The four main types of workers’ compensation benefits that injured workers may receive include medical, disability, rehabilitation, and death benefits. The types of benefits you are able to recover will depend on the severity of your injury and level of disability.
Here you’ll learn more about the different types of benefits and how they work, along with how much you may be able to collect.
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What Types of Medical Care Are Covered By Workers’ Compensation Insurance?
The primary category of coverage is medical care. The main purpose of workers’ compensation coverage is to compensate for the medical expenses victims incur as a result of a work accident.
Workers’ comp insurance companies may provide compensation for many types of medical care, including:
- Immediate treatment
- Diagnostic tests
- Hospital visits and stays
- Wheelchairs and other types of assistive devices and equipment
- Medication and other types of treatment
Seeking Treatment After a Work-Related Incident
The first step to take after sustaining a work injury is to seek treatment from a medical professional. Waiting too long to seek treatment could enable your condition to worsen and will also make it appear as though your injuries aren’t serious, even when they are.
Depending on where the work accident took place, you may need to see a doctor or provider that your employer’s workers’ comp insurance company has approved. If you must see these professionals to receive an exam, you may also get a second opinion from another professional. This second opinion may benefit you if the workers’ comp insurance company denies your claim, as it may provide evidence in a workers’ compensation hearing.
Insurance agencies don’t normally cover examinations after the first, so you may need to pay for a second independent medical examination (IME) from your physician.
Workers’ Compensation Disability Benefits
Depending on how your injury has impacted your ability to return to work, the injury may count as a disability. In these instances, you may be able to recover disability benefits in addition to medical benefits.
The following are the different types of disability benefits you may be able to recover in a workers’ comp claim.
Temporary Partial Disability (TPD)
If an injury has limited your ability to work but hasn’t rendered you entirely disabled, you may be able to recover TPD benefits. For instance, you may sustain a leg injury that limits mobility but still allows you to perform certain tasks in another role that pays a lower wage. In other cases, you may be able to work the same job but with shortened work periods.
In the event of an injury that still enables you to work in a limited capacity, workers’ comp insurance companies may pay TPD benefits. These cover around 66.6% (i.e. two-thirds) of the difference between the wages you currently earn and what you earned before your injury.
Temporary Total Disability (TTD)
If injuries or illnesses prevent you from returning to work in any capacity for a limited time, TTD benefits may apply to your case. The amount of time you must be out of work will depend on where you sustained your injuries or developed a work-related illness. In Illinois, you may be able to recover TTD if you are unable to work for at least three consecutive days.
If you qualify for TTD benefits, the employer will need to begin paying benefits within two weeks of the injury. Like TPD benefits, TTD benefits pay two-thirds of an injured worker’s lost wages, specifically the worker’s average weekly earnings.
If the insurance company approves TTD benefits but fails to begin paying them within 14 days of becoming eligible, employers or insurers may need to pay certain fees. If you need to recover these benefits and employers or their insurers are uncooperative or unresponsive, a workers’ compensation lawyer may be able to file a petition to help recover them.
Permanent Partial Disability (PPD)
Some injuries may make a person permanently disabled to an extent due to the disability of a part of the body or a specific body part. Individuals may still be able to work in these cases to a limited extent. To qualify for these benefits, you will need a medical professional to assess disability after reaching maximum medical improvement (MMI), which will determine how an injury or illness led to lasting or permanent damage.
Some examples of permanent partial disabilities may include:
- Severed thumbs or fingers
- Back pain that treatment doesn’t help
- Partially paralyzed limbs
- Permanent hearing loss
Based on the degree of disability, the doctor will give you a permanent impairment rating. If employers or insurance companies approve PPD benefits, you may be able to receive them for a certain number of weeks.
Permanent Total Disability (PTD)
If an injury or illness is extensive enough, it could cause permanent total disability that prevents you from returning to work in any capacity. These injuries may include severe back injuries, spinal cord injuries resulting in paralysis, amputations, traumatic brain injuries (TBIs), and others that render a person permanently disabled.
If an employer or insurer approves these benefits, they will cover two-thirds of your average weekly earnings before the injury, and you may receive them in a lump sum. However, unlike TTD benefits, you will be able to receive PTD benefits that cover a lifetime of disability. Like PPD benefits, you will need to obtain a rating from an approved doctor upon reaching MMI confirming that you have a permanent total disability before receiving these benefits.
Rehabilitation Benefits for Career Support
Workers often sustain serious injuries that prevent them from working in the same capacity as they could before the injuries. For example, some workers may have worked in a demanding position involving manual labor. An extensive physical injury may prevent the worker from returning to the same position, and employers may not have another position available at the time to accommodate the injured worker.
In these instances, you may be able to recover rehabilitation benefits if you need to find another job. With the help of the Illinois Workers’ Compensation Commission, you could begin searching for another position that works for you. As you continue to recover, rehabilitation benefits would help cover the costs of physical therapy and other types of therapeutic care, helping you make as much of a recovery as possible to reach MMI. Additionally, these benefits could cover the costs of rehabilitative training to help restore your ability to work in the same capacity as you could before the injury.
Workers’ Comp Death Benefits
Some work accidents result in a worker’s death. In these instances, the worker’s family may be able to recover workers’ comp death benefits from employers or insurers.
These benefits could cover various expenses that resulted from a work-related incident, paying the family for medical expenses that accrued while the worker was still alive, along with funeral and burial expenses. They may also cover two-thirds of the worker’s average weekly wage during a certain period leading up to the fatality.
In most cases, dependents are the only ones who qualify to recover death benefits due to the loss of a loved one. Typically, benefits go to the worker’s spouse and children who are either under the age of 25 or incapacitated. These individuals can receive up to $500,000 or 25 years’ worth of benefits.
How Much Can an Injured Worker Collect in Wage Replacement Benefits?
Workers’ compensation insurance only replaces a portion of lost wages. In Illinois, workers’ comp pays 66.6%, or two-thirds, of a worker’s average earnings. Also, unlike personal injury cases, workers’ compensation doesn’t cover a worker’s pain and suffering following a work-related accident.
One benefit of workers’ comp insurance is that injured workers won’t need to wait as long to receive benefits as they would with other types of claims, as they won’t need to prove fault in these cases. While you may not be able to recover all lost wages resulting from an injury or illness, you will still be able to get compensation for medical expenses and a portion of your wages, along with other benefits depending on the extent of your injury or illness.
How Workers’ Compensation Investigations Work
When filing a workers’ comp claim, the workers’ compensation insurance company involved may begin an investigation to determine whether your injury is as severe as you claim it to be. It’s important to know how investigators approach workers’ compensation investigations and what they look for throughout this process.
An investigation will likely only take place if your injuries are extensive enough to warrant large amounts of compensation. If your injuries are relatively minor, an investigation may not be worth the cost. Insurers may hire investigators even after denying your claim to gather evidence to support their case in the event you decide to appeal the decision.
When conducting an investigation, private investigators may collect different types of evidence. This may involve a combination of video and non-video surveillance.
Investigations Involving Video Surveillance
Investigators may use video surveillance to gauge your behavior upon sustaining a work-related injury or illness. They’ll look for any potential evidence proving insurance fraud. For example, an investigator may record you entering or exiting a medical facility and determine whether you’re using assistive medical equipment consistently. If they see you enter the building in a wheelchair but proceed to get out of the wheelchair and place it in your vehicle when leaving, this could indicate that your claim is fraudulent and that your injury isn’t serious.
In addition to or in place of video surveillance, investigators may be able to collect different types of non-video surveillance. For example, investigators may contact you and your family to ask questions regarding your disability. They may also conduct brief interviews with neighbors, colleagues, and friends who could have observed behaviors that indicate your injuries aren’t serious.
Additionally, investigators may look for evidence on social media that conflicts with your claims. They might see posts showing you enjoying a night out with friends and exhibiting no signs of injury. This evidence can be damaging to a workers’ comp case, which is why you should avoid using social media as much as possible during the claims process.
What a Workers’ Comp Attorney Can Do
If you develop work-related injuries or illnesses, you may be able to recover worker’s comp benefits from employers and their insurance companies. However, these entities may deny your claim even if you have sustained real and serious injuries.
If injured workers truly qualify for workers’ comp benefits, workers’ comp lawyers help recover all the benefits they’re entitled to recover. Skilled workers’ compensation lawyers can speak with insurers and negotiate with them, collect medical records and other evidence to support claims, and help with appeals if insurers initially deny your claim.
Insurance companies aren’t on your side in workers’ comp or other cases. Adjusters may appear friendly and helpful, but they want to reach the lowest settlement amount possible and work to find reasons to deny a claim. Workers’ comp attorneys will be able to help support a claim and prove the extent of injuries. Experienced attorneys will understand the ins and outs of these cases to help you recover the full amount of compensation you deserve if you sustained a work-related injury or illness. They may also help the loved ones of workers who died from their injuries recover the death benefits they’re eligible to receive.
With a successful workers’ comp case, you may be able to recover a variety of benefits depending on the nature of the accident and a worker’s condition. These benefits could include medical, disability, rehabilitation, and death benefits.