What is Worker’s Compensation: How Long Does It Last?

Worker’s compensation is the coverage provided by employers to give to employees that are injured or sick due to their job or workplace. Worker’s compensation provides benefits such as medical treatment and wage replacement, and it covers medical expenses, ongoing care costs, and even funeral expenses if the injury results in an untimely death.

According to the Bureau of Labor Statistics, in 2004 there were over 4.2 million job-related injuries and illnesses and over 5,700 on the job fatalities. The most common causes of work-related fatalities include:

• Highway incidents
• Falls
• Falling or moving objects
• Overexertion
• Accidents caused by machinery
• Repetitive strain incidents i.e. carpal tunnel, bursitis

Common causes of non-fatal work-related injuries from the list above include falls and overexertion in lifting and moving objects. These kinds of injuries are just a few examples of what worker’s compensation can cover.

Worker’s compensation can vary for each individual or worker, so that’s why it’s important to read on how it works. Here are the questions frequently asked regarding worker’s compensation.

How Long Do Benefits Last? Medical Benefits?

Medical benefits provided by worker’s compensation vary from state to state. For example, in the state of Texas, worker’s compensation lasts the entire lifetime for those that file the claim. Others states limit the range to three to seven years for temporary disabilities. In addition, most states will allow the employee to be reimbursed for all transportation costs that relate to medical appointments.

If the insurer believes the medical benefits should be suspended, or if treatment is no longer necessary, the insurer may refuse to offer to pay for treatment. That’s when the injured worker will need to file a claim with the state workers’ compensation agency to try to get the treatment paid for.

The workers that return to work after being injured on the job still receive medical benefits if the treatment is deemed necessary to continue. If workers would like to return to their job but are still injured, employers offer return-to-work programs that will make changes to your regular job or placing you in a temporary or alternate work assignment that fits your abilities.  

How Long Does Temporary Disability Last?

Temporary disability has two kinds of benefits: Temporary Partial Disability (TPD), or Temporary Total Disability (TTD). TPD is known as wage-loss. Temporary disability is the state of injury disability that isn’t permanent.  Under TTD and TPD, the injured worker can get benefits to replace lost wages until your doctor says it’s okay to work again.

Just like medical benefits, temporary benefits vary from state to state as well (Texas doesn’t categorize TTD). As mentioned earlier, temporary benefits range from three to seven years depending on the state. Payments for TTD or TPD usually end until you:

1. Return to work
2. Doctor approves you returning to work
3. You have reached “maximum improvement,” a state that means you’re no longer expected to improve
4. Have received more than 104 compensable weeks of payments within a period of two years. In some states it can extend to 500 weeks.
5. You or the insurance company disputes the treating doctor’s evaluation

If temporary disabilities continue, injured workers can qualify for permanent disability.

How Long Does Permanent Disability Last?

Permanent disability typically exceeds temporary disability. This kind of disability can last a lifetime, and there’s not usually a limit to these kinds of benefits. There are two kinds: Permanent Partial Disability (PPD) and Permanent Total Disability (PTD).

With PPD, you can do limited work and still receive some worker’s compensation benefits based on the body part injured and anatomical loss found by your doctor.With PTD, you receive benefits indefinitely, or if your state declares otherwise. Usually you can never work again with PTD. Unfortunately, some states half benefits at a particular age and some may not offer PPD at all.

Generally speaking, permanent disability is considered when a temporary disability reaches its plateau in recovery. Depending on state rules, the insurance company may request an IME, or independent medical examination, in order to transfer your disability from temporary to permanent.

You don’t necessarily have to prove that you can’t work at all in order to receive total permanent disability benefits. For instance, you may be considered totally and permanently disabled if you have certain kinds of injuries. You may also qualify if you have a combination of permanent impairments that add up to a 100% disability rating.

Permanent partial disability and total disability comes with benefits.

1. Partial disability benefits are limited to 300 weeks and may have a cap of $220 per week. These vary by illness or injury.
2. Total disability benefits are unlimited. These equal to two-thirds of your average weekly wage, subject to the state maximum. These benefits are paid out to workers who cannot return to the workforce. Some states cap at PTD and some may reduce benefits once the employee qualifies for Social Security Disability Insurance.

There are also Social Security disability benefits and these are rarely terminated due to medical improvement. However, SSI recipients can lose their benefits if they have exceeding income or assets.