Types of Workers' Compensation Policies

Most insurance companies and state fund workers' comp plans offer the same benefits to all policyholders. However, there may be some variations depending on the state where you reside. Here are examples of the standard benefits available:
 
Medical treatment - Injured workers can file a claim for medical care benefits that can help them pay for the following:

• Doctor's appointments
• Emergency room or hospital visits
• Ambulance fees
• Necessary surgery
• Medications
• Therapy and rehabilitation
• Medical devices that assist in recovery

You may need ongoing care depending on the extent of your injuries, which should be covered. Still, there are some exclusions, so be careful to understand what is covered before seeking care using the following alternative options:

• Acupuncture
• Homeopathic medicine
• Naturopathic treatment

Although the following treatments can hardly be considered "alternative," you may need the help of a workers' compensation lawyer if you're denied coverage for anything below:

• Surgery
• Extensive testing
• Pain management
• Psychiatric care
• Home modifications to accommodate your disability
• Specialized medical devices beyond standard models
• Experimental treatments

It's important to note that some states may require you to use approved medical care providers. These policies are dictated by your employer's insurance provider and state laws. If you have any questions regarding which doctors and treatments are covered by workers' compensation benefits, be sure to speak to your employer.
 
Disability - Serious injuries may result in some form of disability which generally falls into the following categories:

• Temporary total disability means you're unable to work for a period of time while you recover, but you will recover and be able to return to work without limitation.
• Temporary partial disability means you're able to continue working but at a diminished capacity while you recover. For example, if you sprain your back after a slip and fall, you might be ordered to work half days until you recover fully.
• Permanent total disability means your injury is severe enough that you will never be able to return to your former job duties.
• Permanent partial disability means you'll be able to return to work but never work in the same capacity as you did prior to your injury.

Rehabilitation - Workers’ comp benefits should cover your ongoing care, including physical therapy and vocational rehabilitation to help you learn new skills that can accommodate your injury. Vocational rehabilitation can pay for your training in a new role and cover any fees for certifications.
You'll also get an analysis to understand what sorts of skills you currently have that could be transferred to a different type of job. This kind of training is typically covered for up to two years. Meanwhile, you can still collect wage replacement benefits and continue ongoing health care that is necessary.
 
Death and funeral services - If you've lost a loved one due to a workplace accident or illness, as a beneficiary, you're entitled to collect payments to cover the cost of their final expenses and receive ongoing income for lost wages. Funeral and burial expenses are typically capped at a certain amount. Beneficiaries usually include the deceased's spouse, children, and elderly parents. Children over the age of 18 with disabilities can usually collect as well.
 
Wage replacement - The exact amount you can get for wage replacement will depend on where you live and the severity of your injury. Generally, you can expect to receive about ⅔ of your average weekly pay replaced, but there are maximum allowable payments.

Suppose you've suffered a work-related illness or injury that's left you with a long-term medical issue. In that case, you may get permanent disability benefits, but you will need to go through a lengthy process to show that your medical issue isn't likely to change or improve. It will need to keep you from working or is a barrier to your ability to maintain gainful employment. You must meet all the basic eligibility requirements, such as:

• Your employer carries workers' compensation insurance.
• You are an eligible employee (exemptions may include household, seasonal, and volunteer workers, for example).
• You have filed a workers' compensation claim, followed the procedures, and met deadline requirements by your state.

 Additionally, you'll be required to follow your state's rules concerning which medical professionals you can use and their decision about the nature and extent of your disability.

Requirements vary by state, but generally, you will need to have missed more than seven days of work to get reimbursed for lost wages. As mentioned previously, you will not receive the full value of your lost wages, but the wages are not taxed, so you should get close to the same amount you usually get for a paycheck.
 
If you are able to return to work but need to work fewer hours or in a role where you receive less pay, you should be able to get compensated for the difference. Likewise, if you previously were able to work a lot of overtime, the difference should be included in your wage replacement.
 
Your loss of earnings may have to meet a threshold before you receive wage replacement. For example, if you can work but in a different capacity that pays slightly less, you might not qualify. Finally, if your doctor approves you for light duty and you choose not to accept this work, you will lose your right to receive wage replacement benefits.

Ideally, any injury caused through your employment will be minor, and you'll quickly recover and return to work as good as new. But not every workplace accident goes this well. Here are common reasons why a worker might consider hiring a workers' compensation lawyer:
 
You have a preexisting condition - If you have a medical history that shows previous injuries or an underlying health condition, this may give your employer's insurance carrier an excuse to deny your benefits. However, a preexisting condition should not preclude you from coverage if the workplace incident aggravated or worsened it.
 
The employer contests that you were injured on the job - A dispute might arise if your employer will not accept that the injury is related to work duties. A highly competent workers' compensation attorney can work to demonstrate the link between your injury and employment.
 
Benefits are denied or held up - An astonishing number of workers' comp claimants give up after their initial claim is denied. However, you have rights and options to pursue the benefits you deserve. Your Morgan and Morgan legal advocate can help you obtain the medical documents needed to have your claim validated.
 
You have a permanent or long-term disability - Medical costs and lost wages can be substantial with a serious injury. When this is the case, you may have a hard time getting the quality medical care you need, and your employer's insurance provider will likely fight to reduce their losses to your detriment. Our attorneys can work to ensure you get the medical coverage you need and the wage benefits that you are owed.
 
Your employer disagrees with a medical determination or is disputing a decision made by your state's workers' compensation board - Your employer has a right to contest decisions. Still, they don't have a right to avoid honoring their responsibility toward you. A workers' compensation lawyer can work to apply legal measures to force their hand.
 
You're required to get an independent medical examination after receiving long-term benefits - It's not unusual for your employer to question your eligibility for benefits after paying for them for a long time. Many times, another examination is a tactic to reduce or discontinue benefits. Morgan and Morgan can work to ensure an unfair decision doesn't impact your benefits.
 
If you're researching the legal aspects of a workers' compensation claim, you may already realize you need help. We can give you personalized answers because we know this is a challenging process, and it's hard to find explanations in non-specialists' terms. If we accept your case and are unable to help you secure the benefits you need, you won't owe us any fees—none whatsoever.
 
Contact us today for a free, no-obligation case evaluation to get started.