Workers’ Compensation Disability (Indemnity) Benefits
After a work injury, you may be entitled to several different types of disability benefits. Below are answers to some of the most Frequently Asked Questions regarding Workers’ Compensation Disability Benefits.
All of your benefits are based upon your Average Weekly Wage (AWW).
Here is how you may calculate your AWW:
- Take all income for the 13 weeks prior to the week of your accident; add up the pre-tax income, and divide by 13. This is your Average Weekly Wage (AWW).
If you did not work at least 75% of the 13 weeks prior to your date of accident, you may use one of the following:
- The AWW of a similar employee
- The contract for hire rate (i.e. $12 per hour, 40 hours per week)
- Annual earnings (in some circumstances)
Bonuses and Commissions may be included in certain circumstances.
Fringe benefits, such as health insurance, may be included in certain circumstances.
If you had another job that was also covered by a workers’ compensation policy, you may include those earnings as well.
Your disability and impairment benefits are all based upon your AWW.
Temporary Total Disability (TTD) is two-thirds of your AWW, and is called your Compensation Rate.
Temporary Partial Disability (TPD) is paid when you are released to work with restrictions but are unable to earn at least 80% of your AWW. In that case, you subtract your actual earnings (which may be $0.00 if you are not working) from 80% of your AWW. If that gives you a positive number, your TPD benefit is 80% of that number.
Your Impairment Benefit is 75% of your Compensation Rate if you are not working, and 50% of your Compensation Rate if you are working AND earning at least 80% of your AWW.
In Florida Workers’ Compensation cases, you are not entitled to disability benefits for the first 7 days of disability UNLESS your disability lasts for 21 days.
Under this law, if you are only disabled for 10 days, you will be entitled to 3 days of disability benefits.
In most cases of disability that go beyond 21 days, your benefits will begin after your first 3 weeks of disability, which means you will see your first check after you have been disabled for 3 weeks.
After the first check, your disability checks typically come every two weeks.
Your check is due within seven (7) days of the last day of your pay period.
If you do not receive the check within this period, you may be entitled to penalties and interest.
Also called Form DWC-19, these are forms that injured workers must complete and submit in order to receive benefits.
Important! You MUST declare all income from all sources on these forms. If you do not declare all of your income, you risk losing all of your workers’ compensation benefits and being prosecuting for workers’ compensation fraud.
If you do not return the forms in a timely manner, the insurance carrier may suspend your disability benefits until you do.
You should get Temporary Total Disability benefits until you are either released to work by your doctor or you reach Maximum Medical Improvement.
If you are released to work and their is no work available for you to do, you may be entitled to Temporary Partial Disability benefits.
The maximum amount of time you will receive temporary disability benefits is 260 weeks (5 years).
If you are unable to perform at least sedentary employment within a 50-mile radius of your home, you may be entitled to Permanent Total Disability benefits until you reach 75 years old.
Your benefits will end when you are released to work by your authorized treating physician and/or you are placed at Maximum Medical Improvement (MMI).
If you reach MMI and are still unable to work, you may be entitled to Permanent Total Disability benefits.
If you reach MMI and are unable to do your old job, you may qualify for vocational rehabilitation with the State of Florida. If so, you may be entitled to Rehabilitative Temporary Total Disability.
You may be entitled to Temporary Partial Disability (TPD) Benefits.
This is a common fight in the workers’ compensation system, and what drives many people to hire a lawyer.
A good option may be to request a Job Assessment from the insurance carrier. This is where a vocational expert meets with you, your Employer and your doctor to make sure that the job is within your limitations.
The question will be: does your doctor approve of ALL the work activities? If so, and you disagree, there is not a simple answer. You probably need lawyer, but you definitely need to tell your doctor that the work is causing you pain, if it is.
Impairment Income Benefits are due if your doctor assigns you a Permanent Impairment Rating under the 1996 Uniform Florida Impairment Guidelines.
Here is how it works:
- Number of weeks of benefits for each percentage point of impairment:
- 1 to 10% = 2 weeks for each percentage point
- 11-15% = 3 weeks for each percentage point
- 16-20% = 4 weeks for each percentage point
- +20% = 6 weeks for each percentage point
- Amount of your check
- If you are working AND earning at least 80% of your AWW, you will get 50% of your Compensation Rate.
- If you are not working, or earning less than 80% of your Compensation Rate, you will get 75% of your Compensation Rate.
You get TTD (temporary total disability) benefits when your doctor takes you out of work prior to MMI.
You get TPD (temporary partial disability) benefits when you released to work with restrictions prior to MMI, but are unable to earn at least 80% of your AWW.
MMI (maximum medical improvement) is the point at which, in the opinion of your doctors, lasting improvement can no longer be reasonably anticipated.
In other words, you are as good as you are going to get.
There are several ways an injured worker may qualify for Permanent Total Disability (PTD) benefits.
Florida Statute 440.15 lays out the requirements. You are entitled to Permanent Total Disability benefits, if you have
- Spinal cord injury involving severe paralysis of an arm, a leg, or the trunk;
- Amputation of an arm, a hand, a foot, or a leg involving the effective loss of use of that appendage;
- Severe brain or closed-head injury as evidenced by:
- Severe sensory or motor disturbances;
- Severe communication disturbances;
- Severe complex integrated disturbances of cerebral function;
- Severe episodic neurological disorders; or
- Other severe brain and closed-head injury conditions at least as severe in nature as any condition provided in sub-subparagraphs a.-d.;
- Second-degree or third-degree burns of 25 percent or more of the total body surface or third-degree burns of 5 percent or more to the face and hands; or
- Total or industrial blindness.
- Your injury renders you unable to perform at least sedentary employment within a 50-mile radius of your home.
Most claims fall under this last category. If you find yourself in this category, your burden of proof is a tough one and you will most likely need the services of a lawyer to be successful your claim for Permanent Total Disability benefits.