Most people know that workers’ compensation pays for time lost from work because of a job-related injury or illness. However, there’s a lot more to the program than that.
For example, it provides medical coverage for reasonable expenses associated with a work-related illness or injury. It also covers funeral costs and death benefits.
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Medical treatment is a vital aspect of workers’ compensation. Depending on the state and industry, workers’ comp provides cash for lost wages, medical bills, and other related expenses if an employee is injured or ill.
Physicians who treat workers with work-related injuries or illnesses face complicated and detailed regulations for test procedures, medications, therapies, and other treatments. Identical injuries may receive radically different medical care under the system, which many experts describe as “broken.”
Workers’ comp is designed to provide medical treatment for a workplace injury until an authorized doctor determines that a worker has reached maximum medical improvement and has fully recovered from the injury or illness. However, there can be disputes over the existence or duration of a disability or the extent of the damage.
While a doctor hired by an employer or insurance company plays a crucial role in a workers’ comp case, it is in a victim’s best interest to seek treatment from a private medical professional with whom they are comfortable. This can help prevent a doctor from trying to downplay the extent of the injury or illness, which could impact how long the benefits last.
Injured workers who cannot return to regular work may receive temporary disability cash as part of workers’ compensation benefits. Typically, these benefit payments are calculated as two-thirds of the average weekly wage before the injury. However, the maximum weekly use is limited by state law. The temporary disability usually ends once the injured worker reaches statutory maximum medical improvement. This is a high standard, meaning the claimant can no longer perform their previous job or any other jobs available, including sedentary work.
In most states, workers’ compensation will also pay for temporary partial disability if the worker can return to work but can only earn less than their pre-injury earnings. In some states, the rate of temporary partial disability is based on a doctor’s estimate of the extent of the permanent impairment.
Many injuries and illnesses that are deemed permanent require long-term disability benefits. In some states, permanent partial disability (PPD) is paid at a percentage of the pre-injury weekly wages or in a lump sum. In others, it is based on the degree of permanent impairment determined by a medical practitioner using one of several impairment rating guides.
Workers’ compensation and medical care also cover loss of salary. Typically, this is calculated by multiplying an hourly rate by the number of days lost from work. The precise calculation, though, is determined by your employer’s compensation policy. A letter from your company that certifies the value of your missed payments and includes other details like tax returns and bank statements may be helpful.
This wage replacement benefit helps you pay for everyday expenses while you cannot work. It can make it significantly easier to stay afloat financially during a recovery period that could last for years, depending on the severity of your injury. Let’s say you sustain a serious injury, such as an amputation, severe burns, or unreversible blindness. In that situation, you might be eligible for two-thirds of your average weekly wage, up to a legal maximum, plus a dependant allowance. Workers’ compensation also covers a percentage of the death payments for family members who lost a loved one in a working accident and funeral expenses.
Permanent Partial Disability
Workers’ compensation compensates lost wages after a waiting time (usually three or seven days) and paying for acute medical care. However, workers’ compensation payments typically terminate when a medical professional decides you have attained your “maximum medical improvement,” which typically means you won’t get any better.
At this point, a physician or physical therapist conducts an objective examination and assigns an impairment rating. This percentage indicates how much functionality you have lost in the affected body part. This is the critical number to calculate your permanent partial disability (PPD) benefit.
In Schedule Loss of Use (SLU) cases, states set benefit levels based on whether your injury involves a body part listed in the statute. In Non-Schedule PPD cases, a state may determine the value of your impairment based on its impact on your ability to work or a combination of factors, including age, occupation, education, and training. Sometimes, the injury or condition is severe enough to affect your entire wage-earning capacity, and you can’t return to any employment.
Losing a family member due to an accident at work is one of the most traumatic experiences anyone can go through. The grief and anger can be even more intense when that death is tied to a workplace injury or illness.
Workers’ compensation can offer financial security through death benefits for families left behind. These typically equate to two-thirds of the dead employee’s average weekly income, up to a state-determined maximum. Surviving spouses may continue to collect these payments until their passing or subsequent marriage. However, if a youngster is enrolled full-time in a college, university, or trade school until age 23, they can continue receiving them until 18.
The need that the employee’s death be determined to be work-related is essential to collecting these benefits. While most deadly workplace accidents are thought to be related to the job, this is not always the case. The incident or disease must be considered to have happened to be eligible for death payments.