The average cost of a work-related injury in the United States is a little more than $42,000, according to the National Council on Compensation Insurance (NCCI).
Fortunately, most employees in Tennessee don’t have to pay this out of their own pocket because they are covered by workers’ compensation insurance. Workers’ compensation insurance is a type of insurance that pays benefits to workers injured on the job.
More specifically, injured employees (or, in the case of a death, the spouse or dependents of the deceased employee) may be entitled to:
- Medical care
- Income-replacement benefits
- Death benefits
Let’s take a look at each type of benefit.
As an injured employee, you’re entitled to receive “reasonable and necessary” medical treatment up to the point that additional treatment will no longer improve your injury (otherwise known as the point of “maximum medical improvement”).
What’s considered “reasonable and necessary” depends on the nature of your injury, but may include:
- Ambulance transportation
- Doctor visits
- Surgery and followup appointments
- Diagnostic testing
- Prescription medication
- Physical therapy
- Medical devices (e.g., oxygen tanks, hearing aids, wheelchairs)
- Any other items or services deemed reasonable and necessary to treat your injury
Will I be reimbursed for treatment I receive prior to the approval of my workers’ compensation claim?
Once your workers’ compensation claim is approved, your employer will provide you with a list of 3 doctors. From this list, you’ll choose your “authorized treating physician.” From that point on, it’s important that you only receive treatment from your authorized treating physician in order to be covered by workers’ comp.
However, if you suffer a serious injury, you may need medical treatment before your workers’ compensation claim is approved. In general, medical care received prior to your claim being approved will only be reimbursed if the need for care was immediate, necessary, and reasonable.
In addition to receiving medical care, you’ll be reimbursed (at the state-set rate) for mileage to and from your medical appointments if the travel exceeds 15 miles in one direction.
Work-related injuries may impact your ability to work now in the future. Your injury may force you to reduce your hours, change positions, or stop working altogether.
Workers’ compensation provides limited income to help cover these situations. Generally speaking, the amount you can receive depends on whether your injury resulted in temporary or permanent disability.
Let’s take a closer look.
Temporary disability benefits
A temporary disability is an injury that isn’t expected to last for the rest of your life. Temporary disability can be either partial or total:
- Temporary partial disability (TPD) benefits apply to injured employees who can still work but in a limited role. For example, a back injury may force you to work fewer hours or may force you to work in a different position (such as a sedentary job). Workers with a TPD tend to make less than they did before their injury, so workers’ compensation attempts to bridge the gap. TPD benefits are paid at the rate of 66⅔% of the difference between your average weekly wage pre-injury and your average weekly-wage post-injury (subject to the state maximum).
- Temporary total disability (TTD) benefits apply when you’re temporarily unable to work at all. TTD benefits are paid at the rate of 66 ⅔% of your average weekly wage pre-injury (subject to the state maximum). Benefits start on the 8th day of the disability (unless the disability lasts only 14 days, in which case the benefits will be back-paid to the first day of disability).
Let’s look at an example:
Jim’s doctor determines that Jim can still work so long as he remains seated until he is fully healed. Consequently, Jim’s boss demotes him to conveyor-belt operator.
In the year prior to his injury, Jim made $750 per week as a ground service agent. Following his injury, he makes $500 per week as a conveyor-belt operator (a difference of $250). Consequently, workers’ compensation would pay Jim $166 per week to make up for the lost income (i.e., 66⅔% of $250).
Permanent disability benefits
A permanent disability is an injury that’s expected to last for the rest of your life. Just like temporary disability, permanent disability can be partial or total:
- Permanent partial disability (PPD) benefits apply to employees who are permanently injured but still able to perform a job (though not necessarily the same job) in the future. Calculating a PPD award is a little complicated, so let’s take a look at each step:
- When a physician determines that you have a permanent injury, the physician will assign an “impairment rating.” The impairment rating represents the loss caused by the injury.
- The impairment rating is then multiplied by 450 to determine how long your benefits will be paid (this is called the “compensation period”).
- The compensation period is then multiplied by 66 2/3% of the average weekly wages you received pre-injury (subject to the state maximum).
- If, at the end of the compensation period, you’re still not working (or not making as much as you did previously), a second award may be given (usually the amount of the original award times 1.35). Additional amounts may be paid based on education and age. This amount is only paid once.
Got all that?
Let’s look at an example:
Susan filed a workers’ compensation claim and the treating physician assigned her an impairment rating of .05%.
What’s Susan’s PPD award?
To calculate Susan’s PPD award, we must first multiply her impairment rating (.05) by 440. This gives us 22.5 (the compensation period).
We must then figure out 66⅔% of her pre-injury wages ($1,000 x 0.6667 = $667).
We now know that Susan will receive $667 for 22.5 weeks (which amounts to $15,007.50 total).
What’s more, if at the end of the 22.5 weeks she’s still not working (or not making as much as she did previously), she’ll be eligible for a one-time payment. This one-time payment is generally the amount of the original award ($15,007.50) times 1.35. In this case, the one-time payment would be $20,260.12.
- Permanent total disability (PTD) benefits apply to employees who are permanently injured and unable to return to any type of work. PPD benefits are easier to calculate than PTD benefits. To calculate PPD benefits, you simply take 66⅔% of your average pre-injury weekly wage. You are then paid that amount until you’re eligible for Social Security.
When a work-related injury results in the death of an employee, the surviving spouse and dependents can receive the following income-replacement benefits:
- If the deceased employee leaves no dependents, $20,000 goes to the deceased’s estate.
- If the deceased employee leaves a surviving spouse, 50% of the deceased’s average weekly wages (subject to the maximum benefit) go to the spouse.
- If the deceased leaves a surviving spouse and 1 or more dependent(s), 66⅔% of the deceased’s average weekly wages (subject to the maximum benefit) go to the surviving spouse for the benefit of the spouse and dependent child(ren).
A surviving spouse receives the benefits list above until they remarry. Minor dependents receive the benefits until they turn 18 (or 22 if they’re full-time students).
In addition to these benefits, the deceased’s burial expenses (up to $10,000) will be paid by workers’ compensation insurance.
Want to make sure you receive all the workers’ compensation benefits you deserve? Use our free online lawyer directory to locate a workers’ compensation attorney near you.