Injured at Work Compensation

Medical Benefits

All reasonable and necessary medical care incurred to treat a qualifying injury is required to be paid for by the employer.  If the employer is accepting liability and they are paying for the medical bills, they get to choose the medical provider.

Mileage Reimbursement

Injured workers are entitled to have their mileage expenses reimbursed for traveling to and from doctor’s appointments.  The mileage reimbursement rate for workers’ compensation is the same as is allowed by the IRS for business travel.  It is best practice for injured workers to keep a log of the mileage for each doctor’s appointment.

For injured workers who are unable to drive to doctor appointments and require special transportation, those costs are also subject to reimbursement.
 

Disability Benefits

Basically, the weekly rate is 80% of the injured worker’s after-tax average weekly wage.  Weekly compensation benefits have a fixed minimum and maximum that are available and those numbers are adjusted from year to year. 

To determine the weekly rate payroll records must be used.  The average of the thirteen representative weeks prior to the injury is used.  “Non-representative” weeks are not used.  “Non-representative” weeks are those where the injured worker was sick or took a vacation.  Regularly paid bonuses and overtime may be able to be included in the rate calculation.  However, it is important to note that full credit is not given for overtime; it is paid at the regular rate.

The claimant’s marital status and number of dependents also affects the weekly rate.  The applicable rate increases if the claimant is married; it also increases with the number of dependents.
There are weekly rate tables available at the Workers’ Compensation Commissioner’s website to determine the applicable weekly rate.  To determine rate, follow the table down until you reach the average gross weekly wage of the claimant, look at if they are single or married, then choose the rate that corresponds to their number of dependents.

Types of disability benefits include:

Temporary Total Disability

An injured employee who is off work for more than three calendar days, temporary total disability benefits may be available beginning the fourth day.  Benefits continue until the employee returns to work or is medically capable of returning to similar employment, whichever occurs first.  If the disability period exceeds fourteen calendar days, the employee is entitled to be paid for the three-day waiting period.

Temporary Partial Disability

If an injured employee returns to work at a lesser paying job due to the injury the employee may be entitled to temporary partial disability benefits.  The value of the benefits is 2/3 the difference between the employee’s average gross weekly earnings at the time of the injury and the actual earnings while working at the lesser paying job.  The three-day waiting period also applies to temporary partial disability benefits.

Healing Period

When an employee has an injury which results in permanent impairment, the employee may be entitled to healing period benefits during the period of recuperation.  Healing period benefits begin on the first day the employee is off work until either: (1) the employee returns to work; (2) it is medically indicated that significant improvement from the injury is not anticipated; or (3) the employee is medically capable of returning to substantially similar employment to that engaged in at the time of injury.  

Permanent Partial Disability

If an injury results in permanent disability the employee may be entitled to permanent partial disability benefits based upon the degree of permanent disability.  Permanent partial disability benefits are payable in addition to healing period benefits and commence at the termination of the healing period.

Two types of permanent partial disability benefits exist:

Scheduled member disabilities: When an injury occurs to a scheduled member the value of the benefits is based upon the functional impairment to that body part.  Each scheduled member is valued at a specific number of weeks as follows:

  •     Loss of thumb: 60 weeks
  •     Loss of first finger: 35 weeks
  •     Loss of second finger: 30 weeks
  •     Loss of third finger: 25 weeks
  •     Loss of fourth finger: 20 weeks
  •     Loss of hand: 190 weeks
  •     Loss of arm: 250 weeks
  •     Loss of big toe: 40 weeks
  •     Loss of any other toe: 15 weeks
  •     Loss of foot: 150 weeks
  •     Loss of leg: 220 weeks
  •     Loss of eye: 140 weeks
  •     Loss of hearing in one ear: 50 weeks
  •     Loss of hearing in both ears: 175 weeks
  •     Permanent disfigurement, face or head: 150 weeks

The number of weeks of benefits payable is for 100% loss, or loss of use.  If the disability rating is less than 100%, the percentage of rating is multiplied by the number of weeks shown.  As an example, a 10% loss of use to the first finger would be computed as 10% of 35 weeks, or 3.5 weeks of permanent partial disability benefits.  

Unscheduled (Body as a Whole) Disabilities: An injury that results in permanent disability to a part of the employee which is not a scheduled member is an unscheduled disability.  Unscheduled disabilities are also referred to as an industrial disability and are compensated according to the percent the disability reduces the employee’s earning capacity.  Unscheduled disabilities typically include injuries to the back, neck, shoulder, and hip.  Factors that are considered when determining industrial disability include:

  • Change in the employee’s earnings due to the injury;
  • Medical condition of the employee prior to the injury, immediately after, and presently;
  • The site of the injury
  • The severity of the injury and length of the healing period;
  • The work experience of the employee prior to injury, after the injury and the potential for rehabilitation;
  • The employee’s qualifications intellectually, emotionally, and physically;
  • Age;
  • Education;
  • Motivation;
  • Functional impairment due to the injury;
  • Loss of earnings resulting from a change in employment as a result of the injury;
  • Inability to engage in employment suited to the employee as a result of the injury
  • Industrial disability is computed by multiplying the percentage of disability by 500 weeks of pay.  

Permanent Total Disability

When an employee is injured to the extent they are incapable of returning to gainful employment they may be entitled to permanent total disability benefits; which are payable for life at the same weekly rate as permanent partial disability benefits.

Death Benefits

A surviving spouse receives weekly benefits for the remainder of his/her life, unless they remarry.  If the surviving spouse remarries, they receive a lump sum of two years of benefits, if there are no surviving children entitled to benefits.  Surviving children may receive benefits until the age of 18, or until age 25, if they are a student.
 

Second Injury Fund

If a worker has suffered two scheduled injuries to separate body parts from separate incidents, they may be entitled to Second Injury Fund (SIF) benefits.  Basically, the idea behind the SIF is that compensation for two separate scheduled injuries may not adequately compensate a worker for the resulting loss of earning capacity from the two injuries.  The employer pays the scheduled benefits, the Second Injury Fund pays any extra industrial disability created by the two injuries.
         
Only the second injury needs to be work-related, the first injury can have been sustained by any cause.  Both injuries must be to scheduled members (i.e. arm, leg, hand, foot, etc.) and cannot be a body as a whole injury.  
 

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