The system of workers’ compensation benefits can be complicated, so if you are eligible, ensure you understand the guidelines well and manage your eligibility properly.
One of the main things you must remember is determining how long workers’ compensation can cover you. Ultimately, the end of your workers’ compensation benefits can vary, depending on factors like the rules of your state, the type of disability, the prognosis, the chances of recovery, the type of work you were doing, and the type of work you can do now.
In this guide, we will take a deeper look at these factors to further understand the extent and limits of worker’s compensation.
Workers’ Compensation Benefits And Their Time Limits
The length of workers’ compensation benefits depends on various factors and, in some cases, can extend even if the worker is able to go to work. In theory, workers’ compensation benefits can last for a lifetime.
However, there are factors that can hinder this from happening, and one of them is the type of disability. Technically, the states decide the extent of coverage, but what they follow and set is influenced by the severity of the illness or damage.
1. Temporary Partial Disability
Temporary partial disability is a situation where the employee can return to work in a light-duty capacity while still recovering. Often, employees in this category receive two-thirds of the difference in their pre-injury and post-injury wages.
The benefits are provided for 104 weeks in states like Florida, 350 weeks in states like Georgia, and 520 weeks in Louisiana. The coverage may cease earlier, however, once the doctor determines that you have achieved maximum medical improvement. Because of this, the state will also require regular doctor’s visits — in most cases, at least once a year.
2. Temporary Total Disability
Temporary total disability refers to employees whose diagnosis shows that they can fully recover, but can’t return to work as their body recuperates. In this situation, the disability benefits are set at two-thirds of their gross weekly income, up to the maximum amount of the state.
The duration of temporary total disability benefits depends on state laws, ranging from three to seven years. Georgia goes longer at a 400-week timetable, and Pennsylvania offers the benefit for a long time, as long as the loss of earning power is presented by the employee.
3. Permanent Disability
Permanent disability describes an illness or injury that hinders a person from working full-time for the rest of their life. Because of the incident, to put it simply, their work life is over forever.
Similarly to other types of disability, the states dictate their own benefit guide. Usually, the disability benefit that is received for this case is sent as a lump sum payment, with the total amounting to 400 to 450 weeks worth of wages.
However, compensation may still vary, especially with varying degrees of disability. States use a disability rating scale to determine the final payout.
In some cases, because of the limitations of workers’ compensation insurance coverage, employees are encouraged to apply for Social Security Disability Insurance (SSDI) benefits.
What Other Reasons Cause Workers’ Compensation Benefits To End?
Aside from the standard guidelines set on workers’ compensation benefits, there is a chance that the benefits you receive will suddenly stop. Here are some reasons that can lead to a termination of workers’ compensation benefits:
1. Ignoring Requirements To Get A Medical Exam
Since some illnesses and disabilities can disappear, most employers and insurance companies require medical exams once or twice a year to check the worker’s health progress. This is a way for them to determine their eligibility for compensation.
In most states, it is a requirement to have a medical exam regardless of the state of your health. If you fail to do so, they may decide to terminate the benefits you receive.
2. Committing And Are Convicted Of A Crime
Workers’ compensation benefits are not extended to people who commit a crime, get convicted, and are sent to jail. There is no rule that dictates family members who are dependent on you to claim the compensation on your behalf.
3. Not Complying To Doctor-Prescribed Medical Treatment
The main purpose of workers’ compensation is to allow injured and ill workers to maintain access to the medical care they need to provide monetary means. Therefore, it is a must that the worker make an effort to recover from the injury and eventually get back to work — that’s why the worker must also strictly follow the medical treatment as advised by their doctor.
If your doctor recommends a treatment plan and recovery timeline and you don’t comply, the insurance company and your employer may be forced to take the compensation away.
4. Failing To Complete The Employee Verification Form
There are cases when a person who receives workers’ compensation is strong enough to still continue working. In this situation, they are required to report the income they receive and provide it to the insurance company within the set deadline.
If a worker fails to fill out their employee verification form, the employer has the right to cease paying them their benefits until they have completely filled out and submitted the form. Notably, the company is not obligated to repay any gap caused by the delays in filling out the employee verification form.
5. Case Was Reviewed And Was Terminated By A Judge
There are workers’ compensation claims that are sent to the court, usually to identify whether there is a reasonable cause for the claim. If a judge determines that your claims are invalid after their review, you will lose your compensation for lost wages and medical costs.
However, if you believe that the decision was unjust, you can hire an experienced workers’ compensation attorney to help you with an appeal.
6. A Final Receipt Was Signed
There are cases when you are asked to sign a final receipt with the belief that you have fully recovered from an injury. When you sign this final receipt, you will no longer be eligible for workers’ compensation benefits.
Because this can be costly and lead you to lose the compensation you deserve, you should ensure that you consult a lawyer first before signing anything.
7. Returning To Work
Once you decide to get back to work and you are back to earning, your employer and their insurance company will cease providing you your wage loss benefit. However, they may still help you with medical bills until the moment you are fully recovered from the injury.
8. Accepted A Lump Sum Payment
In some cases, insurance companies attempt to save money for their client by offering a lump sum payment to employees injured on the job.
If you agree to accept this lump sum payment, you won’t be able to ask them for further compensation in the future nor appeal to the court, so make sure that you consult with your workers’ compensation attorney before signing an agreement like this.
The Takeaway
Workers’ compensation benefits have limits set by state laws, and they vary based on your location and the intensity of the injury you suffered. There are also special cases that cause your compensation agreement to end abruptly, so follow the guidelines discussed to avoid mishaps. Ultimately, it’s best to seek help from legal experts, especially when it comes to major decisions.
Learn more about disability benefits and receive important advice by exploring the rest of Disability Help!
