Injuries are an unfortunate part of life. From slicing a finger while preparing dinner to injuries sustained in a car accident, everyone faces at least one injury in their life. Injuries sustained at work are different from those that occur at home or in a car accident. Injuries at home are typically accidental and treated as such, using private health insurance or money out of their own pocket to pay for the injuries. Injuries from car accidents or other circumstances often place fault on either the injured party or someone else, with the at-fault party paying for the injuries. In the workplace, finding fault can create an uncomfortable work environment. The lawsuits that could result from workplace injuries could also potentially put a company out of business. Thus, the government created a solution that allows injured workers to be compensated while not blaming employers for their injuries or filing lawsuits for thousands or even millions of dollars. Workers’ compensation insurance provides coverage to workers and protection to employers. If you would like to learn more about the types of workers’ compensation benefits available to you in Vermont, New Hampshire, or Florida, call Shillen Mackall Seldon & Spicer at (802) 457-4848 to review your options and how to ensure you are receiving all the benefits you may be entitled to.
What Is Workers’ Compensation?
Workers’ compensation, or workers’ comp, is a no-fault insurance plan that ensures workers receive certain benefits when they are injured or made ill as part of their job. No-fault insurance means that neither the worker nor the employer must admit fault for the employee to receive benefits. Employers pay for workers’ comp insurance and employees do not contribute to the cost. Each state has its own requirements for what types of workers’ compensation benefits are available, and the United States Department of Labor (USDOL) offers workers’ comp for federal employees and certain other types of employees, such as longshoremen and energy employees.
When a worker is injured while working, or is diagnosed with an illness related to their work, they can file a workers’ comp claim with their employer. The employer then turns that claim over to the insurance company who investigates the claim and then pays a variety of types of workers’ compensation benefits based on the specific needs of the case. The investigation ensures that the injury was the result of the worker’s employment and not an unrelated incident, such as commuting to or from work, personal activities outside of work hours, or intoxication due to alcohol or drug use.
Common Reasons for Workers’ Compensation Claims
There are many injuries or illnesses for which someone might file a workers’ compensation claim. Some of the most common reasons include:
- Cuts and punctures
- Fractures
- Strains and sprains
- Repetitive stress injuries, such as tendonitis or carpal tunnel
More serious injuries, such as traumatic brain injuries (TBI) or amputations, and illnesses caused by exposure to asbestos or silica, are also covered by workers’ comp. The types of workers’ compensation benefits available to an employee will depend on the severity of the injury and what state the employee works in.
Types of Workers’ Compensation Benefits in Vermont
The State of Vermont Department of Labor oversees workers’ comp. They explain the steps for filing a claim, including the requirement to get a written doctor’s note if the employee is unable to work, and the different types of workers’ compensation benefits available to injured employees in Vermont. These can include medical benefits, wage replacement, vocational rehabilitation, and more. The exact benefits a worker will be entitled to will depend on the severity of their injury and whether they can work.
Medical Benefits
Vermont requires that an employer’s workers’ comp coverage pay for all necessary and reasonable medical services and supplies related to on-the-job injuries. These expenses may include hospital treatments, doctor’s visits, chiropractic treatment, medication, physical therapy, and psychological treatment, depending on the severity of the injury. If any of these expenses continue for an extended period (including the rest of the injured worker’s life), workers’ compensation will continue to pay for those related expenses.
Wage Replacement
Known as temporary disability benefits, wage replacement is paid in cases where the injured employee either cannot work at all or is released to part-time or light duty work only. If the employee cannot work at all, they will receive temporary, total disability after they have been unable to work for four or more days due to their injury. They will receive approximately two-thirds of their usual wage.
If the doctor releases the individual to part-time or light duty work, they will receive temporary, partial disability. This pays two-thirds the difference between the part-time pay they are receiving and the full-time pay they received pre-injury. In addition, for both temporary total and partial disability, the employee’s wage replacement may include wages from the second and third jobs the worker has.
Dependent Child Supplement
When receiving either temporary total or partial disability benefits, workers who have dependent children also receive a small dependent child supplement of $10 per week per dependent child. The insurance company’s adjustor should provide the worker with a Form 10 to report their dependents (and any additional jobs the worker has). If they do not receive this form and need the supplement for dependent children, the worker can contact Vermont’s Department of Labor to request the form.
Permanent Impairment Benefits
In cases of permanent impairment, or a permanent disability, the worker can receive additional compensation after their temporary disability benefits end. This does not necessarily mean the worker is unable to work at all. For example, a worker may have an impairment such as permanent nerve damage that causes numbness in one limb. This benefit is additional compensation for this loss of function. Vermont law provides a schedule to calculate these benefits. Benefits are typically paid periodically, but in some cases, a lump-sum payment may be approved.
Vocational Rehabilitation
Some injuries or illnesses may allow the individual to recover, but not to return to the employment they were already trained or experienced in. When this is the case, one of the types of workers’ compensation benefits available may be vocational rehabilitation. Vocational rehabilitation may include on-the-job training, job placement, or other training and assistance that allows the individual to return to suitable employment.
Death Benefits
In the event that a worker dies due to an injury or illness sustained in the workplace, workers’ comp will also pay death benefits to their spouse or family. These death benefits may include weekly compensation that is a percentage of the deceased worker’s wages, which is calculated based whether the benefit is paid to a spouse or a spouse and children, and how many children. Additionally, this benefit may include burial and funeral expenses up to $10,000 plus an additional $5,000 for transportation out-of-state, if necessary.
Available Types of Workers’ Compensation Benefits in New Hampshire
The New Hampshire Department of Labor oversees the different types of workers’ compensation benefits available. Like Vermont and many other states, New Hampshire stipulates that not every injured employee will be entitled to all the benefits listed. Benefits received by an injured or ill employee are dependent on the injuries sustained and their severity.
Weekly Indemnity Benefits
Also known as wage replacement, weekly indemnity benefits pay a percentage of the employee’s average weekly wage. This is based on totaling the gross earnings of the employee for the previous 26 weeks prior to the injury and then paying a percentage of that wage. However, the state also has a minimum and maximum compensation rate. This means that it is possible for a worker to receive their full weekly wage, if the wage is equal to or less than the minimum compensation rate. Workers may also receive compensation for additional employment, as long as those additional jobs are reported income that is not earned doing a federal job or other employment not subject to New Hampshire workers’ compensation law.
Temporary Partial Disability
Temporary partial disability benefits are paid when a worker is able to return to work, but is not able to earn the same amount as they did pre-injury. Most of the time, this occurs when they return to work part-time or do light duty work. In these cases, pay stubs are used to determine the worker’s current earnings with the injury and their previous earnings before the injury. The benefit pays 60% of the difference between the two earnings. There is a three-day waiting period before this benefit will be paid, but if the worker continues to be disabled beyond 14 days, the three-day waiting period is waived. The maximum number of weeks an injured worker can collect temporary partial disability is 262, and if they also receive temporary total disability benefits, those are included in the 262 weeks as well.
Medical Bills and Related Expenses
One of the most commonly used types of workers’ compensation benefits is the payment of medical bills and related expenses. Workers’ compensation typically pays all medical bills related to the injury, including hospital and remedial care. If workers’ comp declines to pay a particular medical bill, they must put the denial in writing to the injured employee, provide a reason for the denial, and give the employee information about their right to request a hearing. A copy of this denial must also be provided to the medical provider and the Department of Labor. Payment must be made or the denial issued within 30 days or the carrier faces a fine of up to $2, 500.
Related expenses that may be paid include prescription reimbursement and milage to attend doctor visits. These expenses may require receipts, invoices, or other proof that they were incurred and/or paid.
Permanent Impairment
Under RSA 281-A:32, the loss of function of specific body parts makes an injured employee eligible for permanent impairment benefits, which are separate from any weekly indemnity benefits, medical benefits, or vocational benefits. The compensable body parts include the total loss of arms, hands, thumbs, index fingers, middle fingers, ring fingers, little fingers, feet, any toe, total loss of vision in one or both eyes, and total loss of hearing in one or both ears. Each body part has a specific number of weeks for which the worker would be eligible for permanent impairment benefits.
If the worker has less than a total loss of the compensable body part, the percentage of loss determines the number of weeks they are eligible for benefits. For example, the total loss of an arm would result in 210 weeks of benefits, so a 50% loss would result in 105 weeks of benefits. Additionally, spinal cord injuries do not result in permanent impairment benefits unless they result in the loss of use of lower or upper extremities. If a worker believes they are eligible for permanent impairment benefits but has been denied such benefits, they may wish to consult with a New Hampshire workers’ compensation attorney at Shillen Mackall Seldon & Spicer to review their claim and learn more about their benefit eligibility.
Temporary Alternative Duty
While this is not specifically one of the types of workers’ compensation benefits, all New Hampshire employers with more than five employees are required to develop alternative work opportunities for their injured workers. The insurance adjustor handling the claim will determine whether there is alternative work available for the employee. This does not mean that every injured worker will be expected to return to work in an alternative position. The insurance adjustor and the worker’s doctor will determine whether there is alternative duty available to the worker based on the daily tasks of any light duty roles available and the restrictions of the worker’s injury. However, if it is determined that there is light duty work available and the worker refuses to return to work, the employer can write to the Department of Labor, with a copy sent to the employee, requesting the employee’s benefits be terminated as a result.
Reinstatement of Employee Sustaining Compensable Injuries
Another of the benefits that is not precisely a benefit is the requirement for reinstatement of employees who sustained compensable injuries. For this benefit, a worker who is injured on the job and can return to their previous role within 18 months of that injury must be reinstated to that role by their employer. This benefit does have some restrictions, such as that the employer is not required to reinstate the employee if they are unable to return to work within 18 months or if the employee has a permanent impairment and is not released to return to their previous role.
Cost of Living Adjustment
Certain worker’s comp cases are eligible for a cost of living adjustment to assist the worker in remaining financially stable while receiving benefits. In order to receive this benefit, the injured worker must be receiving total disability benefits from workers’ comp as of the third anniversary date of their injury, must not be receiving Social Security benefits due to a denial, and be receiving less than 60% of the state’s average weekly wage.
Vocational Rehabilitation
In New Hampshire, when a worker is injured on a job that requires a specific kind of education or training or a certain amount of experience to do the job and they are unable to return to that job, they may be eligible for vocational rehabilitation. Vocational rehabilitation, or vocational rehab, provides services to assist the injured worker in restoring them to, or as close as possible to, their previous weekly wage earnings prior to the injury. These services may include vocational counseling and testing, job development services, vocational exploration, or job seeking skills training.
Typically, vocational rehab is done with a hierarchy of intentions. Usually, the initial goal is to return the worker to their previous role with the same employer. From there, the goal becomes returning the worker to a modified role with the same employer, and moving through a series of goals including different roles with different employers, on the job training, new skill training or retraining, and other academic or educational programs.
Death Benefits
Like Vermont and most other states, New Hampshire also offers a death benefit to the spouse or family or a worker who dies as a result of their work-related injury or illness. The widowed spouse and any dependent children of the deceased worker receives weekly compensation equal to a portion of the deceased worker’s wages. The employer will also pay burial expenses up to $10,000.
Florida’s Types of Workers’ Compensation Benefits Offered
Florida’s Department of Financial Services oversees the state’s workers’ compensation program. They also offer an injured worker FAQ, benefit calculators, a link to report employer non-compliance, and other educational and informational material to assist injured workers in understanding how workers’ compensation works and what benefits they may be entitled to receive.
Medical Benefits
Through their workers’ comp insurance carrier, the employer is responsible for all medical bills associated with the work-related injury. This includes (but is not limited to) seeing an authorized primary doctor and any necessary specialists, all doctor visits, medical tests, prescription drugs, hospitalizations, physical therapy, prostheses, and attendant care. Milage to and from the worker’s authorized doctor and the pharmacy is also reimbursable.
One important note for injured Florida workers is that the insurance carrier must authorize the doctor who treats them. Therefore, if a worker suspects that an injury may be work-related, they should not see their private doctor. Additionally, skipping any appointments can result in medical benefits being stopped. If the worker needs emergency treatment in the emergency room, they should be sure to tell the medical staff that they were injured on the job and provide either the workers’ comp insurance carrier’s contact information or their employer’s.
Temporary Partial Disability
Temporary partial disability is the replacement of a portion of the worker’s wages while they are unable to work without restrictions. This may mean they can return to work part-time, engage in light duty work, or do their former job but with certain accommodations or avoiding certain parts of the job. If this return to work with restrictions results in the worker earning less than 80% of their previous wages, the worker may be eligible for temporary partial disability benefits.
Temporary Total Disability
Temporary total disability is the replacement of a portion of the worker’s wages when they are unable to work at all. The worker will receive 66 ⅔% of their usual weekly wages. The worker will not receive this benefit for the first seven days of disability, unless their disability continues longer than 21 days. In some severe injury cases, the worker may be eligible for up to 80% of their wages for as much as six months after the injury. In all cases, there is also a statewide maximum reimbursement amount.
Impairment Income Benefits
People who have been injured either make a full recovery as if the injury never occurred, or they reach a point where they have recovered as much as they are going to, despite still having some issues related to the injury. When a person still has restrictions but is not expected to recover any further, this is called maximum medical improvement (MMI). The doctor will indicate when someone is at MMI, indicating that further treatment is not going to improve their condition in any significant way, and will then evaluate them to determine an impairment rating and any possible work restrictions that will apply. If the impairment rating is higher than 0%, the injured worker will receive impairment income based on that rating. With these benefits, the injured worker can work, but must find employment that they can do with the restrictions placed on them.
Permanent Total Disability
In some cases, when the individual has reached MMI, the injuries are so severe that they are unable to work ever again. When this occurs, the individual who is permanently unable to work can receive permanent total disability benefits. In Florida, it is possible to receive permanent total disability benefits through workers’ comp and also receive Social Security disability benefits. However, injured workers should note that these benefits will be offset to ensure that the total benefits received do not exceed 80% of their pre-injury wages.
Death Benefits
Florida’s death benefits are slightly different from those in Vermont and New Hampshire. In Florida, death benefits can be paid if the injured or ill worker dies within one year of the accident date or continuous disability for five years. Funeral expenses can be paid up to $7,500. Additionally, there may be other compensation for dependents, and the surviving spouse may receive educational benefits. The maximum payout for these combined death benefits is $150,000.
How a Workers’ Compensation Attorney May Assist You
Being injured at work can have a devastating effect on the injured employee and their family. Fortunately, workers’ compensation provides a no-fault, relatively quick and simple process for ensuring that a workplace injury does not completely destroy the worker and their family financially. With several different types of workers’ compensation benefits available, the worker is usually not responsible for any medical bills and they often receive money that helps replace lost wages so they have some money to help pay their bills. A knowledgeable workers compensation attorney with Shillen Mackall Seldon & Spicer may be able to assist you in appealing a denied claim, understanding your rights and responsibilities, and determining whether you have other legal options, such as a third-party negligence lawsuit. Call (802) 457-4848 to schedule your free initial consultation and learn more about how we work on a contingency fee basis.