Workers’ compensation generally begins to pay the costs of an injured worker’s medical care immediately after the workplace injury. However, disability payments may only begin once the workers’ compensation claim has been approved.
The timeframe for claims to be approved or denied depends on the state. It is usually around 21 days.
When do workers’ compensation benefits begin to pay out?
When workers’ compensation benefits begin to get paid will depend on the particular benefit. There are 2 main types of workers’ comp benefits:
- medical expenses, and
- disability payments.
Medical expenses often begin to pay out immediately.
Types of disability benefits
Many states split disability payments into 4 types:
- temporary partial disability benefits,
- temporary total disability benefits,
- permanent partial benefits, and
- permanent total benefits.
Whether the injury produces a partial or a total disability will not affect when payment begins. However, temporary benefits begin to pay out soon after the injury or impairment. If the worker will not make a full recovery, temporary benefits give way to permanent ones.
Are my medical bills covered immediately?
Yes, an injured worker’s medical treatment is usually covered immediately by workers’ compensation law. These workers’ compensation payments may begin to pay out even before the worker files a workers’ comp claim.
When a worker gets hurt on the job, they can notify their employer and schedule a doctor’s appointment immediately. Many states have a limited network of doctors for workers’ compensation claims.
At the doctor’s office, hurt workers can tell the physician that they are planning to file a workers’ comp claim. The doctor will then send the bill to the employer or to the workers’ compensation insurance company.
In most states, employers or their insurers will cover the bill, even if the claim is later denied. Some states even reimburse hurt workers for the miles they travel to and from the doctor’s office.
What about disability benefits?
Temporary disability benefits only begin to get paid once a workers’ compensation claim has been accepted or approved. This can take as little as 2 weeks or longer than a month. The timeframe depends on the state and whether the insurer can request a delay.
Most states also require a doctor’s certification that the worker is unable to work. If the worker will not make a full recovery, permanent disability benefits will soon replace these temporary benefits.
Investigation by the insurance company
Once a workers’ compensation claim has been filed, the insurance carrier will investigate the incident. This investigation will determine:
- whether the accident was actually a work-related injury,
- whether the injuries are covered by the insurer, and
- the extent of the injuries.
Workers’ compensation insurers have a set amount of time to conduct this investigation after the date of injury. That time limit varies by state, and there can be important exceptions. Generally, though, inspections have to be completed in around 3 weeks. For example, in Texas, insurers have 15 days. In Pennsylvania, they have 21 days.
Extension of time to investigate claim
Some states allow insurers to request additional time to complete their investigation. In California, for example, insurers have 14 days to investigate a claim. However, they can ask for a delay of up to 90 days to complete the investigation. During that waiting period, though, they have to pay medical benefits.
If the insurer fails to complete the investigation in the given time period, state law may either penalize the insurer or require them to accept the claim.
Temporary disability payments begin
Once the claim is approved or accepted, temporary disability benefits will begin. In most states, they have to begin immediately after acceptance. These benefits are meant to cover the worker’s lost wages. Many states do not cover the full amount of wage loss, though. For example, in Missouri, the workers’ compensation check will only cover two-thirds of the injured employee’s average weekly wage.
The payment schedule for disability payments is usually the same as the worker’s normal pay period. Workers who were paid bi-weekly before they were hurt will usually receive disability checks bi-weekly, as well.
These payments will continue until the injuries heal enough for the worker to return to work. Injured workers will often have to go to regular check-ups to look for signs of improvement. If they have reached their maximum medical improvement and still cannot work or are limited to light duty, the temporary disability may turn into a permanent one.
What if my workers’ comp claim is denied?
If the workers’ compensation claim is denied, then the hurt worker will not receive disability payments. Workers can either:
- accept the ruling, or
- appeal the denial.
Appealing a denied claim
Appealing a denied claim can add months or even years to the process. Workers’ compensation may not begin to pay until the case has gone to court. This may take years, and lead to a lump sum payment.
Workers who want to appeal a denial should strongly consider establishing an attorney-client relationship with a workers’ compensation attorney from a reputable law firm. With their legal advice, victims of a workplace injury can recover the compensation they need and deserve.