If you're injured in the course of your job, your employer's workers' compensation insurance should be paying your medical, prescription and rehab bills. This system is designed to shield workers from steep medical bills and employers from costly, time-consuming liability lawsuits. With conditions and limits, this kind of insurance also indemnifies the worker for any time lost from work due to the injury.
The Basics of Workers' Compensation Insurance
Individual states enforce laws on workers' compensation insurance. Employers generally must maintain this insurance to cover their workers in the event of an injury, accident or chemical exposure on the job. The laws require the injured worker to notify the employer, and the employer to guide the worker to allowed doctors and treatment. If a doctor recommends time off from work, the insurance pays a portion of the missed salary.
The insurance company will pay lost-time benefits if a worker is partially or totally disabled by a work injury, and unable to return -- either permanently or temporarily -- to his job. A doctor's written opinion is required. State law sets the amount of lost-time benefits, which are not subject to any negotiation by the worker or the employer. A typical percentage is two-thirds of the average weekly wage, as calculated over the 52 weeks prior to the accident.
Legal Complications of Lost-Time Benefits
A legal snarl can ensue if the worker disputes the average weekly wage, or the insurance company denies treatment. In such a case, workers can file a claim against the insurance company with the state agency that adjudicates workers' compensation cases. The dispute may be resolved through mediation or a court hearing. If the employee hires a lawyer to represent him, the lawyer's fee may come out of any compensation paid by the insurance company, or be added to that amount. It's common for a "statutory" fee set by law to be a percentage of the benefits obtained.
Permanent, Total Disability Benefits
If the insurance company agrees that a workers' injury is total and permanent, it may offer a lump-sum settlement to the worker. In "closed" cases, the worker then becomes responsible for his medical bills; other settlements keep the medicals open. If a permanently and totally disabled claimant returns to work in any capacity, he's subject to a limit on wages, combined with the PTD benefit, that is set by state law. Receiving work comp benefits does not affect your eligibility for Social Security disability or retirement, but state law may limit the amount you can earn in combined SSA and lost-time or PTD benefits.
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