When can I collect Workers’ Compensation?

Workers’ Compensation is insurance paid for by the employer. It provides cash benefits and medical care for workers who become disabled because of an injury or sickness related to the job. If death results, benefits are payable to the surviving spouse and dependents as defined by law.

No cash benefits are paid for the first seven days of disability, unless the disability extends beyond 14 days. In that event, the worker may be due cash benefits from the first day off the job. However, necessary medical care is provided no matter how short or long the length of disability. A person disabled by work-related occupational disease receives the same benefits as for an on-the-job injury. However, time limitations on claim filing vary. The time limit for filing a claim for all occupational diseases, except loss of hearing, is two years from the date of the disabled worker’s disability or two years from the time the disabled worker (or his or her dependents in the case of death) knew or should have known the disease was due to the nature of the employment, whichever is later.

What am I entitled to?

A worker who is disabled, whether permanently or temporarily, receives two-thirds of his average weekly wage, up to a maximum of $400 per week, depending upon the date of injury and the degree of disability. The average weekly wage is based on payroll records for the year prior to the date of disability or accident for all jobs held at the time of injury. If the worker dies from a compensable injury, the surviving spouse and dependents, as defined by law, are entitled to weekly cash benefits (subject to possible Social Security offsets). The amount is figured as two-thirds of the deceased worker’s average weekly wage for the year before the accident. In no event may the compensation exceed $400 per week, no matter how many dependents are involved. If there is no surviving spouse or children, then other dependents such as parents, grandchildren, or siblings, as defined by law, may be entitled to cash benefits. Funeral expenses are payable subject to a fee schedule.

When will my benefits start and end?

If the employer or insurance carrier accepts responsibility, the first payment must be made within 18 days after disability begins or 10 days after notice is given to the employer. Payments are then due every two weeks thereafter until you return to work or there is medical evidence you are no longer disabled.

Can I sue my employer or anyone else?
You cannot sue your employer. However, if your injuries were due to the negligence of a third party such as the driver of a vehicle, the manufacturer of a piece of equipment or a property owner, you may be able to sue the third party. Any accident on a construction site may also give rise to a lawsuit.

• Permanent Partial Disability – The employee has permanently lost part of his wage-earning capacity in his job. Benefits are payable as long as the partial disability exists, and you are earning less than your average weekly wage. These cases may be settled for a lump sum, but either side may elect to continue weekly payments.
  
  
• Schedule Loss – This is a special category of Permanent Partial Disability, and involves loss of eyesight or hearing, or loss of a limb of the body or its use. Compensation is limited to a certain number of weeks, according to a “Schedule” set by law. For instance, a worker who loses an arm, or total use of an arm, receives compensation equal to being paid the partial disability rate for 312 weeks. Proportionate losses are paid on a percentage basis. For instance, 25 percent loss of use of an arm is equal to 78 weeks – one-fourth of 312. This is what most people think of as the settlement of a compensation case.
  
  
• Disfigurement – Serious and permanent disfigurement to the face, head or neck may entitle the worker to compensation to a limit of $20,000.
  
  
• Death – Claims may result in a lump sum payment, but weekly payments of death benefits once elected cannot be settled by a lump sum unless the surviving spouse remarries.

What about my medical expenses?

The injured worker who is eligible for Workers’ Compensation is entitled to all necessary medical care as the nature of the injury or the process of recovery may require. The broad range of services available covers medical, osteopathic, dental, podiatric and chiropractic treatment, surgery and hospital care, x-rays, laboratory tests, prescribed drugs, authorized nursing service, and medical or surgical appliances required by the injury. The worker is free to choose any physician, podiatrist, or chiropractor authorized to give medical care by the Workers’ Compensation Board. The employer or his insurance carrier pays the cost of necessary medical services. The doctor may not collect a fee from the patient. However, if the injured worker’s claim is disputed by the employer or insurance carrier, the doctor may require the claimant to sign form A-9, guaranteeing payment if the Board disallows the claim or if the worker does not pursue his claim.