What Benefits Can I Receive In A Worker’s Compensation Case?

If your claim is accepted, you are entitled to Temporary Total Disability (TTD) payments in the event you are not able to work due to your work injury. TTD benefits are calculated based on 2/3 of your Average Weekly Earnings based on your earning capacity, not necessarily your actual wages.  TTD benefits continue until the doctor finds your condition has plateaued or you have received 104 weeks of TTD payments, whichever comes first.  Once TTD stops, the WC carrier will commence permanent disability (PD) benefits based on its estimate of your PD, which reflects the residual functional impairment you have or will sustain from your work injury.  Except in cases of severe and extreme disability, this is NOT a lifetime benefit and is paid out at no more than $290 per week for several months to several years depending on the extend of your PD.

You are also entitled to medical care that will help you get better or feel better from your work injury. You must use the doctors identified on the WC carrier’s Medical Provider Network list.  Your treating doctors will submit a written treatment request to the WC Carrier, who will request that Utilization Review determine the medical necessity of the treatment requested.  UR uses the Medical Treatment Utilization Schedule (MTUS) to determine medical necessity.  If the treatment requested is not in the MTUS, then UR will use other evidence based treatment guidelines such as the American College of Occupational and Environmental Medicine or the Official Disability Guidelines to determine medical necessity.  If UR approves, you get the treatment.  If UR denies, you don’t get the treatment.  It is our experience that UR approves about 65-70% of all treatment requests.  The right to treatment extends for the remainder of your life until you settle.  If the Legislature changes the treatment system again, then you will receive treatment under those guidelines.  There have been at least 4 changes in the way injured workers have received treatment in the WC system in the last 20 years. 

There is also the right to receive a Supplemental Job Displacement Voucher in the event your physician determines that you are unable to return to your usual duties. The SJDV has a value up to $6,000 that you can use for education that will help you return to the workforce.