If you’re eligible for workers’ compensation because of a work-related injury or illness, you may be wondering what benefits you might receive through your employer's workers' comp insurance. This article takes a brief look at the basic types of workers' comp benefits: medical treatment, rehabilitation, disability, and death benefits.
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.
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.
State laws also 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.)
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 consumer friendly Lawyer Directory for a list of attorneys in your geographic area.