woman with crutches during rehabilitation

13 Apr

What Benefits are Available to Me After a Severe Work Injury?

Written by admin
Category
Professional

Severe work injuries are scary. For purposes of this article, “severe” is going to be used when describing a work injury that prevents someone from working ever again, essentially meaning a total disability injury. This is not to diminish other injuries that can also be very bad and difficult for daily life. However, let’s focus on the benefits available after a severe work injury that would prevent someone from re-entering the workforce.

The chaos a severe injury can cause in a person’s life is traumatic. Severe injury disrupts a person’s life on a scale that is unimaginable. Questions start coming into a person’s head like: how can I afford to pay my bills? Will my spouse leave me? When can I play with my kids again?

There aren’t always answers to these questions.

However, if you get a severe work injury, the Florida workers’ compensation system provides answers for two classifications of benefits: medical and indemnity. Within these two benefits, there is a wide range of what can be expected depending on the severity of the injury.

Indemnity Benefits

Indemnity, also known as Lost Wage benefits, falls into a few types of categories. As previously stated, this article is going to focus on the types of injuries that prevent someone from working ever again. However, just because you have a severe injury that prevents you from working, doesn’t mean you don’t initially qualify for the temporary benefits available under workers’ compensation.

Temporary Total Disability

Temporary Total Disability^[1] is typically available to an injured worker when they have started treatment for the injury. Their treating physicians will attempt to get them to the stage of maximum medical improvement. This means that the injured worker has essentially reached the highest level of health and recovery possible according to their treating physician.

While the patient may have not healed completely, their treating physicians do not have a treatment plan that would increase their functionality significantly. The pay rate for this category is roughly two-thirds of what the injured worker was making when they were employed.

Catastrophic Temporary Total Disability

The statute does provide for a different level of temporary total disability. Within Fla. Stat. 440.15(2)(b), the law states that if the injury is one in which the injured worker has “sustained the loss of an arm, leg, hand, or foot, has been rendered a paraplegic, paraparetic, quadriplegic, or quadriperetic, or has lost the sight of both eyes shall” get temporary total disability paid in the amount of 80 percent of their average earnings. However, those benefits only pay for six months from the date of the injury.

This category is sometimes referred to as “catastrophic temporary total disability”. This increase in pay, from two-thirds to eighty percent of the average wage, is not enough to make up for the severe injury that has been sustained. However, it is a benefit to the system that isn’t as well known and should be pursued if it applies.

Impairment Benefits

Once an injured worker reaches maximum medical improvement, they are typically entitled to Impairment Benefits^[2]. Impairment Benefits are determined by the treating physician. That physician must consider the injuries that have taken place and assign an impairment rating. That rating does not necessarily take into account the subjective issues that are affecting the daily life of the injured worker.

Those issues could be the pain and suffering that are a daily struggle, or playing with their children, or the trouble it takes to get dressed in the morning. These issues are not included in the rating guide at all. Once the impairment rating is issued, it translates to a certain number of weeks that pay Impairment Benefits. However, if an injury is so severe that an injured worker cannot work again, they are likely to be paid a different category of permanent benefits, called Permanent Total Disability.

Permanent Total Disability

Permanent Total Disability^[3] benefits are paid to an injured worker who is not physically capable of working at least sedentary employment. There are also presumptive injuries that can occur when an injured worker is automatically determined to be permanently and totally disabled; however, those can be rebutted if it is shown the injured worker can engage in sedentary employment. It is sometimes a complex issue to determine whether an injury has caused someone to be permanently and totally disabled. Sometimes experts are hired and a job search is done to prove in a court of compensation claims that the status is appropriate.

When the determination is made, the benefits that are paid out shift over time. Two-thirds or 66.67 percent of the worker’s average weekly wage are paid on a bi-weekly basis. These benefits are paid until the worker reaches the age of 75. There are a few exceptions to this rule. The first is if the injury prevents the worker from earning enough quarters, 3-month segments of the year, to qualify for social security payments, then the benefits are permanent. If the worker is injured after the age of 70, the benefits can be paid for up to five years. Also, if the injured worker has suffered a catastrophic injury as the statute describes, the benefits can be permanent. Those are essentially the indemnity or money benefits available to an injured worker when they are severely injured. Unfortunately, there is no enhancement or multiplier on these benefits based upon the severity of the injury.

Medical Benefits

Medical benefits allow for a much broader range of options for the injured worker. Typically, the basic set of medical benefits made available to injured workers include paying for doctor’s visits, diagnostic treatment including x-rays, MRIs, CT scans, and medications. This would also include payment for transportation to and from the medical visits, whether the insurance company provides transportation if the injured worker does not have reliable transportation or in the form of mileage reimbursement.

If treatment gets a little more extensive, the insurance company would be liable to pay for procedures like surgeries or injections and related physical therapy. This is what some might consider “run of the mill” type of treatment after a work injury. For severe injuries, the medical benefits provided in the statute become more tailored to the specific needs of the injured worker.

Attendant Care

Attendant Care^[4]refers to the care performed by trained professionals that is beyond the scope of household duties. Professional attendant care can be needed for a range of needs. The injured worker might need vitals checked regularly or have a traumatic brain injury that requires 24-hour monitoring or complex medication management.

Non-professional care can be provided by family members, but they get compensated differently. This care often includes cooking, cleaning, or helping with ADLs or Activities of Daily Living. Family members usually take on the burden of having to help with an injured worker and don’t ask for anything in return. However, if an authorized treating physician believes its appropriate, they can prescribe that the family member be reimbursed for the help they are providing.

There are some caveats to a family member providing care. The first is the compensation is limited to 12 hours per day, even if more than that is being provided. If more than 12 hours of care are needed, it is worth considering having the insurance company provide hired help. The other downside to having a family member provide the services is that compensation is limited to the federal minimum wage. The current federal minimum wage^[5] is less than the Florida minimum wage^[6].

Home and Vehicle Modifications

Sometimes a severe injury can result in a person not being able to ambulate, walk, or maneuver safely. When safety is a concern, physical modifications to a home are appropriate. Many times, an authorized treating physician will make a referral for a home medication evaluation to take place. This is when a company gets hired to come out to the injured worker’s home and assess what safety risks there are. Once the home assessment report is created, the authorized physician must review and recommend the modifications to take place. These modifications are the responsibility of the insurance company to find, hire, and pay for a construction company to install or build on the home.

Similarly, a vehicle might need modifications to make it safer for an injured worker. One of the more common modifications is adding a wheelchair lift to a vehicle. If the injured worker requires the use of a wheelchair, then generally, they need to be able to transport that wheelchair. Adding the lift to a vehicle makes it possible.

Psychiatric Treatment

Psychiatric Care is not always needed when someone has a catastrophic injury but should be monitored when these injuries occur. Some injured workers are able to cope with trauma and ongoing medical needs quite well. For many people it is not something they were ever planning on dealing with.

Making trips to a doctor’s office as a part of their regular lives, not being able to physical function in the same way, and accepting that they are not going to be able to earn money in the way they planned for the rest of their lives can take a major toll on an injured workers’ mental wellbeing. It isn’t something that should be expected of anyone either. If they want to be evaluated for psychiatric treatment, the injured worker should seek a referral by an authorized treating physician. It becomes important that the symptoms are reported to the treating physicians. Depression and anxiety are regularly treated with therapy and medications when someone has a severe work injury and shouldn’t be ignored.

Severe work injuries and their corresponding benefits can be overwhelming and debilitating to manage on your own, and that’s why I, Matt Carrillo, work hard to guide and advocate for injured workers and their best legal solutions. Reach out today to find out what benefits you may have by emailing me at office@carrilloinjurylaw.com.