Benefits under Worker’s Compensation
Following a compensable injury, the worker’s compensation statute allows for a few different benefits. They can be somewhat confusing, especially when they are referred to in shorthand. This post will explain what those benefits are so you can make sure you are receiving everything you are entitled to receive.
One of the first benefits, and one of the easiest to understand, is that the employer is to provide medical treatment that is necessary due to the injury. §287.140 states that the treatment covered includes “medical, surgical, chiropractic, and hospital treatment” that may be reasonably required after the injury or disability to “cure and relieve” the effects of the injury. One important note on that rule is that, since the employer is paying, they get to pick the provider/doctor. If you want to go to your own doctor, you will have to pay for it yourself.
The next set of benefits is where it sometimes gets confusing. If you have been around the worker’s compensation system at all, you have probably heard terms like TPD, TTD, PPD, and PTD thrown around quite a bit. They stand for Temporary Partial Disability, Temporary Total Disability, Permanent Partial Disability, and Permanent Total Disability. Like the names suggest, the Temporary benefits are to be paid to you while you are healing and actively treating for the injury. The Permanent benefits are benefits paid to you when you suffer injuries that you will have some continuing problem with for the rest of your life. While all the short-hand names sound alike and they are forms of payment you could possibly receive, it is important to break them out:
1. Temporary Partial Disability and Temporary Total Disability
Temporary Partial Disability (TPD) payments are normally made when you are in rehabilitation for an injury but still able to work in some form. It is just meant to help cover the difference between what you were earning and what you are earning while you get better. Temporary Total Disability (TTD) is normally payments for when you can’t work while trying to get better.
a. Temporary Partial Disability (TPD)- This is compensation that is to be paid to you during the rehabilitative process. There is a limit of 100 weeks of payment for this form. The compensation you receive is 2/3 of the difference between your average earnings prior to the accident and what you will be able to earn during the disability. So if you are working a light duty job while recovering but not making as much, TPD is to help cover the difference.
b. Temporary Total Disability (TTD)- This is similar to TPD as it is paid throughout the rehabilitative process. With TTD, the limit is increased from 100 weeks (like TPD) to 400 weeks. TTD payments are 2/3 of your average weekly wage (We have another post on calculating this number!) However, there is a maximum cap on that number. You can only be paid up to a maximum of 105% of the state’s average weekly wage. So if you are out of work, TTD benefits will be paid to you in order to keep some money coming in while you get better.
c. Caution- You need to be careful though: either benefit can be cut off in certain situations before you are cleared to return to work. First, if you apply for and receive unemployment compensation, you will lose your Temporary Total benefits. The second situation applies to both Temporary Total and Temporary Partial- if you get fired for “post-injury misconduct” you are no longer entitled to benefits. Post-injury misconduct, in most situations, does not include missing work due to the injury.
2. Permanent Partial Disability and Permanent Total Disability
Sometimes as a result of a work-related accident, you can sustain a permanent disability. The benefits paid to you as a result of that kind of disability are in addition to the TTD or TPD you receive. Permanent Partial would be a situation where you end up with a life-long injury to a body part but can still work. Permanent Total is when you have become so injured that you can no longer work.
a. Permanent Partial Disability (PPD)- The payment is a combination of different calculations. First, you must know your average weekly wage. Then, once you are at “maximum medical improvement”, meaning as recovered as that body part is going to get, the doctor will give you a ‘rating.’ That rating will be a percentage of how much the disability affects the injured body part. Last, there is a state made “schedule of losses” which puts a number value (weeks) on different parts of the body. To find your payment, take the rating given by your doctor, multiply it by the number assigned on the schedule of losses to the injured body part, and then multiply by your average weekly wage.
To give an example, the knee is given a 160 weeks value on the schedule of losses. Assume a doctor gave you a 10% rating on the knee and your average weekly wage is the max, which is currently 483.48 for PPD. Take 160 x 10% (0.1) x 483.48. The payment on that injury in this situation would be $7,735.68.
b. Permanent Total Disability (PTD)- Permanent total disability is defined as the “inability to return to any employment and not merely an inability to return to the employment in which the employee was engaged at the time of the accident.” This doesn’t require you to be completely inactive but it does mean that the judge would look at your condition and see whether any employer would be reasonably expected to hire you. If you are determined to be entitled to PTD benefits, you will be paid at the same rate as your TTD for the rest of your life. This includes possible weeks of back pay if you were not paid after you reached maximum medical improvement but before you were determined to be permanently and totally disabled.
c. Other- There are a couple other important notes on PTD. One interesting issue is with respect to who will pay your benefits. If you became permanently and totally disabled from your work injury alone, your employer will pay it. If you become permanently and totally disabled as a result of your latest injury combining with pre-existing problems, the “Second Injury Fund” may become liable. Another important note is that, as mentioned above, if you reach maximum medical improvement, your employer doesn’t have to pay TTD. That means there might be some gaps of time between the end of your TTD payments and being determined totally disabled. Money can get tight so it is important that you are careful with your spending and it is a good idea to apply to Social Security for disability if your are, indeed, totally disabled. Finally, it is also a good idea to do your best to find work within the restrictions the doctor has given you. If you find a job, that is great. If you cannot find work, it shows that you have made an effort and employers don’t want to hire you in your condition (which would be some evidence to support your claim that you are totally disabled.)
That is a lot of information to take in and it can quickly get confusing if your injury is slightly more complex than any of the examples provided above. Quickly stated, your employer should pay for the medical treatment you need to recover (remember they get to pick the provider!), pay you a certain amount of money while you are recovering in the form of TPD or TTD, and if you have any permanent disabilities, an additional payment for those disabilities. If you have any questions about what you should receive or are worried that you are not receiving a benefit that you are entitled to, please contact one of the lawyers at Bollwerk & Tatlow and we would be happy to help!