Understanding the Types of Workers’ Compensation Benefits
Workers’ compensation benefits are designed to provide financial support and medical care for employees who have been injured or fallen ill due to work-related circumstances.
As a crucial aspect of the workers’ compensation system, understanding the different types of benefits available can help you navigate the process more effectively.
In this article, we will discuss the four main types of workers’ compensation benefits:
Insider insights: What you need to know to expedite your workers’ comp claim
The most frequent question I encounter as a workers’ compensation attorney is: ‘Why has my claim taken so long?’
Many individuals head to work each day, expecting routine and safety, never anticipating that today might be the day they get hurt at work. Yet, when injury does occur, it can abruptly turn life topsy-turvy.
1. Medical benefits
Medical benefits cover the costs of necessary medical treatment for work-related injuries or illnesses. This includes doctor visits, hospital stays, surgeries, medications, and assistive devices such as crutches or wheelchairs.
In most cases, your employers or their insurance providers are responsible for paying these medical expenses directly.
Bear in mind:
a. Choice of medical provider may be subject to state laws or insurance policies
In most cases, your employer or their insurance company will select the initial authorized medical provider for your treatment.
However, if you’re unhappy with your care, you can request a change in medical providers. It’s always a good idea to be familiar with your rights and the applicable regulations to ensure you receive the best possible care when you are hurt on the job.
b. Always keep accurate records of all medical treatment and expenses.
Organized records will help you stay on top of your medical care and make the claims process smoother and more efficient. Document and keep records of your doctor visits, medications, therapy sessions, and other expenses related to your work injury.
This will make it easier for your attorney to help you secure the benefits you’re entitled to. It also ensures that you’re reimbursed for any out-of-pocket costs you may incur.
c. Pre-authorization may be required for certain treatments or procedures
Before receiving certain types of medical treatments or procedures under workers’ compensation in South Carolina, you may need to obtain pre-authorization from your employer’s insurance company.
This is a process in which the insurance company reviews your doctor’s proposed treatment plan to determine if it’s medically necessary and related to your work injury. It’s essential to be aware of this requirement, as failure to obtain pre-authorization may result in the denial of coverage for the specific treatment or procedure.
If you need clarification on whether a particular treatment requires pre-authorization, consult your attorney or medical provider to avoid any potential complications or delays in receiving the care you need.
2. Temporary disability benefits
Temporary disability benefits provide wage replacement for employees who cannot work due to work-related injury or illness. These benefits are generally calculated as a percentage of the worker’s average weekly wage up to a state-mandated maximum amount.
Bear in mind:
a. There may be a waiting period before benefits are paid
In South Carolina, when it comes to temporary disability benefits, it’s important to know that there may be a waiting period before you start receiving payments.
Typically, you’ll need to be out of work for at least seven days due to your work-related injury before you’re eligible for these benefits.
However, if your disability extends beyond 14 days, you may also be entitled to compensation for the first seven days.
Understanding this waiting period can help you manage your expectations and plan for any short-term financial needs that may arise during this time.
b. Benefits typically continue until the worker can return to work or reaches maximum medical improvement (MMI)
Temporary disability benefits are designed to provide financial assistance to workers who are unable to perform their job duties due to a work-related injury.
These benefits typically continue until you can return to work or reach maximum medical improvement (MMI).
MMI is a term used to describe the point at which your medical condition has stabilized and no further improvement is expected, even with continued treatment.
Once you reach MMI, your temporary disability benefits may be replaced by permanent disability benefits, if applicable.
Keep in close communication with your attorney and medical provider throughout this process to ensure you receive the appropriate benefits for the duration of your recovery.
c. Temporary disability benefits are categorized as either temporary total disability (TTD) or temporary partial disability (TPD), depending on the worker’s ability to perform some work duties
These classifications depend on the worker’s ability to perform work duties during the recovery period.
Temporary total disability (TTD) benefits apply when you’re entirely unable to work due to your injury.
Under TTD, you’ll typically receive a percentage of your average weekly wage up to a maximum amount set by state law. This is designed to help you maintain financial stability while you’re unable to earn an income.
Temporary partial disability (TPD) benefits come into play when you can perform some, but not all, of your regular job duties during your recovery.
This may include working reduced hours or handling lighter tasks. TPD benefits are calculated based on the difference between your pre-injury wages and current earning capacity. This ensures you receive financial support as you gradually return to your regular work responsibilities.
Understanding the distinction between TTD and TPD benefits can help you anticipate the type of support you’ll receive during your recovery and make informed decisions about your return to work.
3. Permanent disability benefits
Permanent disability benefits are awarded to workers who have sustained permanent impairments due to their work-related injury or illness. The amount and duration of these benefits depend on the severity of the impairment, as determined by a medical evaluation.
Bear in mind:
a. Permanent disability benefits can be either permanent total disability (PTD) or permanent partial disability (PPD)
In South Carolina, if you suffer from a work-related injury that results in a permanent disability, you may be entitled to receive permanent disability benefits. These benefits are classified as either permanent total disability (PTD) or permanent partial disability (PPD), depending on the severity of your impairment and its impact on your ability to work.
PTD benefits apply when you cannot engage in any form of gainful employment due to your injury. In contrast, PPD benefits are provided when you can work, but your earning capacity is permanently reduced.
b. The calculation of benefits varies by state and may involve a complex formula
The calculation of permanent disability benefits can be pretty complex, as it varies from state to state and depends on several factors.
In South Carolina, these factors may include the type of disability (PTD or PPD), the extent of your impairment, your average weekly wage, and the specific body part affected.
A complex formula is often used to determine the appropriate compensation for your unique situation.
Our work injury attorney at Smith, Born, Leventis, Taylor & Vega will work closely with you to ensure that your benefits are calculated correctly and that you receive the compensation you deserve.
c. Settlement options for permanent disability benefits may include lump-sum payments or structured settlements
When it comes to permanent disability benefits in South Carolina, there are typically two settlement options available:
- Lump-sum payments: a one-time payment that covers the total amount of your permanent disability benefits.
- Structured settlements: a series of smaller payments made over a set period, providing ongoing financial support.
The choice between these two options depends on your individual needs and circumstances. Some people prefer the immediate financial security offered by a lump-sum payment, while others may find the steady income provided by structured settlements more appealing.
Our attorney will discuss these options with you to determine which settlement is best for your unique situation.