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Breaking Down Workers Compensation Benefits

Columbus Work Compensation Attorney Explains Your Benefit Options

The workers’ compensation system is an invaluable safety net for all workers in Ohio. Unfortunately, trying to determine which benefits you qualify for isn’t easy, especially when you’re hurt or sick and trying to focus on your recovery. If you’re unable to work and worried about paying your bills, the good news is that you don’t have to face the workers’ compensation system alone. A Columbus work compensation attorney from Malek & Malek Law Firm can help you get the benefits you need to move forward with your life.

Receiving Payment for Lost Wages After an On-the-Job Injury

Workers’ compensation is a compromise between injured workers and employers; the workers comp system removes the employee’s requirement to prove negligence on the part of the employer, and shields the employer from massive lawsuit payouts through personal injury lawsuits. On the one hand proving negligence on the part of the employer or overcoming a claim of contributory negligence would be a high burden for most claimants to overcome. On the other hand if an employee was seriously injured and the employer was at fault, the economic, non-economic, and punitive damages could bankrupt an employer. 

 Workers’ compensation is intended to supplement some of your lost income caused by a work-related injury or illness. It will not cover all of your lost wages, but they will help you pay medical bills related to your allowed work injury and keep you and your family above water, rather than face financial ruin as a result of being unable to work. 

As a general rule, workers’ compensation will pay two-thirds (66%) of your lost weekly wages up to the maximum statewide average weekly wage (SAWW) for the year of the date of injury. If you are able to work on a part-time basis or at a different job that pays lower wages, your lost wages benefit would be calculated based on the difference between your current income and your pre-injury/illness income. 

There are two types of lost wages benefits available in Ohio: 

  • Working wage loss benefits that are paid when you return to work but earn less income due to your injury or illness. These benefits are available for up to 200 weeks. 
  • Non-working wage loss benefits that are paid when you are released to return to work with restrictions but cannot find employment. In order to qualify for these benefits, you will need to demonstrate that you are making a good faith effort to secure employment. These benefits are available for up to 52 weeks, but receiving benefits past 26 weeks can affect your working wage loss benefits. 

While the basic idea behind lost wage benefits is simple, the details can quickly become complicated in how they apply to your case. A Columbus work compensation attorney at Malek Law Firm can help you figure out what benefits you are entitled to after an injury or illness.

Medical Benefits Explained by a Columbus Work Compensation Attorney

One of the principal benefits of workers’ compensation is coverage of your medical expenses. Workers’ compensation will pay for any reasonable and necessary treatment related to your injury or illness. These benefits can be critical when you have no health insurance coverage or you have a high-deductible plan. Oftentimes medical providers will not cover medical treatment for a work injury through your personal insurance. You’ll need to pursue the treatment through your workers comp claim, before the medical provider will provide the treatment through your personal insurance. 

Generally speaking, workers’ compensation should pay all medical expenses related to a work-related injury or illness, but they must be deemed “reasonable and necessary” by the Bureau of Workers’ Compensation (BWC). The caveat is that the treatment must be directed at the allowed conditions in a claim. 

If you imagine a house as a workers comp claim, when you get injured the door to the office is locked. Once the claim is allowed you are allowed to go into the first floor of the house. Each on the first floor represents different treatment for the conditions allowed in the claim. For a soft tissue condition, this might be physical therapy, diagnostics, and a surgical consult. You’re not allowed to go upto the rooms on the second floor where treatment like injections, surgery, and pain management exist until more significant conditions are added to your claim like herniated discs, and torn rotator cuffs. 

If you are having trouble getting your medical expenses approved, you should speak with a Columbus work compensation attorney right away because the process can be quite complicated and frustrating for those inexperienced in that matter.

About Workers’ Compensation Disability Benefits

Disability is one of the core benefits provided by workers’ compensation. There are four different types of disability benefits that workers’ compensation may provide for workers who have suffered an illness or injury at work: 

  • Temporary total disability (TTD) are benefits paid when you have suffered a work-related illness or injury and are unable to return to work at all. They are temporary benefits because you are expected to recover or your future has not yet been determined. 
  • Working Wage Loss are benefits paid when you have suffered a work-related injury or illness but are able to return to work in some capacity, either at another job or on a part-time basis. 
  • Permanent Partial Disability (PPD or C92 Award) is an award of compensation analogous to a pain-and-suffering award for your allowed conditions which you can apply for 26 weeks after the date of injury or 26 weeks after the last receipt of compensation, whichever is later. 
  • Permanent Total Disability (PTD) is the type of benefit paid when you are unable to return to gainful remunerative employment and have been deemed permanently and totally disabled by the Industrial Commission. 

Determining which benefits you qualify for isn’t easy. The Ohio Bureau of Workers’ Compensation (BWC) will determine fairly early on whether you qualify for temporary benefits, but determinations regarding permanent benefits happen much later in the process. A Columbus work compensation attorney can help you navigate the process to ensure you get all of the benefits you qualify for.

Payment of Disability Benefits from Workers’ Compensation in Ohio

Temporary total disability benefits are paid at 72% of what is called the Full Weekly Wage (FWW) rate. The FWW is determined by 6 weeks of wages prior to the injury divided by 6, 7 days of wages prior to the injury, or if you have worked at a job for less than a week than what you would have made each week at your job. 

The basis for the FWW is whichever of the options is higher. The 72% of your FWW is paid for the first 12 weeks of the period you are incapable of working due to your work injury. After 12 weeks, your benefits will be compensated at two-thirds (66%) of your pre-disability weekly wages called your Average Weekly Wage. 

The average weekly wage is based on the year of income you made prior to your work injury divided by 52. For example if you were injured on May 26, 2018, and you would provide all the income you made from May 26, 2017 up to May 26, 2018, divided by 52 (the number of weeks in a year). The wage rate is capped by the maximum average weekly wage for the date of injury. 

You would provide your wages for all the jobs you worked. If you worked less than 52 weeks prior to the date of injury because you were unemployed, incarcerated, or recovering from an illness, your Average Weekly Wage would be lower. Because you are already being paid at 66 ⅔% of your AWW, you want it to be as high as possible. Our Columbus work compensation attorney team can help to make sure your wage rate is set correctly so you are fairly and accurately compensated. There are a number of ways we can ensure this happens.

Payment of Permanent Total Disability Benefits

Temporary total disability (TTD Comp) benefits are available as long as you are certified incapable of working or certified to work with restrictions but your employer cannot accommodate these work restrictions. Once you return to work or your work conditions have been found to have reached “maximum medical improvement”. 

If there are “new and changed” circumstances that justify entitlement to temporary total comp, then you may re-open the door the door to receive a new period of compensation. “New and changed” circumstances may include your claim being additionally allowed for a new condition, undertaking surgery or some other significant treatment authorized through the claim, or you had returned to work and suffered an exacerbation of your allowed conditions. 

Permanent total disability is available if you meet either of the following criteria: 

  • You have completely lost the use of both hands, feet, arms, legs, eyes, or any combination of any of those two body parts; or 
  • You are incapable of returning back to gainful employment due to the physical or psychological conditions in your claim. This remedy usually requires that you make some effort in returning back to work, either through your own volition or participation in vocational rehabilitation. 

If you qualify for permanent total disability benefits, you would be entitled to receive permanent total disability benefits for the rest of your life. One caveat is that some folks who are found to be permanently and totally disabled also receive social security disability benefits. The one type of benefit will be offset by the other, i.e. no “double-dipping.” 

Payment of Permanent Partial Disability Benefits

If you’ve suffered a permanent disability but are able to return to work, you may still be entitled to workers’ compensation benefits. Assuming that you will be earning less than you did prior to your disability, you could qualify for one of the following permanent partial disability benefits: 

  • Scheduled losses. Scheduled losses are those that have a set amount of benefits for loss of a specific body part. 
  • Percentage losses. If you do not qualify for a scheduled loss, you may qualify for benefits determined by the percentage that you are disabled. You receive two weeks of compensation for every percentage you are assessed. This is paid in a lump sum. This is not a settlement of your workers comp claim. For example, if your doctor determines that you are 50% disabled, you will receive benefits equal to your temporary partial disability for an additional 100 weeks. 
  • Disfigurement. If you have suffered a serious disfigurement to your head or face that impacts your ability to work, you could qualify for compensation up to a maximum of $10,000. 

Determining what benefits you may qualify for isn’t easy and can have a significant impact on your future. A Columbus work compensation attorney can help you understand your options. 

Can’t Work Due to a Work-Related Injury or Illness? Contact a Columbus Work Compensation Attorney

Malek Law Firm has been helping injured workers navigate the workers’ compensation system since 1972. If you have suffered a work-related injury or illness, we can help you get the benefits you need. To speak with an experienced Columbus work compensation attorney, contact us today at 888-444-7440 to schedule a free consultation.