Frequently Asked Questions - Do Workers' Compensation Insurance Companies Pay For Lost Wages?
It depends on the specifics of your particular case. If your claim has been accepted by your employer and their workers’ compensation carrier, they are responsible for furnishing you with authorized medical care. They may also owe you lost wages depending on several factors.
At each visit with an authorized doctor, the doctor will be asked to address various aspects of your case including your work status and whether you have reached Maximum Medical Improvement (MMI). MMI simply means that your medical care has plateaued and your medical issues are not likely to improve. Put another way, MMI means that you are “as good as you are going to get”.
Before MMI, you would be entitled to temporary lost wages in three separate situations.
The first is if the your treating doctor places you on a no work status meaning you cannot work at all. If you are on a no work status, you are entitled to Temporary Total Disability or “TTD” benefits for short. Lost wages are always paid based on your Average Weekly Wage (“AWW”) for the 13 weeks immediately before your industrial accident. For example, if you averaged exactly $500 per week for the 13 weeks before your accident, you would be paid 66 2/3% of this figure or $333.33 per week while on a no work status. It should be noted that if you are incarcerated or confined involuntarily to a public institution such as a mental hospital while on a no work status, this would preclude you from receiving lost wage checks unless you have dependents. If so, the insurance carrier must pay benefits to the qualifying dependents while the injured worker remains an inmate.
The second situation where you would be entitled to payment of temporary lost wages Is if your authorized doctor places you on a light duty work status and your employer is unable or unwilling to accommodate your limitations. In many cases, your doctor will not place you on a no work status taking you out of work entirely. Instead, your authorized doctor will place you on some type of light or modified duty. Light duty work may be offered depending on the company where you work and whether they have light duty work to offer you. If your employer is willing to offer you work within your work restrictions and you are earning at least 80% of your pre-accident earnings, lost wages would not be owed. If work is offered and it is refused, your employer and their insurance company will likely take the position that you are voluntarily limiting your income and deny any claim for lost wages.
If your employer does not have work available within your work restrictions, or is otherwise unable or unwilling to accommodate you, the insurance carrier will owe you Temporary Partial Disability benefits or “TPD” benefits for short. These benefits are paid at 64% of your Average Weekly Wage (slightly less than the 66 2/3% owed when on a TTD or no work status). Please understand that while TTD and TPD benefits are paid at only a percentage of your regular pay, you would not be taxed on the lost wage checks received which does help soften the blow.
The last situation where temporary lost wages would be owed is if you are placed on light duty and your employer offers you work within your limitations, but you are earning less than 80% of your pre-accident earnings through no fault of your own. For example, you are offered work at a lesser rate of pay or given less hours and end up earning less than 80% of your pre-accident earnings, you would be entitled to partial TPD benefits depending on your specific earnings during that particular time period. The insurance company should have you complete Employee Earning Reports (also known as a DWC-19) documenting your earnings for that particular time period. It is important to fill out the Employee Earning Reports in a timely manner so it can be determined if lost wages are due and you are paid for such benefits in a timely fashion.
Again, please recall that your right to collect TTD or TPD benefits ends once you are placed at MMI by your treating doctor. Once the authorized doctor (or doctors) place you at MMI, no additional lost wages would due or owing. Lastly, any right to temporary lost wages would end once work is offered within your limitations or if placed on a full duty status by your authorized doctor. If you disagree with your doctor’s opinions regarding work status or MMI or wish to challenge your right to collect lost wages, you should consult with an attorney specializing in workers’ compensation for a legal opinion.
Once placed at MMI, the only way lost wages would be owed is if you can prove that you are Permanently and Totally Disabled or “PTD”. If you are entitled to PTD benefits, you would receive 66 2/3 % of your AWW until age 75 or death, whichever occurs first. For all accidents occurring after October 1, 2003, PTD benefits are NOT payable if the claimant is engaged in, or is able to engage in, at least sedentary work. Put another way, an injured worker needs to establish that they are unable to engage in at least sedentary work to be eligible for PTD benefits.
For some injuries or conditions, such as a spinal cord injury involving severe paralysis of an arm, leg or trunk, or a severe brain or closed head injury, it would be presumed that you are PTD although this could be challenged by your employer and their insurance company. If an injured worker does not suffer a presumptive condition (like a spinal cord injury involving paralysis or a severe brain injury), the injured worker has the burden to prove they are entitled to PTD benefits. Please understand that this can be a difficult burden to overcome. And, most insurance companies will not agree to provide such benefits without a fight. Thus, if you suffer a serious injury, you should strongly consider talking to a lawyer specializing in workers’ compensation as early in the process as possible.