Workers’ comp benefit overview

Workers’ compensation benefits are established by state law to:

  • Replace wages lost due to a work injury
  • Cover medical bills for work-related injuries

 

State laws determine:

  • Whether you’re eligible for workers’ compensation
  • Which medical costs are covered, and how much money you’ll receive to replace lost wages

Workers’ compensation benefits are established by state law to replace wages lost due to a work injury and cover medical bills for work-related injuries.

Covering costs of medical treatment

Workers’ compensation benefits generally cover what is medically reasonable and necessary to treat your work injury.

Medical benefits may include:

  • Exams
  • Office visits
  • Medical tests
  • Prescriptions
  • Medical supplies and equipment
  • Mileage to doctor appointments

Compensating for lost wages

If you are losing time from work because of your injury, you may be entitled to wage-loss benefits which help cover your wages while you are unable to work. State law dictates how much you receive, and for how long.

Your state’s law also specifies:

  • A waiting period — the number of days you must be off work before wage-loss benefits begin
  • The minimum and maximum amount of wage-loss benefits you can receive

Specific types of workers’ compensation benefits

Depending on your specific medical and wage-loss situation, you may be eligible for the following types of benefits:

  • Temporary total disability (TTD): This is when you are temporarily unable to work at all due to your injury. Workers’ compensation typically reimburses about two-thirds of your pre-injury average weekly wage, and you receive checks at the same interval your employer issues paychecks. These benefits are subject to your state’s waiting period as well as minimum and maximum limits.
  • Temporary partial disability (TPD): This is when you are temporarily unable to work at your pre-injury wage. Typically, you receive this benefit when you have not fully recovered, but are able to do some type of work. This could mean working fewer hours than usual, doing light-duty or modified work that fits within your medical restrictions, or both.
    In many states, TPD benefits cover half to two-thirds of the difference between the pre-injury wage and the reduced wage. Some states calculate benefits based on a percentage of lost wages, which generally is around one-half to two-thirds. These benefits are subject to your state’s waiting period as well as minimum and maximum limits.
  • Permanent total disability (PTD): If you are so severely injured that you can never return to work, you may be eligible for permanent total disability benefits. In most states, PTD benefits cover two-thirds of your pre-injury average weekly wage and are paid until presumed retirement age or for the rest of your life, depending on state law. If you receive both PTD benefits and Social Security disability benefits, in some states the two benefit systems may coordinate to determine the total amount to replace your weekly wages.
  • Permanent partial disability (PPD): If you have a permanent injury such as the loss of a body part or inability to perform a specific function ever again, you may be eligible for permanent partial disability benefits. Once your doctor determines that no further significant medical recovery is expected, he or she determines a disability rating for your condition. Each disability rating is assigned a specific dollar value set by state law. In states where some disabilities are not assigned dollar values, compensation instead is based on loss of earnings capacity.

    PPD is not a wage-replacement benefit, and it typically can only be paid once you have returned to work or a doctor determines you are so severely injured that you can never return to work.

Get more information on benefits in your state

You can also find more information about benefits on your state’s department of labor website:

This information is not intended to be legal advice and may not represent the entire benefits package an injured employee may be entitled to. Please consult your SFM claims representative regarding the specific benefits you may be entitled to, which are dependent on the circumstances and state where the injury occurred.