People who are considering filing a workers’ compensation claim often ask how much they can expect in benefits. The short answer is that it depends on your specific injury. A workers’ compensation claim may pay for many of your expenses, though they won’t cover everything that a personal injury lawsuit will. Nonetheless, this should not stop you from filing a workers’ compensation claim. If you suffered injuries on the job, and there is nobody else whom you can sue, this is the only way that you will receive any compensation for your injury.
Your Benefits Would Be Less than You May Receive in a Personal Injury Lawsuit
In a sense, the workers’ compensation system is meant as a compromise to get employers to provide insurance for workplace injuries. Somewhere, many years ago, policymakers decided that it was better to get all worker protections from their employers than to allow each employee the right to sue for personal injury.
The system works because employers must participate in the program under state law. In return, it grants general immunity from most personal injury lawsuits filed by workers. That makes a difference for injured workers’ possible compensation.
Make Sure to Follow Rules and Deadlines Very Closely
The first step that you should take when you injure your back at work is to report the injury to your employer. The law imposes tight timelines on reporting your injury. If you do not meet them, you can lose the right to claim benefits. Make sure that you report your injury in a manner that follows your employer’s written policies and inform the right person.
The other thing that you need to do is to obtain treatment quickly. Not only would this help you on the road to recovery, but you are going to need to document your injury. When you file your claim, the insurance company will want to know exactly why you can’t work. They will need to see your condition in clear detail. In addition, if your employer wants you to see a certain approved medical provider, you must also visit them to be eligible for benefits.
Then, your state will usually impose a deadline by which you need to file your claim. Of course, since you cannot work and need the benefits, chances are that you need the money and will not delay. Unless you are waiting for necessary documentation of your injury, chances are that you will file for workers’ compensation benefits at your first possible opportunity.
Workers’ Compensation Claims Will Cover Economic Damages Only
With that in mind, you are wondering how much you can receive in workers’ compensation benefits for your back injury. First, we should begin by setting expectations for exactly what a workers’ compensation claim is and the damages that it does not include.
One thing that is not a part of your workers’ compensation check is any payment for pain and suffering. This is something that you would receive if you filed and won a personal injury lawsuit. However, workers’ compensation is different from a personal injury lawsuit. When you have a court case, the law’s goal is to put you in the same position as if the injury never happened. This includes all aspects of your experience, including what you have felt. If you experienced emotional distress or anxiety, a personal injury lawsuit would cover this.
However, the workers’ compensation system functions somewhat differently. This system intends to be compensation. While this term also implies that you receive payment for your injuries, it is more the economic aspects of your injury as opposed to the non-economic ones. The entire non-economic piece of personal injury damages would be off-limits in a workers’ compensation claim.
Ways to File a Personal Injury Lawsuit to Get Non-Economic Damages
Unfortunately for the injured worker, these forms of compensation do not exist in a workers’ compensation action.
You could get non-economic damages from a workplace injury if you find some way to file a personal lawsuit against the employer. However, you could only do this in most states if the employer has committed gross negligence. Proving gross negligence requires meeting a very high standard.
Another way to recover non-economic damages for a back injury is if the employer intentionally caused the harm to their employee. Here, you would have to show that the employer knew that the harm existed and did absolutely nothing to fix it. For a back injury, this could be a defect in the workplace that puts an undue strain on employees’ backs or a dangerous condition that caused an employee to fall that the employer did nothing to fix.
Finally, you’ll want to discuss with your lawyer whether someone other than your employer or coworkers may have injured you. If a third party caused your accident—a different contractor on a construction site, for example—then you could seek pain and suffering damages in a personal injury claim against that third party.
The Factors that Determine Your Workers’ Compensation Benefits
If you must proceed through the workers’ compensation system, you will want to know how the insurer will calculate your benefits.
Usually, your benefit would depend on:
- The amount of time for which you would be out of work
- The wage that you earned before your injuries
Your workers’ compensation benefits factor in both wages and medical costs.
Covering Your Medical Expenses
Your workers’ compensation benefits will cover the cost of treatment of your injuries. Many health insurance companies will not pay for work-related injuries because they know that the worker’s compensation system will cover them.
Nonetheless, you will not have to pay any money out of your own pocket. Usually, you will receive a list of doctors from your employer and the state workers’ compensation agency. You will need to pick a doctor from this list to treat your injury. You will not be responsible for any kind of deductible or copayments for your treatment. Your workers’ compensation claim should cover all of your medical expenses.
You may also need ongoing rehabilitation services and treatment. Usually, when you have this taken care of by your health insurance company, you have co-payments. Your workers’ compensation claim should also cover rehabilitation costs. This is not money that would go into your pocket and be a part of your benefit.
Instead, it is part of your claim that goes directly to the rehabilitation provider. In a similar regard, medical equipment and the cost of prescription medication would also be covered parts of your claim. Finally, you may be entitled to mileage reimbursement for your trips back and forth to the doctor to receive treatment.
However, this does not mean that the workers’ compensation insurance will automatically pay everything that they are obligated. In some cases, you may need a workers’ compensation attorney to take action because the insurance company is refusing to pay.
How to Calculate What You Should Receive for Lost Wages
When it comes to calculating your benefits, you first need to know your average wage. Each state will have different regulations for how insurers calculate and pay your lost wage benefits, but the framework is largely the same.
Multiply your annual earnings by two-thirds (or 0.666) to get your yearly benefit. Divide
it by 52 to get your weekly benefit. Each state will also have a maximum cap for what your weekly benefit can reach.
States Could Use Different Measures to Calculate Wages
However, different states calculate your average wages differently. For example, Pennsylvania claimants divide their year into four different 13-week periods and use the highest three periods. Other states just strictly use your average weekly wages.
Your workers’ compensation payment, unfortunately, does not include the overtime that you usually work. If you regularly worked overtime before your injury, you will be out of this amount. The base wage rate used to calculate workers’ compensation benefits only takes into account your scheduled hours and those wages.
How Permanent Partial Disability and Permanent Total Disability Work
Depending on the severity of your injury, you may be entitled to other amounts in your claim. Injured workers could receive permanent partial disability or permanent total disability. A permanent partial disability applies when you recover from your injury but will never be the same again. This limits your ability to earn what you were making before your injury, although you may still work in some form.
For example, when you have suffered a back injury, the doctor may tell you that you can no longer lift more than 25 pounds. This means that you can do some work but not the amount of work that you could have done before. Here, you will get a disability rating. Usually, for every percent of disability that you are rated, you will receive several weeks of benefits. Hypothetically, if you were 50 percent disabled, you could receive workers’ compensation benefits for three years.
The situation is different when you have a permanent total disability. If your disability rating is above a certain percentage, you will receive permanent benefits. These benefits may be less than your wage before your injury. Usually, the insurance company would take a percentage such as two-thirds and apply it to what you would have received in workers’ compensation benefits. Permanent total disability claims are not uncommon, and the benefits calculated will have a large impact on the rest of your life.
You Can Agree to a Lump-Sum Settlement in Some Instances
Workers’ Compensation Lawyer,
David Brauns
Workers’ compensation benefits for your back injury can be paid as weekly benefits or as a lump-sum settlement. In some cases, you may be better off accepting all of the money upfront. However, there are numerous considerations to a settlement agreement, and you need to spell out all terms clearly in advance. If you agree to something that you are not aware of or do not understand, it could affect your ability to have your medical costs covered in the future, and your health insurance may not foot the bill.
This is why we would strongly urge people not to negotiate a settlement agreement with the insurance company on their own. Not only may they not know how much their possible claim is worth, but they also could have no idea of how the terms of the settlement would affect them in the future. This is why you need a workers’ compensation lawyer to help you with your claim. Even though your claim involves formulas, there are different ways to apply them to your claim. This is even more true when your disability is a serious or long-term one, and you will need every penny of your benefits to support yourself and your family.
