One of the biggest concerns after suffering a workplace injury is when compensation starts. You have bills and financial obligations, and while you are out of work recovering, you have no way to pay for them.
The good news for injured workers is that some of the benefits start relatively quickly. That is because the law requires that an employer, at a bare minimum, pay for medical expenses related to the workplace injury even before the claim is officially accepted. While a worker might not receive compensation for living costs, they at least have medical expenses covered during the waiting period.
However, the severity of the injury plays a role in the amount of medical benefits received. And later, the severity of the injury plays a role in determining how much compensation a worker receives.
Understanding Basic Eligibility Requirements for Workers’ Compensation in Washington, D.C., Virginia, and Maryland
After a work-related injury or illness, an employee should be entitled to workers’ compensation benefits. These benefits include medical expenses and a portion of lost wages. If the worker is eligible, they receive compensation even if they were at fault or partially at fault for the injury or illness.
In exchange for this leniency, however, the worker forfeits his or her right to file a private lawsuit against their employer. While there is a narrow list of situations that still allow for a lawsuit after compensation is recovered, most instances of workplace injury mean that the employee cannot file a lawsuit.
In general, workers are entitled to compensation as long as they meet four basic requirements:
- They are an employee of the company.
- The employer carries workers’ compensation insurance.
- The employee suffered a work-related injury or illness (not one that occurred outside of the demands of employment).
- The employee met all state filing deadlines and reporting statutes when filing his or her workers’ compensation claim.
Also, there is one more stipulation. Even if all four of the above apply, if the worker tests positive for drugs or alcohol (which is a required screening after a work-related injury), then the worker will not receive workers’ compensation benefits.
When Can an Employee Start Receiving Compensation?
In most cases, employees will receive medical benefits almost instantly. Medical costs related to treating the injury claim are paid by the employer or the employer’s insurance company. In some instances, the state pays for the medical expenses if it is the insurer. The benefits start immediately after filing a workers’ compensation claim. The claim does not have to finish processing or even be approved before medical costs are covered.
An injured worker should seek medical attention immediately after they suspect they have suffered a work-related injury or illness. Then, they can start the process of filing an official claim. Also, a worker must notify a supervisor of their injury to have a work injury report started.
While visiting the physician or emergency room, it is essential that any injured worker tell the physician that they are there for a work-related injury or illness in order to receive proper documentation.
When Do Non-Medical Expense Benefits Start?
While medical benefits are almost instant, the non-medical benefits are not as quickly received by the employee.
Temporary disability benefits, known as time loss compensation, and permanent disability benefits do not begin until the claim is officially allowed. Before a check is received, an employee will receive notification about their claim’s acceptance or denial. If the application is denied, they should receive information about their rights to appeal and an employee will not receive benefits until they appeal the decision.
Once the claim is approved, it still takes time for non-medical compensation to start. Also, there are other steps the employee must take before he or she officially receives compensation.
For a start, the employee must have a doctor complete a form and examination that states the employee is physically unable to work at the time and therefore should be considered for temporary disability payments. Once the employee reaches an ability to work or the employer has sufficient proof that the employee can return to work, these benefits cease.
Typically, after a claim is approved, the employee receives a check for their benefits in 14 days. Temporary compensation benefits continue to arrive every two weeks, just like a regular pay period, until the employee is no longer eligible.
What If the Employee Cannot Return to Work?
If the employee will not return to work or fully recover from his or her work-related injury/illness, then permanent disability payments are the next step. Eligibility for this type of non-medical benefit is complicated, and a thorough medical evaluation is required to prove the employee cannot return to gainful employment.
Permanent disability payments are not the same as temporary payments, and the payout process is more complicated. Therefore, if your physician has informed you that you will not recover or cannot return to work and you need disability payments, speak with an attorney.
At What Point Does an Employee’s Condition No Longer Improve?
One requirement for permanent disability is when an employee has reached a point where they will no longer improve further. This point is determined by a medical professional, known as the maximum medical improvement stage (MMI).
The timeframe for an MMI depends on the injury, but can be a few months to a few years after the incident, depending on the type of injury.
Speak with an Attorney for Workers’ Compensation Claims
Workers’ compensation might seem like a straightforward process, but it involves numerous deadlines and paperwork that an injured employee does not have the time to deal with. The attorneys at Koonz, McKenney, Johnson, DePaolis & Lightfoot, LLP, can help with your workers’ compensation case.
Let our team review the facts of your work-related injury or illness and help file a claim. Also, if you will be unable to return to work, our attorneys will help navigate the process of filing for permanent disability and we will advocate for your rights.
Meet with an attorney today at one of our convenient office locations in Washington, D.C., Maryland, and Virginia. You can also ask us a question online.