Workers’ compensation covers most workplace injuries and illnesses. However, disputes do arise. Generally, disputes may involve whether an injury or illness is work-related, the degree of disability, or the monetary awards paid to the claimant. The Board resolves conflicts through various methods.
These include informally, without a hearing; formally with a hearing; and with an independent medical evaluator (IME). Nonprofits have several options for obtaining workers’ comp coverage.
Medical Benefits
Workers’ compensation benefits include coverage of medical bills related to a work injury or illness. It also provides cash payments that partially replace lost income when an employee can’t work. It also pays death benefits to the survivors of a worker who dies from a job-related accident or condition. It is generally beneficial to all parties for an injured worker to return to work as soon as medically possible.
Returning to medically appropriate, productive work helps the wounded worker heal faster and reduces long-term insurance premiums for workers’ comp and health insurance. It is against the law for employers to require or suggest that an injured employee use their health insurance rather than workers’ compensation.
Similarly, it is against the law for insurers to deny medical treatment. If a healthcare provider receives notice that their treatment request has been rejected, they can contact the Board and seek a review of the decision. This should be done sooner rather than later because the injured employee may lose access to the needed services if the claim is denied.
Indemnity Benefits
Indemnity benefits are compensation for the wages you lose while undergoing treatment and recovering from your work injury. Depending on your state’s laws, these payments are broken down into categories such as temporary total disability (TTD), permanent total disability (PTD), and permanent partial disability (PPD). These payments cover the loss of income from your job due to your injury or illness. These are based on two-thirds of your average weekly wage up to a maximum rate set by law.
In some cases, there are additional benefits for specific injuries such as occupational deafness or disfigurement. In addition to compensating you for your lost wages, workers’ comp covers medical expenses incurred due to your work-related injury or illness. This includes doctor visits, surgeries, and tests. Workers’ compensation also has medical treatment guidelines that doctors follow, but you can file for a variance to receive specific treatments not included in the guidelines.
Generally, independent contractors are not covered by workers’ compensation. They should have insurance policies, seek out private workers’ comp insurance, or fund themselves through various financial vehicles.
Temporary Disability Benefits
In addition to workers’ compensation, many employers offer short-term disability insurance. These policies typically cover illness and injuries that occur outside of work. In some cases, these policies also include mental health conditions. While these policies may have different terms, most follow the same basic structure. If an injury or illness prevents you from working, the insurer will pay a percentage of your salary until you can return. In addition to a bank of weeks’ worth of benefits, you can also receive additional payments for travel expenses and mileage to reach medical appointments.
If an injury exacerbates a pre-existing condition, you can still qualify for workers’ comp as long as your job caused it. This is a more complicated process, depending on whether your employer’s policy allows this overlap. This is one of the reasons why speaking with an experienced attorney right away is essential. They can help you understand what is and needs to be covered. They can also help you navigate filing a workers’ compensation claim.
Permanent Disability Benefits
When a doctor determines that your injury or illness has permanent consequences, you may be entitled to endless disability benefits. These benefits will help to pay for the cost of living expenses if you are unable to work again. These benefits are more complex than they sound, and having a workers’ compensation lawyer on your side is essential. Insurance companies will do everything possible to minimize costs, so you need a firm that understands the rules and process.
A workers’ compensation judge or independent medical evaluator will write an impairment rating report which specifies how impaired you are as a result of your injuries. The ratings are based on different formulas, depending on whether the disability is scheduled or unscheduled and whether the disability is total or partial. A permanent and total disability is a condition that prevents you from ever returning to any gainful employment. These conditions are reserved for severe, disabling injuries or illnesses like losing both legs or an arm.
Death Benefits
Death benefits are provided to the family members of workers who die due to a work-related accident or disease. This includes those who die as a result of a fatal workplace accident. Still, it also extends to those who die from occupational illnesses or conditions that develop over time, such as back problems or chemical exposure. For the surviving spouse and children of the deceased worker, these payments typically provide compensation for funeral expenses up to a maximum amount and weekly income replacement payments equal to two-thirds of the deceased worker’s average weekly wage, subject to minimum and leading charges set by each state.
Survivors must prove their dependency to receive these benefits, and they typically continue until the surviving spouse’s death or remarriage. Unfortunately, employers and workers’ comp insurers are businesses dedicated to protecting their bottom line, which can lead to disputes over the validity of claims or the number of benefits a person is entitled to. That is why it is essential to have an experienced attorney to review your case’s specifics and guide you through the process.
