The Ultimate Guide to Understanding Workers’ Compensation Benefits

Depending on state requirements and the policy, workers’ compensation pays employees for medical treatment, lost wages, and other work-related injury or illness expenses. There are special rules for contractors and members of the “gig” economy.

Insurance fraud is a common problem with workers’ comp claims, but an experienced lawyer can help level the playing field.

Medical Treatment

All states except Texas require workers’ compensation insurance to cover employees for time off work and medical expenses associated with workplace injuries. These benefits vary but typically include salary replacement payments and medical care.

The workers’ compensation system generally covers physician visits, hospital stays, physical therapy sessions, chiropractic treatment, acupuncture, and X-rays. Injured or sick workers can also receive medications and specialized equipment such as walkers, wheelchairs, and crutches.

However, in most cases, the workers’ comp insurer will request a second evaluation of your injuries or illness from doctors of their choosing, known as an independent medical examination (IME). If they disagree on the extent of your injury or your ability to return to work, your treatment may be modified or denied. If this happens, contacting a workers’ compensation law firm is essential to protect you. In addition, if your employer retaliates against you for filing a workers’ compensation claim or taking time off work due to an on-the-job injury or illness, you can file a discrimination lawsuit.

Lost Income

Workers’ compensation pays for a portion of an injured worker’s lost income. State laws dictate the specifics of how this benefit is calculated. Generally speaking, two-thirds of the average weekly wage (AWW) that the injured worker was receiving at the time of the injury is what they are entitled to. This includes any overtime pay, bonuses, or commissions they usually earn in addition to their base salary.

Not every work-related injury is the result of a single traumatic incident. For example, a receptionist may develop carpal tunnel syndrome after years of typing with poor ergonomics. Regardless of the cause, many work-related injuries or illnesses can keep employees from working for an extended period.

When workers reach statutory maximum medical improvement – meaning they have recovered as much as possible and further improvement is unlikely – their temporary disability benefits will end. They may then qualify for permanent disability benefits. This is determined by a doctor certified by the workers’ comp board.

Death Benefits

When a worker dies from work-related injuries or a terminal occupational illness, their family members may be eligible for unique death benefits under workers’ compensation. These benefits are intended to help cover funeral expenses and provide a regular income for the rest of the deceased loved one’s family.

Typically, these payments are made in regular installments that represent two-thirds of the average weekly wage of the deceased worker, subject to minimum and maximum limits. However, some states offer a lump sum payment instead of weekly payments.

The person or persons entitled to receive these death benefits are usually those who were dependent upon the employee for support at the time of the injury or illness and continue to be so, including a surviving spouse and children. Dependent grandchildren can also be included. Surviving spouses are entitled to these weekly death benefit payments until their death or remarriage. At the same time, children can continue to receive them until they turn 18 or until they complete specific types of post-secondary education or vocational training.

Permanent Disability

Whether a work injury results in partial permanent disability or permanent total disability, the impact can be devastating on an injured worker and their family. In addition to structured weekly cash benefits, many states offer permanent disability benefits ranging from two-thirds of the injured worker’s average weekly wage at the time of the injury to a lifetime pension.

You may ask for a hearing to be declared permanently incapacitated if your condition reaches the point of maximum medical improvement and your treating physician concludes that you will not get better. When your request is granted, your physician will provide a permanent impairment rating to evaluate permanent impairment.