What Does Workers’ Compensation Cover?
Disability designations affecting your payout include long or short term, full, partial or permanent disability. Learn what injuries Workers’ Compensation covers.
The specific benefits that you would be entitled to receive under workers’ compensation laws will vary depending on the state where you work. Nonetheless, benefit coverage will be roughly the same across the United States. Although there are some exceptions, workers’ compensation pays for medical expenses, some required medical assistance devices, nursing services, and possibly even some replacement for your lost salary.
Coverage May Vary by State
State jurisdiction, not federal laws covers most injuries at work. Basically, workers’ compensation boards in every state will pay all the medical expenses as well as provide some pay each week while the employee is unable to return to work. State statutes will determine the amount paid each week. A permanent injury would entitle the worker to an additional sum.
For general information about your state’s workers’ compensation plan, you should first start with your employer’s personnel or human resources office if it has one. If there isn’t such an office, have your employer help you contact the workers’ compensation board.
What is not Covered by Workers’ Compensation?
Although the workers’ compensation program provides broad coverage for most work-related injuries, illnesses and disabilities, some situations are not covered.
Coverage will likely be available to you unless:
- there are preexisting conditions
- you caused an intentional injury to yourself
- you did not report the incident in a timely manner
- you neglected to complete the required paperwork
- you failed to keep medical appointments or followed medical advice
- committed a criminal act at the time of the incident
- you disregarded company policies
Types of Workers’ Compensation Disability Payments
Payments from workers’ compensation are different depending on the state where you are located. Besides coverage for medical care, you would receive a monthly payment instead of your regular salary, which would normally be lower than your regular wage.
Four different types of disability payments are available:
- Temporary Partial Disability
- Temporary Total Disability
- Permanent Partial Disability
- Permanent Total Disability
Temporary disability means that the injured worker is expected to recover, while a permanent disability means that the worker’s condition is stable. When a person reaches a stage where no further improvement is expected, it can be called MMI (Maximum Medical Improvement). This does not mean the person is back to normal—only that no further medical progress is anticipated.
Partial disability means that the person is able to perform some work, but it may not be in the original job. It could be lighter or sedentary work, such as working at a desk instead of in the field. Total disability means that the worker is not fit to perform any work.
As should be expected, before a settlement is made for a permanent injury, a medical professional would complete an analysis to evaluate permanent limitations on the worker’s daily activities.
Permanent & Stationary Disability Designation
Your medical professional may determine that your condition is permanent and stationary, which is called P&S. You must note the date when this occurs. Once P&S has been established, workers’ compensation insurance becomes effective for benefits.
If your doctor decides that you are not able to return to your former job because of your disability, you may be eligible for training in an alternate job if your state has such a program.
At this point, you must make certain that your doctor completely understands your limitations because a doctor’s notes will have a direct bearing on your subsequent benefits. You should have a daily log charting activities that are affected by your injury, what limits you have, your level of pain, and the length of time you are able to perform those tasks.
Your log should also show any events that trigger your pain and how you try to relieve it, such as with ice, heat, medications, rest, or by elevating a limb. Your notes should reflect how effective these are, and you should be clear and to the point so that your physician can easily understand the details.
Your doctor may also ask you to perform certain movements so that your abilities can be evaluated, such as reaching for something on a top shelf, bending over, or walking and carrying a weight.
Be absolutely certain that you are able to clearly communicate your feelings so that the doctor completely understands your condition. When your doctor asks how you are feeling, you need to provide very specific details for a complete picture of your state of health.
For example, do not say, “I was feeling out of sorts yesterday.” Explain in detail what happened. Instead, you could be very specific and say, for example, “Doctor, I tried to walk two blocks to the grocery store, but I had to stop three times each way because I was out of breath. At the same time, my right leg began hurting because of the injury. Here is the exact spot of the pain. I had to rest about fifteen minutes until I could walk again.”
An occupational expert may interview the employee to find out about the worker’s previous work experience, skills, and education. The local job market will then be analyzed to determine job opportunities for the worker and gauge the worker’s loss of earnings for the remainder of his or her life.
Types of Workers’ Compensation Disability Payments
As an example, one state allows temporary disability for a maximum of twelve months or until the worker’s condition becomes permanent and stationary.
This classification applies once the health condition is believed to be stable and not expected to improve. A waiting period is required before the worker’s permanent disability status becomes effective.
Now a rating can be assigned. The doctor will determine a level of disability, and you and any representative or attorney involved will review it. If there is disagreement as to your condition, negotiations can follow to work out an acceptable compromise. With this final rating in place, the actual benefit will be determined.
If your state offers this type of benefit, it becomes effective after the medical condition becomes permanent and stationary. California has a program called Vocational Rehabilitation Maintenance Allowance (VRMA). This benefit covers 66% of the claimant’s average weekly wage.
If at any time during this process you are asked to sign papers, be sure you completely understand them before signing. If you have a question or something is not clear, you can speak with an attorney who specializes in work-related disability issues to clarify any concerns.