Workers Compensation Benefits

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:

• Medical Benefits

  • Pays for necessary medical care to treat work related injuries or illness.

• Income Benefits

  • Replaces a portion of any wages lost because of work-related injury or illness.

• Death Benefits

  • Replaces a portion of lost family income for eligible family members of employees killed on the job.

• Burial Benefits

  • Pays for some of a deceased employee's funeral expenses.

   

  *Some states also require an additional definition for disability benefits for workers compensation injuries.

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:

• Develop complications that will lengthen their recovery.
   

• Become depressed.
   

• Lose physical conditioning.
   

• 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:

• Temporary income benefits.
   

• Impairment income benefits.
   

• Supplemental income benefits.
   

• 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:

• surviving spouse.
   

• dependent child.
   

• dependent grandchild.
   

• other eligible dependent family members such as parents may be eligible when there are no other surviving eligible dependent family members.

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.

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