD benefits.
State laws require a waiting period before you can collect TTD benefits—meaning that you have to be out of work for a period of time (usually three to seven days) before you’re eligible to receive the payments. But if you’re out for a longer period (usually 14 or 21 days), you’ll receive benefits from the time you were first disabled.
In order to get workers’ comp benefits for COVID-19, including temporary total disability benefits, you generally need to prove that the particular nature of your job put you at a higher risk of exposure than the general public, and that you contracted the disease while you were working.
Several states have enacted measures that make it easier for certain employees to qualify for benefits by presuming that they’ve contracted COVID-19 at work when they test positive or are diagnosed with the disease.
Most of these laws apply to first responders and healthcare workers in direct contact with infected patients, but states like New Jersey, California, and Illinois extend similar presumptions to a broader range of employees.
A handful of states, including Kentucky and Missouri, specifically include wage-loss benefits when certain employees are under quarantine because of exposure at work. Unless you’re covered under these special rules, however, it will be difficult to qualify for temporary total disability if you can’t work because of COVID-19. Learn more about wage-loss benefits while in quarantine for coronavirus exposure.
Temporary disability benefits are generally about two-thirds of your average weekly wage before you were injured, up to a maximum that's based on the statewide average weekly wage for the year of your injury. Some states also have a minimum for low-wage workers. (See our state-specific articles on workers' comp benefits for details.)
Temporary disability benefits through workers’ comp are generally not considered taxable income.
In most states, you can receive temporary partial disability (TDP) benefits if your doctor says that you’re able to go back to work on a limited basis. For instance, your doctor may recommend a schedule of only four hours a day or three days a week. In that case, you’ll usually receive two-thirds of your lost income—the difference between what you were earning before the injury and what you’re earning now.
Generally, you can collect temporary disability benefits until one of the following occurs:
Many states limit TTD benefits to a certain number of weeks (often 104 weeks, but sometimes as much as 500 weeks). Even in states with a limit, benefits may be extended longer for certain serious conditions (such as HIV, some forms of hepatitis and lung disease, amputations, and serious burns).
The time limit on TTD benefits can present a serious challenge for injured employees who get caught in a “gap” before they reach MMI and qualify for permanent disability. Often, this happens when insurance companies delay approvals for medical treatment, especially surgeries or other expensive procedures.
If hit your state’s limit on TTD benefits while you’re still waiting for surgery that your doctor has recommended, you could find yourself unable to work but without benefits to help replace your lost income. The Florida Supreme Court found that when that state’s 104-week limit on TTD was applied to an employee who wasn’t yet MMI, it violated Florida’s constitutional guarantee of access to the courts to seek a remedy for an injury. In cases like that, the court held that the 260-week cap in a previous version of statute should apply. (Westphal v. City of St. Petersburg, 194 So.3d 311 (Fla. 2016).)
Some states address this problem by assuming that injured employees are MMI when they exhaust their temporary disability benefits, which means they’ll be evaluated to determine if they have permanent disabilities.
If the claims adjuster at your employer’s insurance company disagrees with the treating doctor’s opinion on temporary disability (that is, the adjuster says you should be able to go back to work), the insurer can ask for an independent medical exam (IME) or similar evaluation by another doctor who's neutral (at least in theory). If you or the insurer disagrees with that doctor’s opinion, either of you can request a hearing before your state’s workers’ compensation board.
If you refuse to attend an IME, your temporary disability benefits will be cut off.
If you expect to be unable to work for more than 12 months, you can also apply for Social Security disability insurance benefits (SSDI). But if you’re collecting workers’ comp benefits, your SSDI benefits will be decreased so that the combined amount of SSDI and worker's comp payments don't exceed 80% of your average earnings when you were working. (In some states, the offset works in reverse; the workers’ comp benefits are reduced if you’re collecting SSDI.) You won’t get less than you would collecting SSDI alone, however, and your combined monthly payment should be higher than if you were just collecting worker’s comp benefits.
There are ways to minimize the workers’ comp and SSDI offset in your workers’ comp settlement with the insurance company. But in that case—or any time the insurance company is challenging your right to temporary disability benefits, you should strongly consider contacting a workers’ compensation attorney. The laws in this area are complicated and vary significantly from state to state. An experienced lawyer can help protect your right to benefits.
]]>To address this issue, many states allow injured employees to collect penalties from insurance companies when their rights have been violated. The same rules and penalties generally apply to large employers that are approved to be self-insured, meaning that they pay benefits themselves (although they often hire outside claims administrators to handle the claims process).
After you’ve reported your injury and filed a workers’ comp claim, the insurance company has a certain amount of time—usually within 14 to 30 days—to deny the claim or start paying workers’ comp benefits, including medical treatment and temporary disability payments.
If the insurance company hasn’t denied your claim by the deadline but still hasn’t started paying benefits, some states allow you to collect a penalty for late temporary disability benefits (which are typically paid every two weeks). Penalties may also apply whenever you don’t receive a benefit check on the due date. In California, for example, the insurance company should add on 10% to all late payments (Cal. Lab. Code § 4650(d)).
In other states, penalties don’t start until the payments are overdue by a certain amount of time. And there may be different penalties and time limits for paying compensation due under a workers’ comp award or settlement, as opposed to benefits that an insurer is paying voluntarily after accepting a claim.
In New York, for instance, late penalties for voluntary installment payments don’t kick in until they’re at least 25 days overdue; at that point, the insurer must add on 20% to the late payment, along with an additional penalty of $300.
When an employee has won an award after a hearing or going through the state’s conciliation process, there’s a late penalty if the insurance company doesn’t pay the award within 10 days; the insurer must pay the employee an additional 20% of an award after a hearing or $300 if the award followed conciliation. (N.Y. Workers’ Comp. Law § 25.)
Many states require insurance companies to pay interest on late payments, separate from any penalties.
Some insurance companies deny legitimate workers’ comp claims in order to reduce their costs. If this happens to you, you may not receive the benefits you deserve—or at least not until you’ve gone through the lengthy process of appealing the denial with your state’s workers’ comp agency. Even if the insurer accepts your claim, it may refuse to pay some benefits without a good reason.
To discourage this kind of behavior, many states impose stiff penalties for unreasonable claim denials, refusals to pay, or delayed payments. For example, if insurance companies in Iowa don’t have a reasonable justification for denying a workers’ comp claim, delaying payments, or ending benefits, the injured employees will be awarded an additional 50% of the benefits that were owed (Iowa Code § 86.13).
In Massachusetts, when an employee appeals a claim denial and a workers’ comp judge finds that the insurance company didn’t have a good reason for fighting the appeal, the judge will order the insurer to pay the employee twice the amount of benefits owed, as well as the employee’s attorneys’ fees and legal costs (Mass. Gen. Laws Ch. 152, § 14).
Workers’ compensation is a no-fault system, which means that employees with work injuries may receive benefits regardless of whether the employer did anything wrong. Unlike personal injury lawsuits, the employer’s conduct is generally irrelevant to an injured worker’s right to benefits.
However, a few states impose additional penalties on employers when their actions caused injuries. These penalties may be relatively low for simple violations of safety rules, such as a 10% penalty in New Mexico for failing to provide required safety devices (N.M. Stats. § 52-1-10).
Ohio’s Industrial Commission may award employees an additional 15% to 50% of the maximum legal award if they were injured because their employers violated workplace safety rules (Ohio Const. Art. II, § 35).
A few states impose stiff penalties for more serious wrongdoing. For example, when employees in Massachusetts are injured because of their employers’ serious and willful misconduct, they may collect double the amount of compensation that would otherwise be owed under the state’s workers’ comp laws (Mass. Gen. Laws ch. 152, § 28). California's penalty for serious and willful misconduct is 50% more compensation (Cal. Labor Code § 4553).
The penalties described above are the ones commonly paid directly to injured employees. Most states also require insurers to pay penalties and/or interest to doctors or other health care providers if they are late in paying medical bills for work injuries. And employers or insurers may have to pay steep fines to the state workers’ compensation agency when they don’t meet certain legal requirements.
The requirements for collecting a penalty are different depending on where you live and the type of penalty. Some penalties are mandatory and should be automatic (at least in theory), like the late fees in certain states. But before you’re able to collect other penalties—especially those for unreasonable delays or denials—you may have to file a request and go to a hearing. The same is true if the insurance company balks at paying the mandatory penalties.
As with everything else related to workers’ compensation, these proceedings may be complex. And your employer or its insurance company is likely to put up a fight if the penalty will amount to a lot of money.
So if you having trouble getting your benefit checks on time and in the correct amount, you’d be wise to speak with an experienced workers’ comp lawyer.
Learn more about when you can handle your own workers’ comp case and when you may need an attorney.
]]>The first step toward getting any kind of workers’ comp benefits is to show that you meet all of the basic eligibility requirements:
Also, you must follow your state’s rules for getting medical treatment from a workers’ comp treating doctor.
You generally won’t be considered for permanent disability benefits until your treating doctor says you’ve reached a plateau in your recovery—meaning that your condition isn’t expected to improve further with more treatment, at least in the near future. In workers’ comp lingo, this is usually called “maximal medical improvement” (MMI), or sometimes “permanent and stationary.”
The amount of time it takes to reach MMI can vary widely—anywhere from a month to a few years after you were first hurt or became ill. The nature of your injury or illness will have the biggest impact on how long it takes. Even if you don’t completely heal from a broken leg—for instance, if you continue to have trouble walking on uneven surfaces—your condition will probably stabilize more quickly than if you got cancer from on-the-job exposure to toxic chemicals. But other factors can play a role too, including the medical treatments that are available and whether the insurance company has been dragging its feet on approving surgeries or other expensive procedures.
Some states, like Texas, assume that employees have reached MMI when they’ve been getting temporary total disability benefits for a period of time (usually 104 weeks).
Once your doctor says you’ve reached MMI, the process will begin to determine whether you have any permanent disability and, if so, how much. This is also generally the point when you’ll stop receiving temporary disability payments if you’ve been off work and those benefits haven’t already run out. (Several states have a time limit on temporary total disability benefits.)
The rules for determining permanent disability vary considerably from state to state. Usually, your treating doctor will say whether you have a lasting medical condition or lost function (referred to as an impairment) that resulted from your work-related injury or illness. An impairment could be anything from a bad back to a severed finger to opioid dependency from painkillers that you had to take for a serious orthopedic injury.
Depending on the rules in your state, the insurance company may request an independent medical examination (IME) to assess your permanent impairments. You might also be able to ask for an IME if you disagree with another doctor’s opinion.
States have different criteria for using the medical information about impairments to decide whether injured employees have permanent disabilities that affect their ability to perform certain tasks—or even to work at all. Most commonly, the result of the process is what’s called a permanent disability rating, expressed in a percentage.
You don’t necessarily have to prove that you can’t work at all in order to receive total permanent disability benefits. For instance, you may be considered totally and permanently disabled if you have certain kinds of injuries (for instance, if you lost both eyes or both legs). You may also qualify if you have a combination of permanent impairments that add up to a 100% disability rating.
If your disability rating is less than 100%, you may be able to receive some kind of partial permanent disability benefits, although states have different systems for compensating employees who have lasting effects from their injuries. (Learn more about how to get permanent partial disability through workers’ comp.)
Once the insurance company hears from a doctor that you have a permanent disability, the company should begin sending you checks for permanent disability benefits shortly (usually about two weeks, as required by state law).
But if there’s a dispute—over the amount of permanent disability or whether you have any lasting impairments—you should contact a workers' compensation lawyer as soon as possible.
The rules and the process are complicated, and insurance companies (and their lawyers) do everything they can to keep their costs down by denying or minimizing permanent disability benefits. You need an experienced attorney on your side to protect your rights and your future.
You should also know that permanent disability benefits don’t necessarily last the rest of your life. If you’re totally and permanently disabled, you’ll usually be entitled to a lifetime pension (though a few states cut off payments at a certain point for all but the most serious disabilities). When it comes to partial permanent disability, however, most states limit how long the benefits last.
Whether the benefits are for partial or total permanent disability, some states allow you to opt for a lump-sum payment in a workers’ comp settlement. Here again, it would be wise to speak with a workers’ comp attorney before you agree to a settlement to make sure you don’t unwittingly sign away important rights.
]]>But what can you do if your claim has been denied? The answer could depend on the reasons for the denial.
Employers or their insurance companies sometimes look for any possible reason to deny workers’ comp claims. Of course, that reason should be a valid one under the law. There are several common reasons for claim denials, including:
Don’t give up your right to workers’ comp benefits just because your claim was initially denied. First, look closely at the letter telling you that your claim was denied. It will probably include the reasons for the denial. If you think it was simply a matter of mistaken paperwork or something similar, you might consider contacting the claims adjuster to see if you can clear up the problem.
But this route isn’t likely to be successful unless your employer or the insurance company made a bona fide mistake and admits it. More likely, you’ll have to consider appealing the denial.
The letter you received may include information about how to appeal the denial of your claim. If so, read it carefully.
The appeals process varies in each state. Often, the first level of appeal will be at a hearing before an administrative law judge, where you’ll have to present medical and other evidence to support your claim.
The hearing can be through a state labor department or a state board of workers’ compensation. There are additional levels of appeal beyond the initial administrative levels as well, which vary depending on the state.
Each state has its own deadline for appealing a workers' comp denial, generally between 30 and 90 days. Look for your state's deadline on your denial letter, or look it up or your state's workers' comp agency's website.
Unless your claim was denied due to a simple mistake that was immediately cleared up, it would be smart to speak with a workers' comp lawyer as soon as possible. An attorney can help you determine whether an appeal would be the best course of action for you. The timelines for workers’ comp appeals are short and strict, and you don’t want to lose your rights to benefits just because you missed a deadline.
Before you consider filing any appeal yourself, you should definitely talk to an attorney. Appeals are complicated legal processes, involving rules of evidence and civil procedure that the judge will expect you to know.
If you don’t win at the initial levels, you may not be able to present additional evidence later in the process. One of the reasons that many injured employees lose their appeals is because they didn’t have an experienced workers’ compensation attorney at their side to help them prepare a strong case.
Also, most workers' comp lawyers charge only a percentage of the benefits you actually receive, so it won't cost you anything unless you win.
]]>If your doctor isn't willing to help with your workers' comp claim, seriously consider finding one who will. An experienced workers' comp attorney can help point you in the right direction.
Below, we discuss the significance of your treating physician—and how to change doctors if necessary.
Your treating doctor’s opinion will carry significant weight in your workers’ compensation case. Unlike a doctor who examines you once, your treating doctor monitors your recovery over time. This gives your treating doctor a better understanding of your injuries, your need for medical treatment, your ongoing physical limitations, and the likelihood of a full recovery.
Your doctor will make important decisions in your case that will directly affect your recovery and benefits, including:
The rules about who selects the treating doctor vary from state to state. In some states, you can choose your own doctor from the very beginning. For example, in California, you may “predesignate” your primary care doctor to treat your work injuries, as long as you do that before the injury. (See details in our article on choosing treating doctors in California.)
In other states, you might be limited to selecting a doctor from your employer’s established health care network or from a list of approved physicians. Finally, some states let your employer choose your initial treating doctor.
If you live in a state that allows your employer or its insurance company to choose your doctor (sometimes called a “company doctor”), you might find yourself receiving substandard care. While some company doctors are unbiased and provide high-quality treatment, others tailor their treatment to minimize the insurance company’s expenses. For example, it’s not uncommon for a company doctor to send an employee back to work too quickly or deny a necessary surgery because of the expense.
Because your treating doctor’s opinions will have serious impacts on your health and your workers’ comp benefits, you need a doctor that focuses on your recovery—not on the insurance company’s financial interests. If you’re worried about the company doctor’s potential conflict of interest—or you’re unhappy with your medical care and lack of improvement—consider changing doctors. In nearly all states, you can change doctors at least once in your workers’ comp case. However, you need to follow the proper procedures in your state. (To learn more see our article on how to switch workers’ comp doctors.)
If your state lets you choose your treating physician, you should take advantage of this opportunity and carefully weigh your options. You should research doctors in your community and consider their:
The doctor’s personality is also important. You should trust your doctor and feel comfortable discussing your conditions and concerns with him or her. To learn more, see our article on finding a treating doctor in your workers’ comp case.
One of the advantages of hiring a workers' comp lawyer to represent you is that they understand how to develop medical evidence in a case. An experienced workers' comp attorney will understand what sort of medical documentation—lab tests, MRIs, x-rays, hospital records—is needed to prove your case, and how to get it.
Your attorney might also be able to point you in the right direction when it comes to finding a treating physician. And, when the time comes, your lawyer can ask your treating physician for opinion evidence on the extent of your work-related limitations. This sort of evidence is critical in a workers' comp case, and often makes the difference between a winning and losing claim.
]]>Each state has its own spin on these general rules, and the details can get complicated; for more information on the rules in your state, see the links in our state-specific articles on workers’ comp benefits.
Workers' comp pays for hospital and other medical expenses that are necessary to identify and treat a work-related injury or illness. Although the details vary in each state, medical benefits generally cover doctor visits, medication, and surgeries.
If you need equipment (such as a wheelchair or special vehicle) to help you deal with your injury, workers' comp will likely cover that cost as well. In some instances, workers' compensation will also cover services like counseling, pain therapy, and acupuncture.
State laws differ on whether you or your employer gets to choose your health care provider, and some states regulate how much the provider may charge for your treatment. (Learn more about seeking medical treatment for a work-related injury.)
Except for emergency care, you or your doctors may need to get advance authorization for medical treatment. For the most part, only generally acceptable medical practices will be covered. If you would like to use an experimental or investigative treatment or therapy, you may have trouble getting paid for those expenses, so you may want to get an attorney's help.
Rehabilitation benefits pay for medical and therapeutic care (such as physical therapy) necessary to help you cope with and recover from your injury or illness. They may also cover the care and training necessary for you to regain the skills and abilities you need to return to work.
If your injury or illness prevents you from returning to your former job, many states allow vocational rehabilitation or similar benefits that pay for evaluation, retraining, tuition, and other expenses associated with helping you become qualified to work at a different job.
Disability benefits are meant to compensate you for part of the wages you lose while your injury or illness makes it impossible for you to work. These benefits fall into one of four categories, depending on whether the disabilities are total or partial and temporary or permanent.
The amount of total disability benefits (whether temporary or permanent) are based on the amount you were earning prior to your injury—typically, two-thirds of your wages. (However, many states set a cap on the amount of the payments, and some states set a minimum.)
You generally don’t have to pay income taxes on workers’ comp benefits, so the amount may be closer to your usual wages than it first appears. Most states will require you to wait a period of time (usually a week) before you can start collecting temporary disability benefits.
When employees die as a result of their work-related injuries or illnesses, most states provide death benefits to some of their relatives (such as children and spouses) who were financially dependent on the deceased employees.
Although at least some funeral expenses are also covered, death benefits are primarily meant to compensate those dependent family members for the loss of financial support. Most states calculate this benefit as a percentage of the deceased worker's earnings. Some states have maximum and minimum amounts; others provide a lump sum.
Sometimes, the relationship between the dependent and the deceased worker can pose difficult legal issues. States have different rules for spouses (such as setting limits on their own earnings in order to qualify), stepchildren, children born outside of marriage, unmarried partners, and other relatives such as parents, siblings, and in-laws.
If you have any questions about your workers' comp benefit eligibility, or if your employer (or its insurance company) is disputing your right to benefits, you should consult with an attorney in your state who has experience dealing with workers' compensation issues. See Nolo's Lawyer Directory for a list of attorneys in your geographic area.
]]>An IME is conducted by a physician who will give an expert opinion about any disputes in your workers’ comp case. Most often, your employer’s insurance company requests an IME (and selects the examining physician when it disagrees with your workers’ comp treating doctor about whether your injury or illness is work-related, whether any medical treatment (such as surgery) is truly necessary and appropriate, if and when you can go back to work, and whether you have any permanent disability.
In some states, the workers’ compensation agency may order an IME, or you may be able to request one. You may have to attend several IMEs during your case. (To learn more about the selection of IME physicians, what happens during the exam, and how you can counter the IME doctor’s report, see What is an Independent Medical Examination and How Will It Affect My Workers' Compensation Case?)
The claims adjuster for your employer or its insurer may write a letter to the IME doctor describing your injury or illness, summarizing the medical treatment you’ve already received, and asking specific questions about your medical condition that are in dispute. This letter frames the issues that the IME physician will address. You should ask to review this letter ahead of time, so that you can correct any mistakes about the facts of your case and make sure that the questions are appropriate. If possible, make your request in writing and file a copy with the office of the state workers’ compensation agency where your claim was filed.
The IME doctor will likely have all of your relevant medical records, including records of previous injuries to the same part of the body that was affected by the recent workplace injury or illness. The examiner will ask you about all of these things, so take the time to review your medical history. Don’t try to conceal any previous injuries or downplay them, but do point out how your current condition is different than it was in the past, as a result of the recent workplace injury or illness.
The physician will ask you in detail about how the injury happened. Although workers’ compensation is a no-fault system, the examiner will want to make sure that the accident is in fact related to your job. Also, the IME doctor may be looking for inconsistencies in your story. Keep your answers brief, and make sure they’re consistent with what you have reported in the past (for example, in any accident reports or emergency room visits). Any changes in your story may be used as evidence that you are not telling the truth, so don’t be afraid to point out any inaccuracies in the reports.
You will probably also be asked about your treatment history for this injury, so look over your notes and records to review the tests, surgeries, or other procedures or treatment you’ve received so far. This is not a memory test, so if you can’t remember a specific date or medication, that’s fine. But you should have a general knowledge about what medical treatment you have received and when.
It is important to let the examiner know whether you are still experiencing pain, limitations, or other symptoms. Are you experiencing headaches or pain? Are you having difficulty with your everyday activities, such as walking, grooming, or sleeping? You will be asked in detail about your current symptoms and limitations, so make sure to include everything, no matter how minor it seems at the time.
Present yourself in a manner consistent with your injury. For example, if you have an ankle injury, you probably shouldn’t show up to the exam in high heels. Also, you should wear or bring any devices you need for your injury, such as crutches, dark sunglasses, or a sling. If you tell the doctor that you need to wear dark glasses all of the time because of constant headaches and you don’t wear them to the exam, you might lose credibility.
If you miss your appointment time, you may face consequences, such as having your benefits suspended. Make sure you give yourself plenty of time to get to your appointment.
You should plan to bring a trusted friend or relative with you to the exam. This person should not speak during the exam but may take notes, provide you with emotional support, and act as a witness to the exam.
Even if the IME doctor has been hired by the insurance company or workers’ comp agency, you should still be polite and respectful. Don’t assume the examiner is out to get you. Even if the doctor is less than friendly, responding with hostility can only hurt you.
IME physicians will often conduct tests or use other methods to help them determine how honest you’re being about your symptoms. They also have years of experience examining injured people to determine if they are accurately reporting their pain or limitations. If you’re caught exaggerating your symptoms, you will lose credibility and may have difficulty getting the benefits you deserve. However, while you should avoid exaggeration, you also shouldn’t downplay your pain or symptoms to seem more credible. Just be honest, thorough, and accurate about what you’re experiencing.
Likewise, you should be completely honest if you’re asked about activities you can and cannot do as a result of your injury. For example, don’t claim that you can’t drive anywhere if you’ve driven since your injury. It is possible that the insurance company has taken video surveillance of you over the last several months. You’ll lose credibility if you’ve said you can’t drive but there’s a video that shows you driving. Instead, if you are still having trouble driving, explain that you can only drive short distances.
If you’ve had a previous injury to the same body part, your employer and its insurance company likely will question whether your symptoms are due to the previous injury and not your workplace injury. Accordingly, it is important for you to explain how this injury is different. For example, if the earlier injury healed several years ago and you haven’t experienced any pain or symptoms for some time, tell the doctor that. Or, if you are experiencing new symptoms, more pain, or additional limitations due to this new injury, make sure to describe them.
If you or a friend weren’t able to take notes during the exam, take a moment to write down what you remember about how long it lasted, what the doctor asked you, what tests the doctor performed, and so on. Remember that you may be under surveillance leaving the office, so don’t do anything inconsistent with your injuries or what you said at the exam.
The IME doctor will write a report after the exam, and you or your attorney should receive a copy. Read it carefully and bring up any factual mistakes about your medical history or treatment. If you don’t have a lawyer, this is the time you should consult with an experienced workers’ comp attorney. Depending on the laws in your state, your lawyer may be able to request another IME with a different doctor to counter the first examiner’s opinion. Your attorney may also file objections, conduct a deposition to ask questions of the first examiner, and use all of the other available workers’ comp procedures for protecting your rights.
]]>Most states do not require employers to hold jobs open for injured workers or even offer other available positions when they are cleared to return to work. However, a handful of states do provide employees with a right to reinstatement or rehire within a certain period of time. And, there are other laws that might provide an injured worker with job protection rights or additional financial support.
In all states, your employer cannot fire you because you injured yourself at work or because you filed a workers’ compensation claim. That would be illegal retaliation, which is prohibited by workers’ comp laws. However, in most states, the protection ends there. Employers are otherwise free to fire injured employees while they are out on workers’ comp leave. For example, if your doctor has taken you off work and your employer needs to fill your position, it is typically free to do so.
However, it can be in an employer’s best interest to hire an employee who is able and willing to return to work. It minimizes the employee’s wage loss, which reduces the workers’ comp benefits being paid out to the employee. In many states, the employee’s benefits will stop or be reduced even if he or she refuses to take the job. (To learn more, see our articles on light-duty job offers and offers of suitable work after reaching maximum medical improvement.)
A handful of states have laws that offer job protection to injured workers. In some states, it is a right to reinstatement to their jobs within a certain period of time. For example, in Rhode Island, injured employees have the right to demand their previous jobs for up to one year from the date of injury. Employers with ten or more employees must return the employee to his or her previous position, even if it has been filled by someone else in the interim.
In other states, employers are prohibited from firing employees who are still healing from their work injuries. For example, in Oklahoma, workers who are receiving temporary total disability benefits may not be fired due to absence from work.
In other states, the injured employee gets a hiring preference only. For example, in Massachusetts, an injured employee who reapplies for employment must be given preference over other applicants who are not already employees of the employer. The preference only applies to suitable and available positions. (To learn more about these laws, see our article on the right to job protection in workers’ comp.)
Sometimes, a work injury causes a significant long-term impairment that qualifies as a disability under the Americans With Disabilities Act (ADA) or similar state laws. Under the ADA, employers with 15 or more employees must provide reasonable accommodations to workers with disabilities to allow them to do their jobs. Reasonable accommodation can take many forms, but it might include additional time off from work, providing workplace equipment, or moving you to another job for which you are qualified.
Similarly, the federal Family Medical Leave Act (FMLA) provides up to 12 weeks of job-protected leave for employees with a serious health condition. A serious health condition may or may not rise to the level of a disability under the ADA. The FMLA applies only to employers with 50 or more employees, but some states have similar laws that apply to smaller employers. At the end of the leave, the employee must be reinstated to his or her old job or an equivalent one. (Learn more in our article on FMLA reinstatement.)
In some states, such as Rhode Island, employees can collect unemployment benefits if their employers refuse to hire them at the end of their workers’ comp leave. You must be able and available to work and cannot have voluntarily resigned from your job. In many cases, though, you cannot receive workers’ comp benefits and unemployment benefits at the same time (at least not in the full amounts). To learn more, see our state articles on collecting unemployment.
]]>In most states, workers’ comp attorneys charge what’s known as a “contingency fee.” That means that your attorney receives a certain percentage of the money you get in an award or settlement—and isn’t paid at all if you don’t win any benefits. Many states set a limit on the percentage as well as the total amount of workers’ comp attorneys’ fees. Typically, a judge must approve the fees. (To learn more, see our article on how much lawyers charge in workers' comp cases.)
States may also have guidelines on which parts of the award or settlement count for purposes of calculating the fee. In some states, the lawyer may take a percentage of your total award. Other states allow attorneys’ fees only on portions of the award, such as the amount of compensation that was in dispute or unpaid benefits that are owed at the time of the award or settlement.
You’ll also have to reimburse any payments your lawyer has advanced for expenses like copying medical records, hiring expert witnesses, and hiring court reporters to transcribe depositions. Typically, lawyers will deduct these costs before attorneys’ fees are calculated. For example, suppose you settle your claim for $50,000, your lawyer has already paid $2,000 in costs, and the contingency fee is 20%; the attorney would receive $9,600 in fees (20% of $48,000) plus $2,000 for costs. However, some attorneys calculate their contingency fee based on the total award, before costs. Be sure to check the details in the fee agreement you signed with your lawyer.
If your workers’ comp claim was denied and you win on appeal, the judge may order the insurance company to pay your medical bills. This will be an extra item in your award. If you paid your own medical bills, you can keep the money in the award that’s earmarked for those costs. However, if your doctors agreed to postpone payment until you received a workers’ comp award (this is called a “doctor’s lien”), the money will go to paying those outstanding bills.
Sometimes, you lawyer may negotiate a settlement that requires the insurance company to paid specific medical bills directly. More often, however, the settlement will simply include a lump sum for medical bills. Your lawyer will usually withhold a portion of the settlement to resolve the unpaid bills—but may be able to negotiate with your medical providers to get those bills lowered. That way, you can keep more of your settlement.
Under federal law, Medicare won’t pay for medical expenses that are covered under workers’ compensation, but it may pay medical bills conditionally when there’s a dispute about workers’ comp liability. So if you’re eligible for Medicare, part of your settlement may go to the government. First, you must repay Medicare for conditional payments it made during your appeal. Second, if your settlement includes any money for future medical expenses (unless the insurance company has agreed to pay all of those expenses directly), you need to make sure that Medicare’s financial interests are protected. In most cases, you’ll do this by putting part of the settlement funds in a Medicare Set-Aside Account (MSA), which will go to pay for future medical treatment related to your work injury.
There’s no law requiring you to get approval from Medicare for the amount in your MSA, but doing so has a big advantage: Medicare will pay any medical expenses for your work injury once you’ve used up the approved amount in your MSA. Medicare will only review and approve your MSA if:
Even if you don’t meet those thresholds (which the government could change), you will still need to set up an MSA except in rare situations where it’s clear that Medicare’s interests are protected. If you don’t set up an MSA, Medicare may decide that your entire settlement was for future medical costs and refuse to pay your medical bills until you prove that you spent all of the settlement money on treatment for your work injury.
When you have an MSA, you must put its funds in a separate, interest-bearing account. You also must follow specific rules about recordkeeping and fund administration. If you use MSA funds for anything other than medical bills related to your work injury, Medicare may refuse to pay for treatment of that injury after the MSA is depleted.
The process of setting up an MSA, getting it approved, and managing the account can be complicated. Any time you’re hoping for a settlement that covers future medical treatment, it would be in your best interest to work with an experienced workers’ comp lawyer who can guide you through the process, help you set a fair amount for your MSA, and educate you about proper account management.
Similarly, if you have Medicaid, you must reimburse your Medicaid insurer for any conditional payments it made for medical bills related to your work injury. Before you settle your workers’ comp claim, you (or your lawyer) should contact your Medicaid insurer to determine how much it paid for your medical treatment.
In some states, you may receive permanent disability payments before your workers’ claim is settled. In California, for example, the insurance company generally must start making permanent disability payments within 14 days of the last payment for temporary disability (Cal. Labor Code § 4650 (2018)). If you receive permanent disability advances, they will be deducted from your ultimate settlement or award.
If you owe overdue child support, part or all of your workers’ comp award or settlement may be taken out to pay what you owe. Some states limit the amount of your settlement that can be taken for unpaid child support. In Maryland, for instance, only 25% of your net proceeds from a workers’ comp settlement can go to pay a judgment lien for unpaid child support (Md. Code, Cts. & Jud. Proc. § 11-504(i)(2) (2018)). Also, workers’ comp benefits for temporary or permanent disability are generally considered income for purposes of calculating the amount of child support you owe, because those benefits are meant to replace lost wages. Similarly, the custodial parent can collect child support by having a portion of your ongoing weekly disability checks taken out, just like wage garnishment for child-support collection. (Learn more about different methods for child-support collection.)
Generally, you don’t have to pay state or federal taxes on your workers’ compensation settlement or award. The one exception to this rule applies if you’re also receiving benefits through Social Security Disability Insurance (SSDI). If your combined workers’ comp and SSDI benefits are high enough, your SSDI benefits may be reduced (which is called an “offset”), and you may have to pay taxes on the amount of the offset. For more information on how the offset works, see our article on taxes and workers’ compensation.
Your workers’ comp settlement or award may also affect whether you qualify for tax credits, because the IRS may consider the amount you receive as income for the purpose of determining your eligibility for those credits.
As we’ve seen, workers’ comp settlements and awards can have significant financial and legal consequences, especially in terms of what you might owe for future medical bills. It can be difficult to make sure that you’ve covered all the bases and accounted for potential problems unless you have the help of a workers’ comp lawyer.
An attorney who’s experienced in this area can help you negotiate a fair settlement, help you estimate what you’ll need for future medical treatment, design the settlement to minimize the workers’ comp–SSDI offset, negotiate reductions in what you owe for medical bills and child support, and ensure that the settlement proceeds are distributed properly.
Under FECA, if you’re a federal worker who sustains a work-related injury or suffers from an occupational illness, you might be entitled to benefits such as medical expenses, compensation for lost wages, vocational rehabilitation, and more.
FECA covers civilian federal employees, including postal workers (who make up the majority of FECA claimants), TSA agents, Border Patrol agents, and almost all other civil officers or employees in any branch of the U.S. government.
The only federal employees who are not covered by FECA are railroad employees, maritime workers, black lung coal miners, and members of the U.S. military, all of whom are covered by separate laws for compensating injured employees.
Federal workers’ comp covers all types of work-related injuries and diseases, including traumatic injuries caused by accidents, illnesses sustained over time—such as repetitive stress injury or repeated exposure to toxins—and death.
You are entitled to benefits under FECA only if your injury occurs while you are performing your job duties, although your injury doesn't necessarily need to have occurred at the job-site in order to be covered by workers' comp.
You are not entitled to benefits if you purposefully cause your own injury, your injury is the result of willful misconduct, or you are under the influence of alcohol or drugs when your injury occurs.
FECA is administered by the Office of Workers' Compensation Programs (OWCP) of the U.S. Department of Labor. If the OWCP approves your workers’ comp claim, you may be entitled to the following benefits:
To make a claim for workers’ comp benefits under FECA, you first need to file a form with your federal employer. Which form you file, and when you need to file it, will depend on what type of injury you suffered. You must file a claim within three years of your injury, but if you fail to do so you can still recover benefits if you notified your employer of your injury within 30 days.
Accordingly, if you sustained a traumatic injury, you should file the appropriate form with your employer within 30 days of your injury; if you suffered from an occupational disease or illness over a period of time, you should file within 30 days of the date you realized the disease or illness was caused or made worse by your employment. Your employer should then submit the completed form to OWCP within ten working days.
Next, OWCP will investigate your claim. If your claim is approved, you will begin receiving benefits. If OWCP makes an unfavorable decision on your claim, there are various methods to appeal the decision.
You can appeal a denial of benefits to the federal Employees' Compensation Appeals Board. You must file your appeal within 180 days of your denial. A panel of judges will hear your arguments and issue a written decision. A workers' comp lawyer can help you present the most persuasive arguments possible to the appeals board.
You don’t need to hire a lawyer to obtain workers’ comp benefits under FECA, particularly if your claim is straightforward. However, if your claim is complex, your injury is serious, or OWCP denies your claim and you want to appeal, you should consider talking to an attorney who is experienced in federal workers’ compensation law. An attorney can help guide you through the process and ensure that you receive all of the benefits to which you’re entitled.
]]>But if there’s a dispute with your employer’s insurance company about any of these issues, you may be asked to undergo a medical evaluation with another doctor who is—at least in theory—neutral. The outcome of these exams, called independent medical examinations (IMEs) in most states, can significantly affect your workers’ comp case and how much you’ll receive in benefits. So it’s important to know how they work and what you can do to counter an IME report that goes against your claim or benefits.
Here's a quick overview of what you need to know about IMEs:
Below we'll discuss these points in more detail.
Usually, the insurance company requests an IME because it disagrees with a decision by your treating doctor about your course of medical treatment (especially if your doctor recommends surgery or other expensive procedures) or the extent of any permanent disability. In some cases, the judge or hearing officer assigned to your case may also order an IME to resolve a disputed issue related to your case.
An IME is supposed to be an objective assessment of your medical condition, including what treatment you need, whether you have a permanent impairment and to what degree, and your ability to work in the future. However, whether your IME is truly objective may depend, in part, on how the doctor is selected.
The rules about these exams are complicated and vary from state to state. Usually, when the insurance company requests an IME, it also selects the doctor who will perform the evaluation. In this situation, there’s good reason to question the impartiality of these doctors, who receive their payment from the insurance companies and often rely on them for referrals. As a result, they have an incentive to lower the insurer’s costs (and your benefits) by minimizing the extent of your injury and your need for potentially expensive medical treatment.
Depending on the rules in your state, you may also have the right request an IME when you disagree with your treating doctor’s opinions—in which case you will usually be able to select the evaluating physician.
Some states have come up with different systems in an effort to make these medical evaluations more impartial. In these states, the examining doctor may come from a randomly selected list of qualified specialists or may be designated by the judge. Sometimes, the procedure is different if you have a lawyer.
Whatever the rules are in your state, you should consider consulting with a workers’ comp attorney if you’ve been asked to undergo an IME. Unless your case is simple or your injuries are minor, you may need the assistance of a lawyer to ensure that your rights are protected during the process.
Before the examination occurs, your medical records and any other documents relevant to your injuries (such as your injury report or statements you’ve given in your case) will be sent to the IME doctor. The doctor will decide whether to review the documents before or after the examination.
If there is a hotly contested issue in your case, the insurance company may write a letter to the doctor explaining your injury, summarizing your course of treatment to date, and posing specific questions about your medical condition. These questions are used to frame the issues for the doctor.
The questions that might be asked include:
You should ask to review any letter sent to the IME doctor by the insurance company. That way you can correct any factual mistakes and make sure that the questions asked are appropriate in your case. Whenever possible, you should make your request in writing and file a copy with the state agency in which your workers’ comp claim is pending.
There is generally no expectation of a normal physician-patient relationship during an IME. This means that anything you tell the doctor is not privileged or protected in any way. Your statements to the doctor could even be used against you at a workers’ comp hearing if your case gets that far. The same goes for observations the doctor makes. For example, if the doctor sees you walking normally from your car to the office, but then sees you grimacing with pain and favoring one leg in the office, he or she will make a note of that. You can bet that this inconsistency will show up in the doctor’s report, and the judge or hearing officer will take this into account when assessing your credibility.
During the examination, the doctor will likely start out by asking you how your injury happened, what your relevant medical history is, and the course of your treatment so far. The doctor may also conduct a physical exam and tests (such as physical tests to measure your grip strength or range of motion). (For more on how to conduct yourself during the exam, as well as how to prepare for it, see our article on How to Handle Your Workers’ Comp Independent Medical Examination.)
After the IME, the doctor will write a report with his or her conclusions and opinions, particularly in response to the disputed issues or questions raised by the insurance company. You or your lawyer should receive a copy of this report. The results of the IME can have a large impact on your case. Workers’ comp judges and hearing officers often see IME doctors as “experts” and give significant weight to their reports. Judges also tend to view IME doctors as more objective than treating physicians—even if that’s not often the case. For these reasons, it can be difficult to discredit an IME doctor’s opinion.
However, there are some situations where you may challenge the IME report effectively. For example, if the doctor’s opinion is based on incorrect information about your medical history or there is some other factual mistake, point that out right away. You should write a letter to the doctor and the insurance company explaining the factual mistake and supporting it with documentation from your medical records, if possible. Request that the doctor clarify his or her report through an addendum. In some states, you can also request a second medical examination, performed by a doctor of your own choosing.
If you dispute the statements in the IME report and cannot get the issue informally resolved, and the IME is being used against you to limit or cut off your benefits, you should consult with a workers’ comp attorney right away. An attorney can help protect your interests by filing objections, scheduling a deposition to question the doctor, or requesting another examination.
For assistance finding experienced workers’ comp attorneys, use Nolo’s lawyer directory.
]]>If you sustained a back injury while on the job, workers’ comp will probably pay for your medical expenses and a portion of any wages you lose as a result of being unable to work. There are a number of hurdles to overcome, however, before you’ll be entitled to any benefits. The most significant of these is proving that your injury really is related to your work, and not—as insurance companies and employers often argue—the result of a pre-existing condition or something you did on your personal time.
In addition to back injuries sustained during on-the-job accidents, such as falling from a ladder, back pain at work is often caused by repetitive stress or strain. These types of injuries typically result from repetitive lifting, lowering, or twisting, but can even be caused by standing or sitting for long periods of time.
Employees who perform physical labor, such as factory workers, construction workers, and healthcare workers, are at increased risk for both accidents and repetitive strain injuries. For example, a factory worker could sustain a spinal fracture when she is struck by a piece of equipment, or a nurse could strain his back as a result of repeatedly lifting and moving patients.
But workers whose jobs are primarily sedentary can also be at risk. For example, long-haul truckers sit for hours at a time, during which they are not using their back muscles, only to arrive at their destination and unload heavy cargo, which puts extra stress on the spine. Even office workers can experience back injuries as a result of poor posture while sitting at a desk all day.
To recover workers' comp benefits for back pain, you need to show that your pain is "work-related." An injury generally is considered work-related if you were doing something for the benefit of your employer when it happened. The injury doesn’t need to happen at your worksite, but it must take place during the course of your employment.
Workers’ comp insurers may claim that your back pain is not work-related, but is instead the result of a pre-existing condition. For example, they may point to a car accident that happened while you were off duty, an old sports injury, or simply the effects of aging on the spine.
Even if you have a prior injury, your new injury may still be covered by workers’ comp if it aggravated the old one (but you might not receive as much compensation). In the case of other claimed pre-existing conditions, such as the effects of aging, you may be able to demonstrate that it was performing your job duties—not getting older—that actually caused your back pain.
To increase your odds of recovering workers' comp benefits, make sure to tell your medical providers that you believe your back injury is work-related, and explain how and why.
Evidence that can help you prove that your back injury was caused by your job, rather than by a pre-existing condition, includes:
Back injuries that result from a traumatic event such as a fall are usually obvious, but repetitive stress or strain injuries may be harder to spot. They may show up slowly, in the form of numbness or tingling, aching muscles, or pain down your leg. If you are experiencing symptoms of a back injury, seek treatment immediately. Unlike common ailments such as colds that go away on their own, back pain tends to get worse if not treated.
In addition, workers’ comp insurers are more likely to find your claim credible if you address it promptly. If you wait, insurers can claim your injury wasn’t that serious, or that it was caused by non-work-related activities that you participated in during the intervening time period.
You’ll also need to report your injury to your employer as soon as you can. This begins the workers’ comp process. Deadlines for reporting vary from state to state, but in some states you only have a few days to report your claim or you risk forfeiting it completely.
Your employer will then provide you with the workers’ compensation claims forms to fill out (or in some cases, the employer will fill them out for you). Again, states strictly limit the amount of time employees have to file workers' comp claims, so file your claim as soon as you can.
Although most workers with back injuries eventually receive compensation, many initially have their claims denied and need to file an appeal. The appeal process can be time-consuming and complex. Hiring a workers’ comp lawyer to help you through the process can result in you receiving much more in compensation than employees who don’t hire a lawyer.
Workers' comp lawyers typically charge what's known as a "contingency fee," which is a certain percentage—usually about 15%—of your overall settlement or award. This means that you don’t have to pay anything up front, and if you lose you only have to pay expenses such as copying costs and filing fees, not hourly attorney fees. Even after accounting for the contingency fee, workers who have a lawyer to guide them through the workers’ comp process still generally take home more in compensation than those who don’t hire a lawyer.
]]>In almost every U.S. state, the vast majority of employers must carry workers’ compensation insurance, either through a third party insurance carrier or through a self-insured program set up by the employer. In most states, employers must get workers’ comp insurance when they hire just one employee. In other states, employers only need to get insurance when they hire a few employees, usually between two and five.
But what can you do if your employer doesn’t have this insurance? Most states will allow employees in your situation to sue their employers in court, through a personal injury claim.
There are some advantages to filing a personal injury lawsuit as opposed to a workers’ comp claim. For one thing, you can seek the full amount of your losses (or “damages,” in legalese) without being subject to an arbitrary cap set by law. (Most states only pay around two-thirds of the worker's wage loss for temporary disability benefits, only up to an established maximum amount, and for only a limited period of time.)
Another benefit of a personal injury lawsuit is that you can collect money damages for the emotional distress caused by your injuries (called “pain and suffering” in legal jargon). You may also be able to collect "punitive damages," which are intended to punish the employer if its particularly bad misconduct caused your injuries. Neither of these types of awards is available through workers’ comp.
However, there are also drawbacks to suing in court. It can be a much slower process. While you might receive benefits through workers’ comp in a matter of weeks, it can be months or even years before you see any money through a lawsuit.
Also, unlike workers’ compensation—which is a no-fault system—you’ll need to prove that your employer was at fault for the personal injury accident. You should talk to a lawyer right away so that you can start the process and make sure your suit is filed in the proper legal timeframe.
There are a couple of other ways that you can seek compensation for your lost wages and medical treatment. Many states have special funds reserved for people who are injured while working for an uninsured employer (often called “Uninsured Employers’ Funds”). You may be able to get your medical bills covered by this fund or receive payments for a portion of your wage loss from the fund. Check with your state’s workers’ compensation office for more information on how to file a claim.
A few states also have temporary disability insurance programs, which may provide you with short-term benefits while you’re unable to work.
If you've been injured on the job and your employer doesn't carry workers' comp insurance, your first call should be to an experienced workers' comp or personal injury lawyer. A lawyer can help you get the financial settlement you deserve whether inside or outside the workers' comp system. Most attorneys offer a free consultation and charge no fee unless you win your case.
]]>Some jobs are inherently more likely to lead to severe anxiety, but even jobs that don’t require exposure to traumatic events can result in mental or emotional injury.
While all mental health issues deserve to be taken seriously, not all are covered by workers’ compensation laws. Here's what you need to know about whether you can collect workers' comp benefits for a mental health condition.
Workers’ compensation laws governing psychological conditions vary from state to state. The majority of states offer limited coverage for mental health conditions under specific circumstances, such as when the psychological injury arises out of a work-related physical injury, or is caused by a stressor that is extraordinary or unusual in nature. An increasing number of states are also implementing or considering laws that provide workers’ comp coverage for PTSD claims by first responders.
Even if you are entitled to mental health coverage under your state’s law, obtaining workers’ comp benefits can be an uphill battle. Employers and insurers are often reluctant to compensate workers for psychological conditions because it can be hard to objectively measure these conditions or prove that they were caused by your job.
As a general rule, you’re more likely to recover workers’ comp benefits for mental health conditions in the following circumstances:
Your odds of recovering workers’ comp benefits are higher if your psychological condition stems from a work-related physical injury. For example, if you sustain a back injury while on the job, and suffer a depressive disorder as a result, you’ll likely be entitled to compensation for psychological injuries as well as for the original physical injury.
Many states don’t allow any workers’ comp recovery for mental health conditions unless they are tied to a physical injury. Even in states without such a law, it can be much easier to prove that mental health issues are work-related when they were caused by an on-the-job physical injury.
In an era of mass shootings, more and more states are instituting laws designed to protect the mental well-being of the firefighters, police officers, paramedics and other first responders who have to witness traumatic events as part of their job. At least a dozen states currently have laws allowing workers’ comp coverage for PTSD claims by first responders, and many more states are considering passing such laws. These laws allow benefits for purely psychological injuries that aren’t tied to any physical injury.
Some states, including Connecticut and New Mexico, have laws that apply only to certain types of first responders. Other states, such as Florida, allow recovery only when the first responders have witnessed a particularly horrific event. And a number of states have created a “rebuttable presumption” that a first responder’s mental health issues are an occupational injury, which means that workers don’t need to prove that their job caused their mental health issues. However, a workers’ comp insurer can still contest that assumption by demonstrating that there is a non-work-related cause for an employee’s psychological injury.
Some states provide workers’ comp benefits for employees who have suffered purely psychological injuries like PTSD, even if they’re not first responders.
In most of these states, however, the psychological injury must be the result of an extraordinary and unusual event or stressor. For example, in Colorado, mental health issues are compensable only if they are caused by a psychologically traumatic event that is generally outside of a worker’s usual experience. And in New York, workers can recover benefits for psychological injuries only if the injuries arise from abnormal stress and unprotected employer actions.
There are a few states that don’t impose this requirement. In California, for example, any employee may recover workers’ comp benefits for a purely psychological injury even if it wasn’t caused by an unusual, traumatic event, as long as the employee meets other requirements, such as being diagnosed with a mental disorder and proving that working conditions were at least 51% responsible for the disorder.
Just because you don’t qualify for workers’ comp benefits for a mental health issue doesn’t mean you have no legal remedies. There are other laws that may help provide the time and resources you need to recover.
You may be able to receive unpaid leave and job protection under the Family and Medical Leave Act (FMLA). If you meet the definition of “disability” under the Americans with Disabilities Act (ADA), you are entitled to accommodations from your employer so you can do your job despite your disability. And if you have a severe mental impairment that prevents you from going back to work, you may be entitled to Social Security disability benefits.
Because workers’ comp claims are often contested, they can be lengthy and complex. This is especially true for cases involving psychological injuries, as they are less straightforward than on-the-job physical injuries.
A workers’ comp lawyer can help you evaluate your claim, navigate the various stages of the process, and recover the benefits to which you're entitled. Most workers' comp attorneys charge a fee only if you win your case, and don't require any money up-front.
]]>The rules for getting medical treatment through workers’ compensation vary from state to state. If you don't follow your state’s rules, the insurance company may refuse to pay for your treatment. All states allow you to get the nearest available emergency care when that's needed. Beyond that, however, your choice of treating doctor may be limited, depending on where you live and who you work for.
The rules are often complicated, but your freedom to choose generally falls into one of three categories: (1) you choose a doctor from a list or medical network provided by your employer; (2) you choose any authorized doctor; or (3) your employer chooses the treating doctor for you.
In many states, employers have the option of contracting with a preferred provider plan, network, or managed care organization to treat their employees' work injuries. This is an increasingly popular way for employers and insurance companies to reduce costs and control medical care for workers' comp cases. If your employer has a plan like this, you must select a treating doctor from within the network and follow its rules for getting medical care.
Certain states allow employers to present injured workers with a list (or panel) of doctors to choose from. These lists usually must contain a minimum number of doctors and specialists; often, there are limits on the number of occupational clinics that may be included.
In some states—like New York, Texas, and Illinois—you have the right to choose your own treating doctor, as long as your employer doesn't have a provider plan or managed care arrangement. Typically, however, you need to choose from a list of health care providers that the state has approved for treating workers' comp injuries.
There may be extra requirements for choosing your own doctor. In California, for example, you may use your personal primary care physician as your treating doctor, but only if you have given your employer written notice before the injury that you want to do that; also, this option is only available if your employer offers group health coverage.
In still other states, you have to go to a treating doctor picked by your employer, at least at first. Some of these states only require you to see the company doctor for your initial visit (as in Florida) or for a certain period of time before you change physicians.
Sometimes, workers worry that a company-selected doctor has a conflict of interest and might minimize their injuries. Unfortunately, this could be true in your case. You may be able to switch doctors if you believe you aren't getting adequate care, but you must follow the rules in your state for changing workers’ compensation doctors.
You should do whatever you can to find the best treating doctor for you, even if you're limited to a network or a list of physicians. When you're speaking to potential doctors or their offices, consider their:
Above all, you should choose a doctor you trust and feel comfortable with. If you need help finding a treating physician, a workers’ comp lawyer may have some recommendations. An attorney can also explain the rules in your state and help you if you want to change treating doctors or are having trouble getting proper medical care.
]]>Before you can qualify for PPD benefits, you need to:
You’ll then continue that medical treatment until you’ve either fully recovered or your doctor says that your condition isn’t likely to get better, even with more treatment. This is usually called “maximal medical improvement” (MMI).
When you’ve reached MMI, your treating doctor will generally perform a series of tests and conduct an overall physical and/or mental exam to determine whether your work-related injury or illness caused any lasting medical conditions or lost function (referred to as an impairments). Some examples of impairments:
The doctor’s opinion will have a big effect on whether you’re able to get any permanent disability benefits. Because of that, it’s often a hot spot for disputes in workers’ comp cases. Depending on the rules in your state, you and/or the insurance company may request an independent medical examination (IME) or similar neutral evaluation in an effort to counter the treating doctor’s opinion about any lasting impairments.
The next stage of the process is to determine the level of permanent disability—that is, whether and how much your impairments limit your ability to perform certain tasks at work. States apply different rules and procedures for calculating and paying benefits for PPD. In many states, the doctor or an appointed professional (often called a “rater”) will use guidelines to translate impairments into a permanent disability rating. This rating, generally expressed in terms of percentages for each body part or system (like the endocrine system), is meant to describe how the impairment limits your ability to perform certain tasks or to work at all. For example, a 50% PPD rating for the lower back could seriously affect your ability to do some of your regular job requirements, like lifting heavy objects, bending over repeatedly, or driving for long hours. In that case, partial permanent disability benefits are meant to compensate you for that limitation, under the theory that it will reduce your earnings in the future.
In other states, PPD benefits may be based on the actual difference between your pre-injury wages and what you’re earning after you go back to work, or on the projected difference in your ability to earn in the future.
Workers’ compensation will usually cover work-related injuries that aggravated or accelerated a pre-existing condition. For instance, say you hurt your neck in a car accident several years ago. Then you recently fell off a ladder at work and seriously sprained your neck. Even though scans showed some residual damage from the old injury, the new workplace injury would probably still be covered by workers’ comp. But if you don’t fully recover—and part of your impairment was caused by the old injury—some states will “apportion” your permanent disability rating between the old and new injuries. In that case, your benefits may be lower than they would be if your disability were caused only by the recent injury. Certain states have special funds to help out employees who are seriously disabled from a combination of old and new injuries.
Whatever system is used to calculate the amount of PPD, states generally limit how long those benefits last. Typically, state laws set out complicated formulas for these time limits, depending on the type and degree of disability. In some states, a certain PPD rating will result in a single lump-sum payment. In most states, however, you can agree to receive a lump-sum payment for any level of PPD as part of a settlement.
After your PPD is rated, your employer's insurance company should send you a letter either offering to start your weekly or biweekly permanent disability payments or making a settlement offer for a lump-sum payment. If you’ve already been receiving advance payments (because a state law requires those payments to begin soon after a doctor indicates that you have a permanent disability), the company should also pay you any balance that it owes you, as well as any interest and penalties for late payments.
Before you agree to a settlement, however, consider speaking with a workers’ comp attorney. If you have permanent disability from your injury, a workers’ comp settlement can have serious consequences, including the possibility of reduced Social Security disability benefits and giving up your right to future medical treatment. Even before you reach that stage, if the insurance company is challenging your doctor’s opinion about your permanent disability, it’s critical to have a lawyer on your side to help you through the complicated process and protect your rights. Learn more about when you may need a workers’ comp attorney, or request a free consultation.
]]>(To get these benefits, you must report your injury to your employer right away—and no later than 30 days after you were injured or were diagnosed with an occupational disease
If your doctor says that you aren’t able to work—or can only work with restrictions—while you’re being treated for your on-the-job injuries, you may receive temporary disability benefits to cover a portion of your lost wages.
You won’t receive these benefits for the first three business days off work, unless you can’t work at your regular job for more than 14 days. Temporary disability benefits will continue until:
If you’re completely unable to work while you’re recovering, you’re entitled to temporary total disability (TTD) benefits equal to two-thirds of your average weekly earnings before you were injured or became ill, up to a maximum amount that changes every July.
The TTD cap is calculated as 105% of the statewide average weekly wage at the time of your injury. For injuries that happened between July 1, 2023 and June 30, 2024, the maximum TTD benefit is $1,186.51 a week. There’s also a minimum amount for these benefits of $40 a week.
You can’t receive TTD benefits for more than 400 weeks.
If your doctor says you can return to work with restrictions (such as light duty), you may be able to receive temporary partial disability (TPD) benefits. These benefits are calculated as two-thirds of the difference between your pre-injury wages and the amount you’re able to earn with “reasonable diligence,” in light of the nature and extent of your injury and your ability to compete in the open labor market.
The maximum and minimum rates for these benefits are the same as for TTD, but the longest time you can receive TPD benefits is 100 weeks.
Once you’ve reached MMI, your doctor will evaluate your condition to determine if you have any permanent disability as a result of your work injury or illness, and if so, to what extent.
If the medical evidence shows that you’re completely disabled on a permanent basis, you may receive permanent total disability benefits at the same rate as TTD benefits (with the same maximum and minimum) for as long as you’re unable to work—potentially for the rest of your life.
In addition to these benefits, workers’ comp will pay an additional amount if your permanent disability resulted from a specific occupational disease resulting from toxic exposure, including mesothelioma and black lung disease.
You will be eligible for permanent partial disability (PPD) benefits if your doctor finds that you have permanent impairments that are only partially disabling. The amount of these benefits is also calculated at two-thirds of your pre-injury wages, but the maximum is only 55% of the statewide average weekly wage at the time of your injury.
For injuries that happened between July 1, 2023 and June 30, 2024, that translates into a maximum benefit of $621.51 per week. The length of time you’ll receive these payments depends on the extent of your disability and the affected part of your body.
Like many states, Missouri has a schedule that lists the duration of PPD benefits for permanent disability to certain body parts, including the extremities, ears, and eyes. If you’ve had an amputation or completely lost use of a listed body part, you’ll receive payments for a number of weeks that’s 10% over the number listed in the schedule. If you’ve lost partial use of a listed body part, the duration of your benefits will be in proportion to the percentage of lost use.
Example: The schedule lists 232 weeks of loss of an arm at the shoulder. If your arm was amputated, you would receive PPD benefits for 255.2 weeks (232 + 10%). If you lost 50% of the use of your arm, the benefits would last for 116 weeks (50% of 232).
Missouri publishes the complete schedule online, along with the maximum PPD and TTD benefit amounts for current and previous years.
If you have a permanent disability to a part of your body not listed on Missouri’s schedule (such as to your back, neck, or internal organs), doctors will give you a permanent impairment rating, expressed in a percentage.
If multiple parts of your body are affected, they will be combined to give you a whole body impairment. There’s a 400-week maximum on these unscheduled benefits; the DWC will generally award benefits for a period of time in proportion to the extent of your disability.
If your head, neck, hands, or arms were permanently disfigured as a result of your work injury, you may receive an additional award that the DWC considers fair, but no more than 40 weeks’ worth of compensation.
In addition to temporary and permanent disability benefits, other types of workers’ comp benefits are available in Missouri, including:
If your workers’ comp claim has been denied, or the insurance company isn’t coming through with the benefits you’re entitled to receive, it would be smart to speak with a qualified Missouri workers’ comp lawyer. An experienced attorney can evaluate your claim and help you receive all of the compensation you deserve under Missouri law.
You can also talk to an attorney about whether it makes sense to agree to a lump-sum settlement in your workers’ comp case. (Learn more about what a good workers' comp lawyer can do for you and what to look for in a workers' comp attorney.)
In almost every state (except Texas), the vast majority of employers must have workers’ compensation insurance coverage for their employees. Usually, companies either buy a workers’ comp policy from a private insurance company or seek approval from the state to insure themselves. Because they will need to pay out accepted workers’ comp claims themselves, self-insured employers typically must show that they have financial stability and significant assets. Once you file a workers’ comp claim, the insurance company or your self-insured employer will either approve or deny it. (Many self-insured employers hire claims administrators to investigate and manage their workers’ comp claims.)
However, four states—North Dakota, Ohio, Washington, and Wyoming—do not allow employers to buy insurance from a private company. Instead, employers must purchase insurance coverage directly from the state (or in some cases, self-insure). In these states, the state workers’ compensation agency or a self-insured employer (or its claims administrator) decides whether an injured worker is eligible for benefits.
In all states, you must report your injury to your employer within certain time limits in order to receive workers' comp benefits. Some states also require the injured employee to file a workers' comp claim with the state agency before benefits can begin. Each state’s notice and claim rules are different. If you do not follow the correct procedure, you may lose some or all of your benefits. To learn about your state’s rules, choose your state from our filing a workers’ compensation claim page.
Once your claim is initiated, the insurance company (or other decision maker) will investigate. The claims administrator will typically speak to you and your employer and review medical records, accident reports, and other documents. You should cooperate with the insurance company's reasonable requests for information and documents. But if you have any concerns about the investigation, contact a workers’ comp lawyer. For example, it would be a good idea to speak with a lawyer if the insurance company is not returning your phone calls or you believe you are under surveillance.
In most states, the employer or insurance company must decide whether you're eligible for workers' comp benefits promptly or within a reasonable time period. Some states also have strict deadlines for approving or denying a claim—often between 14 and 30 days. In some states, the insurance company can ask for an extension of time if needed to investigate further.
If the insurance company fails to make a decision or request additional time within the deadline, it may have to pay a financial penalty. Or, in some states, your claim will be considered automatically accepted if you don't receive a decision in time.
In general, you should receive written notice that your claim was either approved or denied within a few weeks. If you haven’t heard from the insurance company, you should contact your insurance adjuster or claims administrator directly. If you still do not receive adequate information, contact your state’s workers’ compensation agency or an experienced workers’ comp lawyer. Some states also offer online portals where you can check your claim’s status.
If your claim is denied, you may file an appeal with your state workers’ compensation agency. You should receive a letter that gives a specific reason why your claim was denied. Depending on the reason, many denied claims can be appealed successfully. Each state has different appeal procedures and filing deadlines.
Before filing an appeal, it would be in your best interest to speak with a workers’ comp lawyer. A lawyer can ensure that your appeal is properly filed in a timely manner and maximize the likelihood of winning benefits.
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