Am I Eligible for Workers Compensation Long-Term Disability?

Understand the process in how workers compensation handles long term disability.

To be eligible to receive workers’ comp disability benefits over the long-term, you don’t need to be completely unable to work; in fact, most injured workers are able to return to work at some point. If your work-related injury has limited your ability to work and participate in the job market, you can collect long-term disability benefits through workers’ comp (called permanent disability benefits, or impairment income, in workers’ comp terms). On the other hand, if you have completely recovered from your injury, you will not be eligible for long-term workers’ comp benefits.

Let’s take a look at what workers’ comp benefits are meant to do: First, workers’ compensation provides coverage for your medical bills in case you are injured at work, so that you don’t get stuck paying those bills yourself. Once you have missed a set period of work – in most states, three to seven days – worker’s comp is also designed to pay your lost wages while you are recovering. In addition, if your work-related injury has caused you to become “disabled” or “impaired” in some way – that is, unable to work at all, or unable to work without restrictions – longer-term workers’ comp benefits kick in to make sure you and your family have at least some income to live on, or to compensate you for your reduced income in the future.

Eligibility for Permanent Disability Benefits

To recover long-term workers’ compensation disability benefits, you must prove:

  • Your injury arose out of your job. In other words, the injury happened because of your work. It doesn't matter if you were actually at work when it happened; for example, if you were sent to the office supply store and were injured, the injury would be covered by workers’ compensation. For more information on whether your injury is covered by workers’ comp, see Am I Entitled to Workers’ Compensation Benefits?.
  • The nature and severity of your injury renders you disabled or impaired.
  • Your disability makes it impossible for you to either go back to work doing what you were doing, or you can do some work but you have doctors’ restrictions limiting what you can do.

It's important for those injured at work to understand that, unlike in a standard personal injury lawsuit in a court of law, workers injured at work don’t have to prove that the employer was negligent (carelessly violated safety standards) for you to recover. Under workers’ comp, employers are always liable for work-related injuries (unless the employee was under the influence of illegal substances at the time of the injury, the injury was purposely self-inflicted, or an employee was clearly and directly in violation of an expressly stated company policy).

Calculating Permanent Disability Benefits

To receive permanent disability benefits, you can be either permanently totally disabled or permanently partially disabled. In most states, permanent total disability is reserved for a short list of injuries, such as loss of sight in both eyes, loss of both hands or both feet, or paralysis. Thus, most workers in the workers’ comp system who are eligible for long-term disability payments are permanently partially disabled.

If you didn’t recover 100% from your injury, you’ll be considered as having a permanent partial disability. Different states rate a worker’s amount of permanent disability differently. In most states, once an injured worker reaches a state where their condition is not expected to improve (called maximal medical improvement, or MMI), the worker receives a number that reflects their percentage of permanent disability. In some states, such as California, this is called a “permanent disability rating”; in others, such as Florida and Texas, it is called an “impairment rating.”

In some states, your rating is based on exactly what your injury is; for example, the state has a list of specific injuries, such as “arm injury with shoulder instability,” and specific rating numbers that go along with them. In other states, your doctor will use objective and subjective test results to rate the amount of your disability or impairment.

In some states, such as California, Texas, and Florida, your permanent disability rating, or impairment rating, is then used to establish how many weeks of disability payments you will receive (anywhere from 3 weeks to 20 years, depending on your rating and your state). In other states, such as New York, your rating is used to determine your weekly disability rate. You could receive weekly payments at this rate indefinitely, until you are able to return to work at the same level you were working before.

Getting Help

If you’ve been permanently disabled or impaired by a work injury, consider hiring a workers’ compensation attorney to help file your claim for benefits. If your work injury is not severe – a permanent partial disability that doesn’t limit your ability to work too much, for instance – you may have to contact a few workers’ comp attorneys to find one that will take your case. But because workers’ comp is likely to be your sole remedy to recover money damages from your employer, you need to make sure your permanent disability or impairment is rated properly, so that you can begin to get the money that you deserve. A workers’ comp lawyer can make sure your disability or impairment has been rated properly.

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