Alabama Workers' Compensation Claims: Eligibility, Filing, and Appeals
Learn about your rights under the workers' compensation system in Alabama.
Workers’ compensation in Alabama is a mandatory insurance program designed to compensate injured workers for medical care, lost wages, and permanent disabilities. Employees who are involved in workplace accidents or who suffer from occupational diseases (such as asbestosis, a lung disease caused by exposure to asbestos) are eligible for benefits.
In Alabama, private businesses with five or more employees (full-time or part-time) must provide workers’ compensation insurance for their employees. However, this rule does not apply to employers of:
- certain trucking and transportation company workers (leased operators or owner-operators of common carriers)
- casual employees (people doing work which occurs occasionally or at irregular times and which is not related to the type of business normally conducted by the employer)
- household domestic workers (such as house cleaners, nannies, gardeners)
- farm laborers (such as crop pickers and sorters), and
- state and federal government employees.
Generally, these types of employees have to pursue other means of recovering for their work-related injuries. Alabama state government employees are normally covered through the State Employee Injury Compensation Trust Fund, administered by the Alabama Division of Risk Management, while federal government employees are covered under the Federal Employees Compensation Act, administered by the U.S. Department of Labor. All other exempt employees are entitled to file civil lawsuits against their employers – but must prove fault on the part of their employer.
Filing Your Claim
In general, you must report any workplace accident or potential occupational disease to your employer within five days (although failure to do so is excusable in some circumstances). If you fail to give your employer notice within 90 days of your injury, though, you risk losing your right to workers’ comp benefits. If your supervisor witnessed your accident, or a coworker told your supervisor about your accident, this will probably qualify as notice. However, you should never assume that your employer knows about your injury. The best practice is to report your injury to your supervisor right away.
Once you’ve given notice of your injury, your employer (or its insurance company) must complete and file a form called a First Report of Injury with the Alabama Department of Labor.
Obtaining Medical Treatment
In the event of an emergency, you should seek medical care immediately and tell the doctor that you have sustained a job-related injury. In emergency circumstances, you can choose which health care provider to seek treatment from.
For all non-emergency care, Alabama has specific rules that allow your employer and its insurer to control your medical treatment for work-related injuries. Your employer, or its insurance company, may select your initial treating doctor for you when you report your claim.
After your initial treatment, if you are not satisfied with the doctor selected by your employer, you can notify your employer in writing. The insurance company must provide you with a list of at least four other doctors from which you can choose.
The insurance company is responsible for covering all reasonably necessary medical care related to your workplace injury. This may include doctors’ visits, hospital stays, physical therapy, and diagnostic studies, such as x-rays. The insurer must also reimburse you for your mileage incurred in traveling to medical appointments; the 2014 rate is $0.56 per mile.
If you were involved in a workplace accident, your employer may require that you submit to a blood or urine test for drugs or alcohol. If you refuse to cooperate, you may lose your right to workers’ comp benefits.
Temporary Total Disability
If your doctor determines that you are completely unable to work for more than three days due to your injury, you are eligible for temporary total disability (TTD) payments for lost wages.
The amount you will receive in temporary total disability is typically two-thirds of your average weekly wage, subject to a minimum of $146 and a maximum of $531 (as of 2014). If your average weekly wage is less than the $146 minimum, you will receive 100% of your wages. For example, if you make $135 per week, you will receive $135 in weekly TTD payments.
TTD benefits will continue to be paid as long as the doctor finds that you cannot return to work but have not reached maximum medical improvement (MMI), which is the point where your doctor does not expect your condition to improve in the next year or so.
Temporary Partial Disability
Your doctor may allow you to return to work while you are still recovering. The doctor may limit the type of work, or the amount of work, to that which is medically appropriate. If your doctor allows you to return to part-time or modified work, and your employer offers you such work, you must accept it. However, if your earnings are lower than what you previously made, you may be entitled to temporary partial disability (TPD) benefits.
If your pay for part-time or modified work is less than your pre-injury earnings, TPD payments are typically two-thirds of the difference in your earnings. TPD is available until your doctor finds that you have reached MMI or for a period of up to 300 weeks, whichever occurs earlier.
Permanent Partial Disability
If you are partially or totally permanently disabled as a result of your workplace injury or occupational disease, you are entitled to permanent disability benefits. The amount of your permanent disability benefits and how long you will receive them depends on the nature and severity of your permanent disability. Once you have reached MMI, your doctor will determine the level of your permanent impairment and assign a percentage to your disability.
For a permanent partial disability, you will receive two-thirds of your average weekly wage, up to a maximum of $220 per week. If your injury is a scheduled injury (meaning it falls within a list of injuries defined by the state), the amount of your permanent disability benefits will be based on how many weeks you are entitled to receive payments. For example, let’s suppose you have a 10% impairment rating and are entitled to the maximum $220 per week. According to the state’s schedule, you would receive 200 weeks of benefits for the full loss of a leg. Since your impairment is 10% you would multiply that number by 200 (10%× 200 weeks) to get 20 weeks. You would receive $220 per week for 20 weeks, for a total of $4,400.
If your partial disability is not on the state schedule, a “body as a whole” rating system is applied. This means that you will receive benefits for 300 weeks, minus the number of weeks that you’ve received TTD benefits for the same injury. Your impairment rating will then be multiplied by your average weekly wage. For example, if you received TTD benefits for 30 weeks, you will receive benefits for 270 weeks (300-30). If your impairment rating is 10% and your average weekly wage is $900, these numbers will be multiplied to get $90. You will then receive two-thirds of this amount, which is equal to $60. You will receive $60 per week for 270 weeks, for a total of $16,200.
Permanent Total Disability
For a permanent total disability, where you cannot return to your job, nor obtain other reasonably gainful employment, you will receive two-thirds of your average weekly wage, up to a maximum of $220 per week. There is no time limit on temporary total disability benefits; they are paid out for the remainder of the worker’s life. Benefits are paid at the same frequency as your wages were paid (weekly, monthly, or otherwise) or in a lump sum, if you and the insurer agree.
If you and the insurance company are in a dispute about what treatment you are authorized to receive, you may contact the Alabama Department of Labor’s Workers’ Compensation Division. The Workers’ Compensation Division provides assistance with medical disputes only. For all other issues, such as the denial of your claim or certain benefits, you will need to file a civil lawsuit in state court.
In general, you have only two years from the date of your accident to file a lawsuit if your claim remains denied. However, if you received some disability payments (temporary or permanent), you have two years from the date of your last temporary or permanent disability payment to file a civil lawsuit.
Learn more about Appealing an Alabama Workers' Comp Denial.