OFF WORK BENEFITS
While you are off work and under the active care of a doctor you are entitled to a weekly check of temporary total disability (TTD) or “off work” benefits. The law establishes how much your employer or their insurance company must pay to you while you are off work and under the active care of a doctor. The amount of the check depends on your date of injury. The following is a schedule the maximum amounts that can be paid. Of course, your wages may not entitle you to the maximum; however, you can determine the amount of your weekly check by multiplying your average weekly gross wages by 70%.
- Injury between November 1, 2014 and October 31, 2015; The check should be 70 (seventy) percent of your average weekly wage up to a maximum of $571.55.
- Injury between November 1, 2015 and October 31, 2016; The check should be 70 (seventy) percent of your average weekly wage up to a maximum of $589.33; no minimum.
- Injury between November 1, 2016 and October 31, 2017; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $596.03; no minimum.
- Injury between November 1, 2017 and December 31, 2018; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $590.63; no minimum.
- Injury between January 1, 2019 and May 27, 2019; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $607.40; no minimum.
- Injury between May 28, 2019 and December 31, 2019; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $867.71; no minimum.
- Injury between January 1, 2020 and December 31, 2020; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $898.63; no minimum.
- Injury between January 1, 2021 and December 31, 2021; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $923.53; no minimum.
- Injury between January 1, 2022 and December 31, 2022; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $953.18; no minimum.
- Injury between January 1, 2023 and December 31, 2023; the check should be 70 (seventy) percent of your average weekly wage up to a maximum of $986.86; no minimum.
The benefits you receive from workers’ compensation are NOT subject to any state or federal withholding taxes. You do not need to report this money when filing a tax return. If this office’s efforts result in the insurance company starting these benefits, then the law entitles the attorney to a ten percent fee for those services. If you are already receiving these weekly “temporary” benefits then there is not an attorney fee on these off work “temporary” benefits.
Remember, to receive and continue to receive these “temporary” benefits you must remain under the active care of a physician, who is of the opinion you should be kept off work because of the on-the-job injury AND who is of the opinion that the treatment you are being provided is continuing to improve your condition. Once you have reached maximum medical improvement (MMI) the insurance company is allowed to stop these “temporary” off work checks.
A law now exists that limits TTD in cases of soft tissue injuries or injuries where no surgery has been recommended or performed. In the case of a soft tissue injury, only eight (8) weeks of TTD is payable unless there is an injection which entitles an injured worker to eight (8) more weeks of TTD (if they remain under the care of a doctor who is of the opinion they cannot work or restrictions exist which the employer cannot meet). If surgery is recommended, an injured worker can receive sixteen (16) more weeks of TTD and if surgery is performed, the soft tissue limitation is removed.
The law does not require payment for the first three calendar days missed from work while under the doctor’s care for injuries that occur before August 26, 2011. For injuries that occur between August 26, 2011 and February 1, 2014, there is no payment for the first seven (7) days of work missed unless the employee remains off work for more than twenty-one (21) days at which time the first seven (7) days will be paid. The three-day waiting period has been reinstated for injuries occurring after February 1, 2014 and this waiting period is not compensated at any later time. The entire time you are under the doctor’s care you are entitled to be reimbursed for mileage and prescriptions (see additional information below).
The employer or insurance company does not always voluntarily start paying your “temporary” off work benefits. They may believe they have a defense, for example they may be of the opinion you are able to work or that your injury did not happen on the job. Insurance companies are sometimes very quick to claim they have a defense, so they will not have to pay benefits immediately.
It is our experience that in most cases after the judge hears the testimony, the appropriate workers’ compensation benefits are awarded to the employee. If you are not already receiving off work benefits and they are in fact due please be advised that one of the first things we will do is begin work on getting these “temporary” off work benefits for you.
MEDICAL TREATMENT
You are entitled to “reasonable and necessary” medical treatment. The judge can order your employer or their insurance company to pay the physicians reasonable and necessary medical treatment directly related to your injury. There are various rules that the law has imposed as to what is “reasonable and necessary” medical treatment. There are also very specific procedures to follow when changing physicians and they vary according to when your date of injury occurred. Most importantly, an injured worker cannot change doctors without prior approval by the insurance company or the judge
MILEAGE REIMBURSEMENTS
The law provides that the insurance company must reimburse you at the statutory rate per mile whenever you travel in excess of twenty (20) miles round trip to see a doctor for treatment or a doctor for the insurance company. You will not be reimbursed for mileage below this threshold or for mileage incurred traveling to any doctors this office may send you to for a disability report or for any travel expenses you may incur in attending a deposition or hearing. The maximum mileage reimbursement allowed for any individual trip is six hundred (600) miles round trip. If you travel over 100 miles, you should include a request for a meal allowance, although it is not clear that current law allows for reimbursement of same.
ONCE RELEASED
After you are released to return to work, or from the doctor’s care as having reached maximum medical improvement (MMI); you are entitled to be paid for any permanent impairment that remains.
At this point, since your condition is no longer considered a “temporary” one (the doctor has reached a plateau in terms of what he can do to improve your condition) your weekly checks will stop. At this point, we would have you examined by a physician of our choice for his opinion as to your permanent partial impairment. Once that physician’s report is received by this office, we will file a request for a hearing before a judge. The hearing is our chance to prove the extent of permanent partial impairment you still have from the injury.
Approximately 2-5 months after filing our permanent partial disability report, a hearing will be held before a judge. Your employer’s insurance company may have you examined by a physician of their choice prior to that same hearing.
If we have a hearing with the judge determining the extent of your partial disability benefits, then the judge will review the medical reports supplied by the parties, listen to your testimony regarding your present problems and will issue an Order regarding how many weeks of “partial” disability benefits you will receive beyond the “temporary” benefits you received while off work. The judge will issue an order normally one to two weeks following the hearing but they have thirty (30) days to issue the order. We will provide you with a copy of the Court’s order when we receive it from the Court. There will be an attached letter further explaining the Order itself.
The Court will order a 20% attorney fee on the permanent partial disability benefits. Normally, this office may also have additional expenses that were incurred to get your case prepared for trial. This could include the charge submitted by the physician who examined you at the request of our office for the purpose of a disability report, any charges submitted by the doctors who have treated you for supplying the medical records from their office files, or any cost incurred if questioning of the insurance company’s physician becomes necessary. This office will pay all of these expenses initially and then you can reimburse these litigation expenses once we enter into a settlement of your claim.
RETURN TO WORK
The law provides that any person who is receiving the “off work” checks or TTD (temporary total disability) benefits from an employer or its insurance carrier has an obligation to promptly report in writing any change in material fact or change in the amount of income the person is receiving or any change in the person’s employment status which occurs during the period of receipt of such benefits. It is a crime to receive temporary total disability checks while you are working. These are the monetary amounts received while unable to work due to the injury. The other benefits or permanent partial disability that you receive after a court hearing can be received even though you are able to work. It is only a crime to receive “temporary total” disability benefits and work for wages.
Of course, once your physician has released you to return to work you are encouraged to attempt to do so. Once released, it will not hurt your compensation claim if you are able to find any type of work either from your same employer or a new employer. Even though the physicians may be of the opinion you have some “partial” disability that does not mean that you are totally prevented from seeking employment.
By all means, wait until your treating physician releases you or advises you that you can look for work before doing so. The physician may want to continue to see you even though he has released you to look for work or return to work in a limited capacity. This is permitted.
The law does provide for benefits concerning retraining into another field or job placement in the event you receive permanent restrictions that prevent a return to work in your previous occupation. You may want to get started on retraining while you are still drawing the weekly “temporary” checks.
We realize that this is a brief statement outlining how an on-the-job injury claim progresses and the benefits that are available to the injured employee in a workers’ compensation case; however, if you have additional questions, feel free to call or email our office at any time.