Calculate Workers Compensation

Calculating Workers Compensation benefits is a necessary process when an unfortunate accident occurs and you or a loved one are no longer able to work full time. This can be for as little as a week, or for as long as the rest of your foreseeable future, and it can be partial or complete disability. In any of these cases, employers are required to have insurance to cover the lost income. This insurance does not cover emotional distress or other financial needs, so the compensation is strictly for the work that is no longer possible.

Steps

Calculating Temporary Worker's Compensation

  1. Report a legitimate work-related injury to you supervisor. Your supervisor will then report it to your Human Resources or Safety Department, who will then pass it on to their Worker's Compensation Insurance carrier.
    • Discuss it with your immediate supervisor first so that all members of your place of employment are involved and aware of the situation. It is best not to go over someone's head, even for what seems like an emergency.
    • Your workplace may have a particular procedure that you are required to follow.
  2. Provide a medical diagnosis from your doctor. Your physician must show the reason the injury prevents you from continuing to work in the manner you previously had.
    • In order to receive full compensation, most states will require that you are unable to work at all. Some states have partial compensation packages if your capacities are reduced or impaired instead.
    • Many insurance carriers will have specific lists of doctors approved to diagnose workplace injuries. In an emergency this is not a concern, but once a decision has been made to pursue compensation make an appointment with a doctor who can file the report.
  3. Meet the minimum waiting period requirement. This means your doctor will have to report you as unable to work for that specific number of days before the WC insurance carrier will consider the claim.
    • This will generally be three to seven days depending on the state. Before that, time off will just be covered by sick leave.
    • For example, in Minnesota and California, the waiting period is three days.[1] This does not mean you are expected to work immediately after the accident! It is just the technical issue of whether you are being paid by your employer or the Worker's Compensation Insurance Carrier.
    • In North Carolina and New York, the waiting period is seven days.[2][3] Before the first week, your pay is an internal issue.
  4. Find out the percentage of pay due in your state. In different states, the compensation will range, although the general expectation is a majority percentage of the wages (with an upper limit.)
    • It is commonly about 66.67% but can be equal to the worker's full salary. However, the higher percentage states may have a lower "upper limit" so be sure to check the full details.
    • For instance, in Maryland Total Temporary Disability is 66.67%.[4] This means after an accident, disability insurance will cover two-thirds of your wages while you recover.
    • In Texas, Temporary Disability is 100% of wages.[5] This means that in Texas, your full salary is covered by disability insurance during your recovery period.
  5. Check what the maximum benefit is. This is important since the percentage only matters to a point. Once a salary reaches a certain amount, generally the state average wage, the percentage will no longer make any difference. Instead, the employee will just pay the upper limit, even if it is a lower percentage of the employee's wage.
    • In Maryland, the maximum weekly benefit in 2015 is $1005.[6]This is the average weekly wage of the state and about 66% of a $1305 salary. Any salary over $1305 will still receive $1005. If two-thirds of your salary is higher than $1005 it is irrelevant to disability benefits.
    • In Texas, the maximum weekly benefit in 2015 is $861.[7] This is the average state weekly wage, and 100% of the maximum benefit. That means if you make more than $861 per week, it is not part of the calculation. No one receives more than $861 per week.
  6. Calculate retroactively to cover the waiting period. This is the three to seven days after the injury and when you initially notified your supervisor. It is before any official claim is processed since there is a requirement in each state for that time.
    • Especially if your injury only takes you off work for a short period of time, it is important to make sure you are compensated for the waiting period.
    • If WC does not cover the waiting period it might get taken out of your sick leave or vacation package! Check with your employer about how your place of employment runs things, and make sure you are following the protocol.

Calculating Permanent Worker's Compensation

  1. Determine if you have reached Maximum Medical Improvement (MMI). This means that your workplace injury is not expected to heal any further. It may or may not have improved to any significant degree from the original diagnosis.[8]
    • MMI is the point when Worker's Compensation switches from Temporary to Permanent compensation. As long as an injury is understood to be medically improving, insurance will be covering a temporary issue.
    • Some states do have limits to the length of time an issue can be considered temporary.[9]
  2. Provide a medical report from your doctor. You will need to have an approved physician provide details on the status of your injury and its prognosis. Once an injury is deemed to be permanent, the doctor will need to calculate how much it impedes the worker's ability to do their job.
    • Many insurance carriers will have specific lists of doctors approved to diagnose workplace injuries. Make sure you choose a doctor who can file the official report.
    • You can have another doctor who is not filing the report just to give you diagnostic information if you have a trusted physician.
  3. Assess your medical report. In particular, in some states there will be a rating your doctor gives you on the percentage of work you are capable of handling going forth.[10] This rating will be important for the outcome of your disability pay.
    • If you think your doctor's report is inaccurate, seek a second opinion. With a permanent disability, the compensation is making up for a lost capacity over many years, and can be difficult to foresee
  4. Find out the percentage of pay due in your state. In different states, the compensation will range. It will always depend on how much the permanent disability prevents you from the previous level of work.
    • Since a partially injured worker can often still earn some income, the percentage of wages can be considered supplemental. The WC insurance will simply cover the average wage, not future potential.
    • If a permanent claim is reached then the payment will be a lump sum.[11]

Calculating Death Compensation

  1. Be the surviving family or dependent of a worker killed on the job. The laws vary in different states, but someone who dies through a work-related accident will generally have their funeral expenses covered and some compensation guaranteed for any dependents.
    • The compensation may be a lump sum or a weekly payment. A regular payment will usually last for a limited period of time, such as one year.
  2. File a claim in your state. Fill out the appropriate form and have the approved doctor also file the work-related cause of death.[12].
    • The funeral home may be required to fill out a form as well, depending on the state.
  3. Work out the amount the death will be compensated. Usually this is calculated by the average wage multiplied by the number of years the worker would have continued to work.
    • Generally a death benefit will range between $50,000 and $200,000.[13]
    • This amount may be given all at once, or made in regular payments over an extended period of time.

Tips

  • Always be honest in your WC claims.  The insurance carriers utilize private investigators and several other tools to sniff out false claims and it is a crime to report a fake injury.

Warnings

  • Always be honest in your WC claims.  The insurance carriers utilize private investigators and several other tools to sniff out false claims and it is a crime to report a fake injury.

References

  1. ↑ http://www.workerscompensationinsurance.com/workers_compensation/california.htm
  2. ↑ http://www.ic.nc.gov/ncic/pages/statute/97-28.htm
  3. ↑ http://www.wcb.ny.gov/content/main/onthejob/HowSystemWorks.jsp
  4. ↑ http://www.wcc.state.md.us/adjud_claims/comp_rates.html
  5. ↑ http://www.tdi.texas.gov/wc/employee/benefits.html
  6. ↑ http://www.wcc.state.md.us/adjud_claims/comp_rates.html
  7. ↑ http://www.tdi.texas.gov/wc/employee/benefits.html
  8. ↑ https://www.workforcesafety.com/medical-providers/treating-patients/maximum-medical-improvement-permanent-partial-impairment
  9. ↑ http://www.alllaw.com/articles/nolo/workers-compensation/how-much-benefits.html
  10. ↑ http://www.myfloridacfo.com/division/wc/employee/calculators/IBcalc.htm
  11. ↑ http://www.dir.ca.gov/InjuredWorkerGuidebook/Chapter7.pdf
  12. ↑ http://www.wcb.ny.gov/content/main/onthejob/howto.jsp
  13. ↑ http://www.mom.gov.sg/workplace-safety-and-health/work-injury-compensation/types-of-compensation
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