16.3 Benefits Provided
Workers’ Compensation benefits are established by state law, so benefit amounts, benefit types, and disability definitions vary by state. However, most states provide medical benefits, disability income benefits, rehabilitation benefits, death benefits, and survivor benefits.
Medical Benefits
Medical benefits generally provide unlimited coverage for all necessary medical expenses, including hospital care, related to a covered workplace injury that occurs during the policy period.
Example
A line cook suffers a burn while preparing food at work. Although the injury does not prevent the employee from working, Workers’ Compensation pays for the necessary medical treatment because medical benefits cover work-related medical expenses regardless of lost work time.
Disability Income Benefits
Disability income benefits replace a portion of lost wages while an employee is unable to work because of a covered workplace injury. These benefits are generally paid only for the duration of the disability. The four types of disability are:
| Disability Type | Description |
|---|---|
| Temporary Total Disability (TTD) | A temporary total disability is an injury from which an employee is expected to recover and return to work, but they are unable to do any work while recovering. For example, an employee is stocking a retail store, and falling merchandise causes a broken arm. The stocker is not allowed to work while recovering, but they are able to go back to the same job after recovering. Benefits begin after a waiting period of several days, and benefits may be paid retroactively for that waiting period if the disability lasts beyond a certain period. The benefit amount is a percentage, typically 66 2/3% of the employee’s average weekly wage, subject to minimum and maximum limits set by the state. |
| Permanent Total Disability (PTD) | A permanent total disability is an injury that prevents an employee from being able to do any work for the rest of their life. For example, a delivery driver is involved in an accident and suffers a spinal cord injury. They are not expected to recover from it, and the injury keeps them from doing any work. Benefits are subject to the same weekly benefit percentage and the same minimum and maximum limits as temporary total disabilities. In most states, benefits are paid for life. |
| Temporary Partial Disability (TPD) | A temporary partial disability is an injury after which an employee is able to do some work, but they are not able to earn their usual wage until full recovery. For example, a construction worker sprains an ankle while working on a project. They are offered light-duty work, but with a pay cut. Benefits are usually calculated as a percentage of the difference in wages. |
| Permanent Partial Disability (PPD) | A permanent partial disability is an injury after which an employee is able to do some work, but they will never fully recover. The employee can still earn a wage, but not as much as they would have earned if the injury had not occurred. For example, a court stenographer is diagnosed with carpal tunnel syndrome, deemed to originate from the stenographer’s job. Though they are able to do some work, they are not able to work as many hours as they worked before the disease’s onset, leading to a loss of income. Benefits may be limited by a schedule of benefits, which specify a specific dollar amount for specific permanent partial injuries (such as loss of an eye or hand), payable for a fixed number of weeks. |
Rehabilitation Benefits
Rehabilitation benefits help injured employees return to work as soon as possible. These benefits may include physical therapy and vocational training. Rehabilitation costs are typically paid by the insurer, although some states use special state funds financed through taxes on insurers and self-insurers.
Death and Survivor Benefits
If an employee dies from a covered workplace injury, death benefits may be paid to the employee’s family to help cover final medical bills, funeral costs, and burial expenses. The Funeral Expense Benefit, which provides an allowance for funeral and burial expenses, is determined by state law.
Survivor benefits provide ongoing income to eligible family members after a worker dies from a covered workplace injury. These benefits are typically paid as a percentage of the deceased employee’s wages to the surviving spouse and dependents. Benefits for a surviving spouse often end upon remarriage, while benefits for dependents generally continue until age 18 or longer under certain circumstances.