Workers’ Compensation Overview
Workers’ Compensation laws control the insurer’s liability. The current law provides that an insurer will pay only for the following:
Temporary Disability Pay (TD)
The insurer’s potential liability for Temporary Disability Pay (TD) and related costs can be for up to 104 weeks of payments for the time off work due to the work injury that is properly certified by a doctor.
If you have been injured at work and are on a “no-work” status from your authorized treating physician, then you are eligible for lost wages under the TD classification. These benefits are paid at the rate of 2/3 of your average weekly wage. The amount of this benefit is referred to as your compensation rate.
Permanent Disability Benefits (PD)
Once you have been deemed Permanent and Stationary (P&S) by your physician at Maximum Medical Improvement (MMI), or you have been paid the maximum number of weeks of temporary disability benefits, then you may qualify for permanent disability benefits. In addition to several specifically listed qualifying cases, an injured worker may qualify for this benefit if they are physically unable of engaging in at least sedentary employment within a 50-mile radius of their residence. Permanent Disability (PD) payment amounts are based on the impairment identified by a qualified medical evaluator or treating doctor in a competent medical report.
Future Medical Care (FMC)
The insurer may also have a potential liability for Future Medical Care (FMC). FMC costs are the costs for reasonable necessary medical treatment for the parts of the body injured on the job.
Many times, due to a work-place injury, an injured worker can no longer return to his past employment. Supplemental Job Displacement Benefit (SJDB) provides a “voucher” for qualified retraining expenses if the injured worker cannot return to their usual and customary employment and if the employer does not offer alternate or modified employment at 85% of the wages the injured worker was earning at the time of the injury on the job.
Pain & Suffering
There is no provision for pain and suffering in a Workers’ Compensation case and the Workers’ Compensation Appeals Board will not issue an award based on pain and suffering.
Workers Compensation Settlements
Settlements in workers’ compensation cases are voluntary. No one can force a settlement either of an injured worker or of an insurance carrier. If an attorney for their case represents an injured worker, a settlement can be reached at any time. However, there are a lot of factors that need to be considered when discussing and negotiating a lump-sum settlement of your case.
Settlements in workers’ compensation cases may include all future medical benefits. This means that in a settlement, you will no longer be eligible or entitled to any future medical benefits from the workers’ compensation insurance carrier. This is not something to be taken lightly. You should understand that the insurance carrier’s representative (i.e. adjuster, case manager, lawyer, etc.) does not represent you or your interests.
In considering any settlement, you want to make sure that the proposed settlement is in your best interests.