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.