Employees who are covered by workers’ compensation and who are injured at work are generally entitled to four types of workers’ compensation benefits:
- Medical benefits
- Disability benefits
- Rehabilitation benefits
- Death benefits
Every state has different workers’ compensation laws, so these benefits vary. That said, here’s a general overview of the typical types of coverage an injured employee may be eligible to receive.
Typically, medical benefits help cover emergency visits, hospital bills, doctor appointments, prescription medications, diagnostic tests, treatments, procedures, surgeries, medical equipment, and physical therapy.
- Except for emergency treatment, an injured employee may need prior approval for medical care.
- The employee might also need prior approval before receiving any type of non-traditional, alternative, or experimental treatment.
- Employees may need to see a healthcare provider of their employer’s insurance company’s choice rather than their own doctor.
- The number of covered visits for physical therapy or other treatments may be limited, depending on state laws.
- The amount that healthcare providers can charge for services may be limited under workers’ compensation state laws.
- The healthcare provider will typically receive reimbursement for services based on a workers’ compensation fee schedule.
Disability benefits are designed to help replace a portion of lost wages for employees who cannot return to work due to work-related injury.
- Depending on the severity and recovery time of an injury, an employee may receive temporary or permanent benefits that may be classified as total or partial.
- Temporary partial disability (TPD), or wage loss disability, helps employees who have minor injuries but can continue working at lighter tasks or reduced hours. Temporary partial disability helps cover the lost wages for taking a reduced work level.
- Permanent partial disability (PPD) helps permanently injured employees once they have recovered to the point of “maximum medical improvement.”
- Temporary total disability (TTD) helps employees who must miss work for a period of time due to a work-related injury. TTD usually covers 2/3 of the average weekly wage.
- Permanent total disability (PTD) helps employees who are so severely injured they are unable to work again. Each state has its own criteria for permanent and total disability.
- Injured employees are typically entitled to temporary disability benefits after a period of three to seven days.
- An injured employee must typically see a workers’ compensation doctor who will determine the level of disability and issue a “disability rating” or “whole person impairment rating.”
Rehabilitation benefits vary by state but may cover either physical or vocational rehabilitation programs to help injured employees return to work.
- Rehabilitation plans are different in each state.
- This type of benefit may cover vocational training, education expenses, adaptive equipment costs, job placement, career counseling, resume writing, ergonomic equipment, occupational therapy equipment, or other services.
- Rehabilitation benefits have limits that vary by state and by the insurer.
- Rehabilitation programs may need to be approved in writing by employer and insurer.
- Some states require employees on disability to attend vocational rehab.
- In some states, employees receive a voucher for rehabilitation services, while in others, providers bill the workers’ compensation insurance company directly.
Death benefits are designed to provide financial relief and help cover funeral and burial expenses for family members of an employee who died from a work-related injury.
- States have different laws regarding workers’ compensation death benefits.
- Typically, eligible dependents qualify to receive survivor benefits.
- Depending on the state, survivor benefits may be paid weekly and are often around 2/3 of weekly wage of the deceased employee.
- In some states, dependents who are physically or mentally disabled may be eligible for additional benefits.
As always, check the laws in your state to learn about specific benefits.
Thanks for reading! Please note that this content is intended for educational purposes only. As best practices change regularly, you should refer to your trusted advisor for specific counsel. If you’re a small business owner, learn more about workers’ compensation insurance or check your workers’ compensation rate in 3 minutes.