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Workers Compensation benefits are the payments an insurer must make to the insured or
another based on the terms of the insurance policy.
There are four basic types of
workers' compensation benefits paid by insurance companies: |
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Medical Benefits:
Medical benefits are paid only for the treatment of
your work-related injury or illness. The insurance carrier does not
pay for the treatment of other injuries or illnesses, even if the
treatment was provided at the same time you received treatment for
your work-related injury. Your health care provider may not bill you
for treatment related to a work-related injury or illness, but may
bill you for treatment of other injuries or illnesses.
You may receive necessary medical treatment
immediately after the work-related injury or illness. If your
employer has elected to contract with a certified workers'
compensation health care network (network), you are required to
obtain medical treatment through the network if you live within a
network's service area.
A doctor
may only request payment from you when the work-related injury or
illness has been reviewed through dispute resolution and has been
finally determined to be an injury or illness that is not
work-related.
It is
beneficial to all parties involved that employees return to work as
quickly as possible. Injured employees that continue to work as part
of their recovery/treatment plan, in medically appropriate
productive work, heal faster, and may retain their job skills.
There is no specific end date for reasonable and necessary medical
treatment to a work related injury. Claims typically cost less
and help reduce the overall insurance premiums to the insured caused
by increased
experience modifiers.
Return to Work:
Injured
employees who remain off work longer than is medically necessary are
more likely to:
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Develop
complications that will lengthen their recovery.
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Become
depressed.
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Lose
physical conditioning.
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Focus on
their pain and injury.
Many
employers offer Return to Work opportunities. Return to Work is set
up by an employer to help injured employees go back to work more
quickly and safely while they heal. This can be done by either
making changes to their regular job or placing them in a temporary
or alternate work assignment that fits the restrictions as
determined by their treating doctor. All employers should invest the
time and effort in developing a Return to Work Program.
Income Benefits:
There are
four types of income benefits:
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Temporary income benefits.
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Impairment income benefits.
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Supplemental income benefits.
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Lifetime
income benefits.
Income
benefits may not exceed the maximum weekly amount set by state law.
Temporary income benefits, impairment income benefits, and lifetime
income benefits are also subject to a minimum amount set by state
law. Maximum and minimum benefit amounts are based on the state
average weekly.
Employees
must report any income (other than income benefits they may be
receiving) to the Division of Workers' Compensation and the
insurance carrier so an adjustment can be made to your income
benefit payments. You may be fined and/or charged with fraud if you
receive temporary income benefits while also receiving wages from an
employer without informing the Division and the insurance carrier.
Income
benefits are no longer payable following the death of an
injured employee receiving income benefits. The injured employee's
beneficiaries may be eligible to apply and receive death benefits if
the injured employee's death was due to the work-related injury or
illness.
Death Benefits:
Death
benefits can replace a portion of lost family income for dependents
and eligible family members of employees killed on the job.
Benefits may also be payable to parents when there are no surviving
eligible dependent family members.
A
beneficiary becomes eligible for death benefits the day after the
employee's death. Death benefits end at different times
depending on the beneficiary's qualifications to be entitled.
Death
benefits may be paid if there is an eligible:
Eligible
Beneficiaries:
A spouse
is usually eligible to receive death benefits for life unless he/she
remarries. Upon remarriage, the insurance carrier will typically pay
a two (2) year (104 weeks) lump sum payment.
If there
are minor children, the benefit is divided between the spouse and
the minor children. One half is paid to the spouse and the other
half is divided equally among the children.
Eligible
children can usually receive death benefits until age eighteen (18)
or twenty-five (25) if enrolled as a full time student in an
accredited college. If there is more than one minor child, as a
child loses eligibility the benefits are re-distributed among the
other eligible children.
Burial Benefits:
Burial
benefits are paid to the person who paid the deceased employee's
burial expenses. The maximum burial benefit allowed is usually
around $6,000 depending on individual state law.
A
beneficiary becomes eligible for death benefits the day after the
employee's death.
Additional Links and Information:
The Basics of Workers' Compensation
Workers' Compensation Laws
Workers' Compensation Claims
Workers' Compensation Benefits
Workers' Compensation Classification Codes
State Fund Workers' Compensation
Workers' Compensation Forms
Workers' Compensation Audit Information
Workers' Compensation Commission
Workers' Compensation Information by State
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