Workers Compensation

Workers Comp Benefits FAQ

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Q: When do workers' compensation benefits start?

  • A: In some states, medical benefits start as soon as you file your workers’ compensation claim. For example, in California, the insurance company must authorize up to $10,000 in medical treatment while it investigates your claim. Benefits will continue if your claim is accepted and stop if your claim is denied. In other states, the medical bills are not paid for until the insurance company accepts your claim. For example, in Oregon, the insurance company won’t pay your bills until it accepts your claim, but the doctor can’t bill you during that time either.
    If your claim is accepted, you will receive temporary disability benefits while you are still recovering and unable to work. The timing of these payments varies from state to state, but can be as soon as a couple of weeks from the time your doctor finds that you are unable to work. Permanent disability benefits are available to workers who have lasting physical or mental limitations due to their injuries. These payments are available later on in your case, once it is clear that your condition is not likely to improve with further medical treatment.

Q: What are temporary disability benefits?

  • A: Temporary disability benefits are paid to injured workers while they are recovering from their injuries and unable to work. If you are completely unable to work, you will receive temporary total disability (TTD) benefits. These benefits are based on a percentage of your average wages prior to your work-related injury. In most states, you will receive two-thirds of your average weekly wage, up to a maximum weekly amount set by law. For example, if you earned $900 per week before your accident, you will receive $600 in TTD benefits (unless your state cap is lower than $600).

    If you’re able to return to work in some capacity, but you are earning less than before, you will receive temporary partial disability (TPD) benefits. These benefits are paid to workers who need to work reduced hours or work a light-duty job that pays less. Benefits are typically two-thirds of the difference in your earnings. For example, if you are earning $600 instead of $900 per week, you will receive two-thirds of $300 (the difference in your earnings), which is $200 per week.

Q: How are average weekly wages calculated?

  • A: Although the method of calculating average weekly wages varies from state to state, most states follow the same basic pattern. If you work year round, you would add up your earnings in the year before your accident and divide that number by 52. For example, if you earned $39,000 in the last year, your average weekly wage is $750 ($39,000 ÷ 52). In general, you should include only your regular earnings in this calculation. Most states do not include overtime pay, unless the worker regularly worked overtime hours (for example, every week).

Q: How long can I receive temporary disability payments?

  • A: You can generally receive TTD payments until your doctor clears you to return to work or finds that you have reached maximum medical improvement. Maximum medical improvement (MMI) means that your condition has reached a point where it is not likely to improve in the next year or so. In many states, including New York, you can continue to receive temporary disability benefits for as long as your disability continues. However, some states place a time limit on receiving benefits, even if the worker has not reached MMI. For example, in Texas, temporary disability benefits stop after two years if you haven’t reached MMI.

Q: Can I get reimbursed for mileage expenses for traveling to and from the doctor?

  • A: Yes, mileage expenses are generally covered under workers’ comp. In some states, such as California, you can receive reimbursement for all miles traveled to and from doctors’ appointments, physical therapy appointments, and other medical treatment. In other states, you must travel a certain distance to be reimbursed. For example, in Texas, reimbursement is available only if the worker traveled more than 30 miles one-way. The reimbursement rate varies from state to state, but many states have adopted the IRS’s mileage rate. To find the current rate, see the IRS’s list of Standard Mileage Rates.

Q: What is permanent disability?

  • A: Once your doctor has found that you’ve reached maximum medical improvement (MMI), your doctor will evaluate you to determine whether you have any lasting physical or mental impairments. If you do, your doctor will issue a report and assign a percentage to your disability. The disability rating is then used to calculate how much you will receive in permanent disability benefits.

Q: What is vocational rehabilitation?

  • A: Vocational rehabilitation is usually available when you are not able to return to your previous job after you reach MMI. Most states offer these benefits, which will pay for you to get the training or schooling necessary to enter a new line of work. In many states, you may lose all or a portion of your weekly workers’ comp benefits if you refuse to participate in vocational rehab.

Q: What are death benefits?

  • A: Death benefits are available when a worker passes away from a work-related injury or illness. These benefits are typically paid to family members who relied on the deceased worker for financial support. Spouses, children under 18, children over 18 who are unable to care for themselves, and other relatives who lived with and relied on the deceased worker for financial support are eligible to receive death benefits. Death benefits are either paid on a weekly basis, subject to a minimum and maximum amount, or in a lump sum. Most states also provide a separate sum to cover funeral and burial expenses, usually around $4,000 to $10,000.

Q: What if the insurance company stops my benefits even if there's been no change in my condition?

  • A: Unfortunately, this does happen. You should monitor your benefit payments on a regular basis and contact the insurance company immediately if there has been an unexplained decrease in your benefits. If you have a workers’ comp attorney, you should notify him or her as soon as possible in order to resolve the issue. If the insurance company wrongfully stopped your benefits, you may be able to collect interest and penalties.

Q: Can I get interest or a penalty if there's a delay in my benefit payment?

  • A: In many states, you can recover penalties and/or interest if there is an unreasonable delay in your benefit payments. For example, if the insurance company is late with a benefits payment in California, it must automatically pay interest and a 10% penalty. In other states, there must be a significant delay. For example, in New York, a 20% penalty kicks in when the insurance company is 25 days late with a benefits payment.
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This article was verified by:
Lynn A. Bradley | May 01, 2015
307 West Rio Road
(434) 973-7474 View Profile
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