Within one day of filing a claim, your employer is obligated to provide up to $10,000.00 in medical treatment until liability for the claim is accepted or rejected. If your employer has established a Medical Provider Network (MPN), you are required to seek treatment from a physician within the MPN, unless prior to your injury you have predesignated your personal physician to provide treatment. If you have not predesignated your personal physician, your employer can choose a physician you must see for treatment within the first thirty days after you file a claim. After thirty days, you can select a physician within the MPN to provide treatment. All medical treatment requests are subject to “utilization review” procedures, which are rules that may allow your employer or its insurance carrier to delay or deny authorization for treatment requests.
Temporary Disability Benefits
If you are unable to work as a result of your injury, you will receive temporary total disability benefits until your treating physician releases you to perform full or modified work activities, or until your condition has reached a maximum level of medical improvement and has been declared “permanent and stationary.” Most employees are eligible to receive up to two years of temporary disability benefits within a period of five years after the date of injury. Payments are made at the rate of two-thirds of your weekly salary, up to specified maximum rates. These maximum rates are adjusted for inflation each January 1st. Like all workers’ compensation benefits, these payments are not subject to state or federal income taxation.
Permanent Disability Benefits
If you have permanent residual impairment as a result of your injury, you may be entitled to a permanent disability rating, whether or not you return to work. This rating will entitle you to a specific amount of permanent disability benefits. Generally, your permanent disability rating will be based on a physician’s description of your impairment according to the American Medical Association Guidelines to the Evaluation of Permanent Impairment (AMA Guides). Permanent disability ratings vary widely depending on the nature of your injury and its severity. If you are able to return to work after your injury, the amount of your permanent disability benefits will be decreased by fifteen percent. Conversely, if you are unable to return to work, the value of your permanent disability benefits will be increased by fifteen percent.
Supplemental Job Displacement Benefits
If you are unable to return to work as a result of your injury, you will be entitled to a supplemental job displacement benefit. This benefit, which ranges from $4,000.00 to $10,000.00 depending on your permanent disability rating, is a nontransferable voucher that can be used for education-related training or skill enhancement at a state-approved or accredited school.
If a death occurs as the result of a work-related injury, death benefits are payable to those who were financially dependent on the deceased employee. The amount of death benefits payable varies depending on the date of the death, as well as the number and ages of financial dependents. Dependent children of a deceased employee are generally entitled to death benefits until they reach the age of majority, and totally disabled dependent children may be entitled to lifetime benefits. The family members and loved ones of a deceased employee should consult an attorney to determine how best to proceed.
Attorney fees are generally limited to fifteen percent of the amount of benefits awarded, and must be approved by the Workers’ Compensation Appeals Board.