Workers' Compensation FAQ

What types of injuries are covered in a workers' compensation claim?

  • Personal injury or occupational illness or disease arising out of and in the course and scope of employment, including:
    • Traumatic injuries
    • Non-traumatic injuries resulting from repetitive movements or over-use of a body part from work activities
    • Pre-existing conditions or prior injuries that are substantially aggravated or accelerated by work activities
    • Employer or employee's fault in causing the injury (with limited exceptions) has no relation on the work injury claim; in other words, your fault in causing your injury cannot be used to deny or limit your claim

Do I need an attorney and what will it cost?

Yes. Regardless of whether your work injury claim has been accepted or denied, you will need an attorney to assist you in navigating the claim process. Attorney Andrea B. Niesen will advocate on your behalf for your legal rights. Workers' compensation laws are complex and frequently change. You need an attorney to best represent your interests and maximize the benefits you are entitled to under the law.

Attorney fees in workers' compensation claims are paid on a contingent fee basis, meaning fees are only paid if you receive an award of denied benefits or negotiated settlement of benefits. Attorney fees are paid on genuinely disputed benefits or settlements. Attorneys representing injured employees in a workers' compensation claim cannot charge hourly fees or require a monetary retainer. A court may order the employer or insurance company to pay the employee's attorney's fee in disputes involving medical or vocational rehabilitation benefits.

What do I do when the insurance company tells me it closed my file and will not pay for any more medical treatment for my injury?

You are entitled to claim medical benefits under work comp as long as the treatment is "reasonable and necessary and casually related to your injury." There is no cut-off in an admitted claim for medical benefits. Even if the insurance company claims to close your file, your rights under the law allow you to claim these expenses and challenge any denial by the insurance company. Contact our workers' compensation attorney to discuss challenging the insurance company's denial of medical treatment for your injury.

What workers' compensation benefits can I receive?

Wage Loss Benefits

The employer or insurance company must pay you wage loss benefits if you are unable to work due to your work injury or illness if your injury causes a reduction in your weekly earnings. Wage loss benefits are due or payable at the same interval as your employer pays your earned wages.

Temporary Total Disability (TTD)

This is owed when the employee is totally disabled from working; or employee has restrictions that the employer will not accommodate, employee is laid off or terminated.

Rate: Weekly compensation rate is two-thirds (2/3) of the average weekly wage on the date of injury (TTD is not subject to income tax)

Duration: 130 weeks or 2 ½ years (post 10/08 dates of injury)

Cut-off: Maximum medical improvement — 90 days post

Temporary Partial Disability (TPD)

This is owed when the employee is disabled from the work injury and has a reduction in weekly earnings or is working at a wage loss (less hours; less pay) with same or new employer.

Rate: Weekly compensation rate is two-thirds (2/3) the difference between the post-injury earnings and the average weekly wage on the date of injury (TPD is not subject to income tax)

Duration: 225 weeks (approx. 4 years 3 months)

Cut-off: 450 weeks (approx. 8 years 6 months)

Permanent Partial Disability (PPD)

This is owed based on the percentage of permanent functional loss or disability of the injured body part. The assessment is made according to the statutory disability schedule and the disability percentage is then multiplied by the schedule factor for a monetary benefit.

Permanent Total Disability (PTD)

This is owed when the employee is found to be vocationally and medically unable to perform meaningful work with limited or no potential earning capacity. There are statutory thresholds for permanent total disability, permanency from work and non-work injuries, or conditions that must be satisfied before entitlement.

Rate: Weekly payment of full compensation rate (two-thirds of average weekly wage); same rate as TTD

Duration: Entitled to receive as long as employee remains permanently and totally disabled up to presumed age of retirement, currently age 67; or beyond if proven otherwise

Medical Benefits

The employer or its insurance company will pay for reasonable, necessary and related medical care for the work injury or illness. Medical benefits include prescriptions, medical devices or equipment, nursing, home health care, and transportation or mileage reimbursement to medical appointments.

Duration: No cut-off date; as long as the related treatment is reasonable and necessary to cure and relieve the effects of the work injury

Vocational Rehabilitation Benefits

  • Qualified rehabilitation consultant (QRC) assists the employee with a safe return to work and medical management for the work injury
  • Job placement services assist the employee in securing new employment if employee is unable to return to the same job or employer as before the injury
  • Retraining benefits assist the employee to increase his or her employability by acquiring new or additional skills through retraining or education

Contact Klampe, Delehanty & Pasternak, LLC

Call workers' compensation attorney  Andrea B. Niesen at 507-288-2447 or email us to set up your free initial consultation.