Workers' Compensation Benefits

If you are injured in an accident arising out of and in the course of your employment, or if a work accident aggravates a pre-existing condition, you may be entitled to some of the following benefits: medical care, temporary total disability benefits, permanent partial disability benefits, permanent total disability benefits and/or survivor benefits.

Medical Care
Injured employees are entitled to receive all, necessary first aid, medical, surgical and hospital services required to cure or relieve the effects of the injury or disease. The employer's responsibility is to pay for all emergency services, two treating physicians, surgeons or hospitals of the employee's choice, and any additional medical care providers to whom the employee is referred by the two physicians, surgeons or hospitals. When appropriate, an injured employee may also be entitled to receive physical, mental or vocational rehabilitation. An employee may choose any doctor or hospital at the employer's expense. You should inform your employer in writing of the name and address of the doctor or hospital chosen. An employer is responsible to pay for two treating physicians chosen by the employee. However, the employer is also responsible to pay for any additional medical care providers to whom the employee is referred by the two physicians, surgeons or hospitals. If the employee claims to be entitled to benefits and the employer asks for an examination by a doctor of its choice, the employee must undergo the examination at a reasonable time and place. The employer must pay for this examination. In addition, the employer must pay, in advance, sufficient money to defray travel expenses. However, the injured worker does not have to treat at the company clinic. If the employee loses time from work to be examined by the employer's physician, the employer must provide reimbursement for lost wages.

Temporary Total Disability (TTD) Benefits
Temporary total disability (TTD) benefits are paid to the injured employee who must lose time from work to recover from a work-related injury or disease. The employee is entitled to collect TTD benefits until he is able to return to work that is reasonably available to him or her TTD Benefits are paid at the same interval the employee was paid before the injury or exposure. It may take as long as 14 days from the time the employer received notice of the injury or disease before payments begin. TTD Payments are not paid for the 3 work days lost to a work-related injury or disease, unless the disability continues for 14 or more calendar days. The benefit is two-thirds (66 2/3%) of the employee's gross average weekly wage, subject to certain limits. The average is based on the employee's wages during the year before the injury or exposure. The rate is fixed at the time of the injury, and does not change with changes in the employee's salary or statewide average weekly wage. If an employee was working for two or more different jobs, the TTD rate may be based on the combined gross income from all jobs. This will only apply if the employer for whom he or she was working at the time of the accident or disease had prior knowledge that the employee was working another job. Overtime is generally not included in the calculation of the average weekly wage. Overtime pay is included, however, under the Worker's Occupational Diseases Act. If the employer stops or with holds payment of TTD benefits before the employee returns to work, the employer must give the employee a written explanation on the date of the last TTD payment. Furthermore, the employer may be subject to penalties for failure to provide the employee with written notice.

Permanent Partial Disability (PPD) Benefits
A permanent partial disability is the complete or partial loss or loss of use of a part of the body, or the partial loss of use of the body as a whole. "Loss of use' is not specifically defined in the law, but it generally means the employee is unable to do things with the body part or with the body as the whole that he or she was able to do before the injury.

PPD benefits are paid only if the work-related injury or disease results in a permanent loss of use of a part of the body or the whole body. PPD benefits are paid only after the employee's condition has reached a point where it will not improve any more. The Industrial Commission evaluates employee's physical impairment and the effect of the disability on the injured worker's life. Factors that may be considered include the individual's age, skill, occupation, training, and inability to engage in certain kinds of work or activities, pain, stiffness or limitation of motion. There are two ways in which PPD benefits may be determined. In the first method, the amount depends on the part of the body injured and the extent of the loss. The law places a value on certain body parts, expressed as a number of weeks of compensation for each part. The numbers of weeks provided for the various parts of the body are listed in the following chart.

Permanent Partial Disability Benefits For 100% Loss of Use

Body partWeeks Paid
The thumb70
The 1st (or index) finger40
The 2nd finger35
The 3rd finger25
The 4th finger20
The great toe35
Each other toe12
The hand190
The arm235
The foot155
The leg200
The loss of one testicle50
The loss of both testicles150
The sight of one eye150
The removal of one eye160

The hearing of one ear:
 
Due to an accident or trauma50
Due to an occupational disease100
The hearing of both ears200

Fractures resulting in permanent disability: Not less than
Skull fracture6
Fracture of a facial bone2
Fracture of a vertebra6
Fracture of a spine or transverse process3

Removal of a kidney, spleen or lung

10

In the second method, the employee may be entitled to a percentage of 500 weeks that the partial disability bears to total disability. The PPD benefit is 60% of the employee's gross average weekly wage, subject to certain limits.

An employee who sustains a permanent injury or impairment of the body not listed in the chart is entitled to the percentage of 500 weeks that the partial disability bears to total disability. An employee who suffers a permanent disfigurement to the hand, head, face, neck, arms, legs, below the knee or chest above the armpits as a result of a job-related injury is entitled to benefits for up to 150 weeks at the PPD rate. Employees who cannot return to the same occupation after the work-related injury or disease are entitled to receive a wage differential. The wage differential is two-thirds of the difference between the amount the employee would otherwise be earning in the full performance of his job if the accident had not occurred, and the amount he or she is able to earn after the injury.

Permanent Total Disability (PTD) Benefits
A permanent total disability is defined as complete disability which renders the employee permanently unable to do any kind of work for which there is reasonable stable employment market or the loss of both hands, both arms, both feet, both legs, both eyes, or any two such parts. Employees who suffer permanent and total disabilities from work-related injuries are entitled to benefits for life. Employees who received PTD benefits and then return to work or could return to work may have their benefits modified or terminated. The benefit is two-thirds (66 2/3%) of the employee's gross average weekly wage. The average is based on the employee's wages during the year before the injury or exposure, subject to certain limits.

Survivors Benefits
In the event that the work-related injury or disease results in the death of the employee, his or her spouse and children are entitled to full benefits. Benefits are paid to children under the age of 18 or until age 25 if a full-time student or if physically or mentally handicapped for the duration of the incapacity. If the deceased has no eligible spouse or child, the benefits are paid to his or her totally dependent parents. If the deceased has no eligible spouse, children or totally dependent parents, the benefits may be paid to other survivors, including partially dependent children, parents, grandparents, grandchildren or the other heirs who are at least 50% dependant on the employee. If the spouse remarries and there are no children at the time of the remarriage who are entitled to benefits, the spouse is entitled to a final lump sum payment equal to two years compensation. The benefit is two-thirds (66 2/3%) of the employee's gross average weekly wage. The average is based on the employee's wages during the year before the injury or exposure, subject to certain limits. The survivors' benefit is limited to 20 years of weekly benefits, or $250,000.00, whichever is more.

Settlement
A lump settlement is a contract between the employee and the employer to close a claim in exchange for an agreed-upon amount of compensation and medical services. Cases in which the employer denies liability or disputes the amount of compensation are often settled by lump sum settlements. By settling such cases, the employee avoids the risk of getting no compensation or less than is provided in the settlement. Unless they provide otherwise, approved settlement agreements usually close out the employee's rights to future medical benefits, vocational rehabilitation, and additional compensation, even if the employee's condition worsens.