Does Worker Comp Pay Lost Wages?
Employees who have been hurt and are unable to work, temporarily or permanently, understandably have a lot of questions about workers compensation claims. Workers comp is designed to take the place of civil suits against employers whose workers have been injured on the job. In Virginia, if your case meets specific requirements outlined under the Virginia Workers’ Compensation Act, it may be your only option for receiving benefits. However, not all cases meet these criteria, and in some situations you may be able to choose between a civil suit and a workers compensation claim. A Virginia employment law attorney can help you understand what your options are so you can make an informed decision.
What Is Wage Loss Compensation?
In general, workers comp does pay for lost wages, with some exceptions. First, let’s look at the different types of wage loss workers compensation in Virginia:
Temporary Total Disability Benefits. This is designed to provide wage compensation if you are totally unable to work. For example, if you need back surgery and your doctor says you can’t work at all for at least two months, you might qualify. You may also be eligible if your doctor says you can return to light duties with restrictions, and your employer can’t accommodate those restrictions. So if your doctor says you can return to work but you can’t lift anything heavier than ten pounds, and your job consists entirely of moving heavy boxes around a warehouse, you may also qualify for these benefits.
Temporary Partial Disability Benefits. This may be an option if your doctor restricts you to light duty work, and this reduces the amount of hours you can work. For example, if light duties only make up a small portion of your job, you may only be needed at work a few hours a week instead of full time, thus significantly reducing your pay. You may be able to receive benefits to make up for the loss of income in this situation. However, in some cases there may be a requirement that you look for other work.
Permanent Total Disability Benefits. In many cases, temporary disability benefits are capped at 500 weeks, meaning you won’t receive any benefits beyond that time frame. This comes out to a little less than ten years. Most people with temporary injuries or illnesses will recover and be able to return to work full time by then.
However, in some cases, an injury may be permanent and the employee may never be able to work again. It would be unfair to limit someone in this situation to less than ten years of pay when they might have worked for another twenty or thirty years. In this situation, they may qualify for permanent disability. Some examples of injuries that may be eligible include:
- Amputation injuries (loss of one or more limbs)
- Burn injuries
- Spinal cord injuries leading to paralysis
- Herniated discs and worsening stenosis leading to spinal fusion surgery
- Severe head injuries that lead to traumatic brain injury (TBI)
Although these are common injuries associated with permanent disability benefits, this is not an exhaustive list. If you have any injury that your doctors diagnose as permanent, and it is preventing you from working, it’s a good idea to consult an employment law attorney to learn your options.
How does Workers Comp Cover Lost Wages?
In the state of Virginia, workers comp begins to cover lost wages only after you have been unable to work (with documentation from your health care provider) for more than seven days. If you are out of work for more than 21 days, then your workers compensation will retroactively cover the first seven days. Otherwise, this period will not be covered.
“But how much does workers comp pay for lost wages?” or “How much compensation will I receive?” are other common questions. Under the Virginia Workers Compensation Act, you will receive “a weekly compensation equal to 66 2/3 percent of average weekly wages, with a minimum not less than 25 percent and a maximum of not more than 100 percent of the average weekly wage of the Commonwealth as defined herein.”
Essentially this means that in most cases, the injured worker can expect to receive around two-thirds of their average weekly wages. Usually this falls well between the minimums and maximums set, which are determined based on yearly IRS income data for the state. If the amount you are receiving in workers compensation doesn’t seem right, we recommend you consult an employment attorney. They will be able to figure out how your benefits were calculated, and if there’s an issue that should be addressed.
What is the Average Payout for Workers Compensation?
This is a slightly different question, as it includes not only lost wages but also medical bills and other associated costs. The answer depends on many factors, including how much money you make, how long you were unable to work (or if your disability is permanent), the amount of medical bills, expected future treatments, and other aspects of the situation. Depending on the particulars, the average can range from a few thousand dollars to $20,000 or more. Your employment law attorney can help you get a better idea of what you might receive from your workers compensation claim, based on the details of your case.
Does Receiving Workers Compensation Mean You Can’t File a Lawsuit for Your Injuries?
Yes. Accepting a workers compensation settlement means you won’t be filing a civil suit against your employer. Workers comp was invented as a way to help both employers and employees in situations where a worker is hurt on the job. Essentially, it allows employers to avoid an expensive lawsuit and possibly a large award to the worker if they lose. It also allows the employee to receive compensation without having to go to the time, trouble, and expense of filing a lawsuit, going to court, etc. This eliminates risk and expense for both parties, while ensuring the worker does receive compensation.
Depending on the particulars of your accident, you may not be able to file a suit if you are eligible for workers compensation under Virginia law. However, in some cases you may have a choice to make.
“Is it better to file a lawsuit or a workers comp claim?” some workers may ask. Again, there is no one right answer. It depends on your unique situation, and ultimately the decision is up to you (if you qualify to file a suit). Some people prefer the security of knowing they will get a guaranteed amount of money relatively quickly with workers compensation. Others may feel that workers comp isn’t enough compensation and would prefer to go to trial. Your attorney can answer any questions you have about the process so you can make an informed decision.
It’s also important to note that accepting workers comp means you can’t file a lawsuit against your employer. However, it does not rule out other third parties who may have been involved in your injury. For example, let’s say that Jane is driving a car as part of her work duties, when a drunk driver crashes into her vehicle at an intersection. Jane is badly hurt and out of work for several months. She files a workers compensation claim and receives compensation for lost wages and medical bills. However, she still suffered a lot of both physical and emotional pain and suffering from the accident, and workers comp can’t help with this. In this situation, Jane could still file a lawsuit against the drunk driver who caused the accident.
What If Your Workers Compensation Claim Is Denied?
This can be a frustrating experience. There are numerous reasons workers comp claims are denied, and in some cases, the denial can be appealed.
First, we need to understand where the denial comes from. Workers compensation can either be self-funded by the employer, who then pays out claims from a general fund for this compensation, or, more commonly, the employer carries workers compensation insurance. In the latter case, the denial likely comes from the insurance carrier. Some common reasons insurance companies deny workers compensation claims include:
The injury was not reported in time: Under Virginia state law, you need to report the injury to your employer and seek medical treatment within 30 days. If you’ve been injured at work, even if you think it’s not that serious, it’s a good idea to have the injury checked by a health care provider sooner rather than later. Also be sure to document the accident at work.
The claim was not filed in time: Your claim should also be filed within 30 days.
Employer disputes claim: Often the employer will come up with a reason they believe they shouldn’t have to pay. This can range from “the accident didn’t happen at work,” to “it was due to the employee’s reckless behavior.” In many cases, your attorney can present evidence countering the employer’s dispute to appeal the claim.
The injury is not compensable: In some situations, it may be hard to prove your injury was caused by your job. This is common with stress-related injuries like carpal tunnel, where the stress causes injury over a long period of time. On the other hand, if someone rolls a forklift over your foot at work, it’s relatively easy to prove this caused you to have a broken foot.
No medical treatment: In most cases, if you didn’t seek any medical treatment, your claim will not be paid. Again, seek medical care as soon as possible.