What does workers’ compensation insurance cover?
In Alabama, most employees who are injured or become ill on the job are entitled to receive benefits under Alabama’s workers’ compensation laws. These benefits include medical expenses, lost wages and death benefits for certain dependents in the event of the employee’s death.
Let’s look at each of these types of benefits so you’ll have some idea of what to expect if your workers’ compensation claim is approved.
Alabama’s workers’ compensation laws require employers to pay for all medical expenses that are “reasonable and necessary” to treat an employee’s work-related injury or illness.
Reasonable and necessary medical expenses may include:
- Ambulance transportation
- Diagnostic testing
- Doctor and hospital visits
- Medical devices and equipment (oxygen tanks, crutches, artificial limbs)
- Mileage reimbursement ($0.56 per mile in 2022)
- Physical or occupational therapy
- Prescription medication
- Repair, refitting or replacement of damaged artificial limbs
- Surgical procedures and follow-up appointments
Injured employees aren’t responsible for co-pays and shouldn’t have any out-of-pocket expenses.
If you refuse to comply with any reasonable request for examination or if you refuse to accept the medical services recommended by your authorized treating physician, your right to compensation may be suspended.
Wage loss benefits
If your injury or illness requires you to miss work or changes the nature of the work you can perform, you’re entitled to receive wage loss benefits (sometimes called “income replacement benefits”).
In most cases, the amount of compensation you’ll receive depends on whether your injury is classified as a temporary disability, temporary partial disability, permanent partial disability or permanent total disability.
|Temporary partial disability (TPD)||Temporary total disability (TTD)||Permanent partial disability (PPD)||Permanent total disability (PTD)|
|If you're able to return to part-time or light-duty work while you're recovering but earn less than your normal wages, you may be eligible for temporary partial disability (TPD) benefits. TPD benefits are two-thirds of the difference in your average weekly wages (subject to an ever-changing statutory maximum).
TPD benefits are paid when you return to work and cannot exceed 300 weeks.
|If you're temporarily unable to work, you may be eligible for temporary total disability (TTD) benefits. TTD payments are two-thirds of your average weekly wages (subject to an ever-changing statutory maximum).
There is no maximum number of weeks that TTD may be paid.
|If you suffer a permanent injury but are still able to work in some capacity, you may be eligible for permanent partial disability benefits. Your award will be based on the permanent impairment rating assigned to you by your doctor, as well as a state schedule that lists degrees of impairment based on loss of use of certain body parts.
PPD benefits cannot exceed 300 weeks.
|If you're totally and permanently disabled (i.e., you’re unable to obtain gainful employment), you may be able to receive two-thirds of your average weekly wages (subject to an ever-changing statutory maximum).
There is no maximum number of weeks that PTD benefits may be paid.
There are a few important things to remember about wage loss benefits in Alabama:
- There is a 3-day waiting period before you can start receiving wage loss benefits for TPD and TTD injuries. If the disability lasts for 21 days or more, compensation for the first 3 days will be paid after the 21 days. If the disability does not last for 21 days or more, you won’t be compensated for the first 3 days.
- If any installment of compensation is not paid within 30 days after it becomes due, the injured employee is entitled to an additional amount equal to 15 percent of the amount due.
- Wage loss benefits are NOT considered taxable income.
If a work-related injury or illness results in an employee’s death, the deceased’s dependents may be eligible for death benefits.
Which dependents are eligible for death benefits?
Only surviving family members who were “financially dependent” on the deceased employee are eligible for death benefits. In most cases, this means the surviving spouse and minor children.
What benefits are available?
Depending on how many dependents are left behind, wage loss benefits are available at either half or two-thirds of the deceased employee’s pre-injury wages (subject to the maximum).
Death benefits will continue as long as the survivors remain dependent, up to a maximum of 500 weeks.
Workers’ compensation will also pay up to $6,500 toward the burial expenses of the deceased employee. This amount must be paid even if the deceased employee had private burial insurance.
What do I do if my workers’ compensation claim is denied?
If your workers’ compensation claim is denied, you can appeal the decision. Unlike most states, Alabama does not have a court process available to hear workers’ compensation disputes. Instead, you must:
- File a lawsuit with the Alabama district court, or
- Attempt to resolve the dispute with the help of the Ombudsman.