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January 22, 2024

Workers Compensation Benefits Explained

Workers Compensation is a policy that provides compensation to employees who are injured on the job. There is often confusion surrounding what kind of compensation is offered and what it covers.

What Accidents are Covered Under Workers Compensation?

Workers compensation covers injuries and illnesses. It can cover accidents and injuries that occur due to work. This may include:

    • Sprains, strains and breaks
    • Illnesses (such as from working with chemicals)
    • Worsened pre-existing conditionsa magnifying glass sitting on top of a piece of paper
    • Overuse or repetitive motion injuries
    • Stress-related injuries
    • Hearing loss
  • Seeing loss
  • Loss of limbs or use of limbs
  • Death

Injuries must occur in the course of employment while the employee is working. Serious injuries may fall into four different designations:

  • Temporary total disability: A temporary total disability means you are unable to operate a majority of your body for a certain amount of time, such as temporary paralysis from the neck down.
  • Temporary partial disability: A temporary partial disability means that you have lost the use of part of your body, such as breaking a leg and an arm, rendering you unable to work until you are healed.
  • Permanent total disability: Permanent disabilities are ranked based on percentage. Total permanent disability is generally when someone loses 80% or more function of their body, such as permanent paralysis from the neck down.
  • Permanent partial disability: A partial permanent disability is also calculated based on percentages. Permanent partial disability may be losing both hands above the wrist, losing both feet above the ankle, losing one wrist and one foot, etc.

What Accidents are Not Covered Under Workers Compensation?

Not everything is covered under workers compensation. Intentional injuries are not covered under workers compensation insurance. Injuries may also not be covered if they are caused by a fight that the employee instigated, either with a customer or a fellow employee.

Not all pre-existing conditions are covered under workers compensation, either. The only instances where a pre-existing injury will be covered by workers compensation insurance is if that pre-existing condition is actively made worse by work. For example, say you have a history of back injuries and you have a plate in your spine. As you are lifting boxes in the warehouse, your back pain grows, eventually causing a flareup. In this case, workers compensation may help with medical expenses related to the flareup.

How Do Workers Compensation Benefits Work?

There are four main types of benefits under workers compensation:

Medical Expenses

Medical expense coverage helps with costs related directly to the work injury, such as emergency services, surgeries, prescriptions, hospital visits, physical therapy, and more. These benefits will last as long as necessary for the employee to be cleared by the doctor.

Wage Replacement

Another part of workers compensation benefits is wage replacement, or lost wages. This allows you a percentage of your wages while you are unable to work due to your injury. This percentage is calculated based on your original wage and the injury. Generally, your wages are replaced only if you cannot return to work for more than seven days. Temporary total disability may earn you around 66% of your original wages. Temporary partial disability may result in 80% of your wages while a permanent total disability or impairment depends on a percentage of your injury. In extreme cases of permanent disability, wage replacement can last for the rest of the disabled employee’s life.

Vocational Services

In the case of an injury that prevents an employee from returning to their industry permanently, workers compensation may also help pay for vocational services and training so the employee may find a job in a new field.

Death Benefits

Unfortunately, there are circumstances where employees may pass away either on the job or due to a work-related injury. In this case, a lump sum benefit may be paid to the late employee’s family members.

When are Workers Compensation Benefits Paid?

Most workers compensation policies allow a period of time (usually 30 days) after a claim is filed for benefits to be paid. This allows the insurer to investigate the claim and calculate how much compensation will be provided.

Medical expense compensation is paid once they arise. As the employee’s medical expenses arise, workers compensation will pay the applicable bills.

Wage replacement benefits come at the same time as the employee’s regular paycheck would. For example, if you were regularly paid biweekly and you are approved for workers compensation, your wage replacement will arrive biweekly on your normal payday.

Death benefits are paid in a single lump sum to the surviving family members once the workers compensation claim is approved, which may require a death certificate as proof.

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