Workers Compensation Blog
Paw Paw - Workers Compensation Law Blog

Special Benefits:

Posted August 24, 2016

There are certain special types of injuries or disabilities that are treated differently from others. Section 361 of the Act provides for compensation for certain specific losses. For example, if John Doe loses his thumb while on the job, he is entitled to 65 weeks of compensation benefits regardless of whether he is disabled and regardless of whether he has a wage loss. If John Doe recovers and returns to work after two weeks, he still continues to receive benefits for the remaining 63 weeks. Assume that John Doe was a skilled watchmaker and is unable to return to work at the end of 65 weeks or assume that he is an ordinary laborer but suffers an infection in his amputation and is unable to work at the end of 65 weeks. Under those circumstances, his situation at the end of 65 weeks is evaluated in the same way as any other "general disability." If he is disabled, has a wage loss, has not refused a reasonable offer of work, and has not established a wage-earning capacity, he will continue to receive benefits.

Generally speaking, the amount of benefits paid is calculated in the same way as for any other injury. The exception is that Section 356(3) of the Act provides a minimum rate of 25 percent of the state average weekly wage for a specific loss. Thus a worker with a very low wage could receive benefits higher than 80 percent of the after-tax value of his or her average weekly wage. This is a special category of disability. Workers who meet certain requirements can get additional benefits. Which workers can benefit if they qualify as totally and permanently disabled? Until 1982, relatively low maximums limited the benefits of many disabled workers whose earnings would otherwise have entitled them to a higher rate. Workers who can qualify as totally and permanently disabled, however, may be entitled to have their benefits increase each year as the maximums increase while other disabled workers are limited to the maximum that was in effect on their date of injury.

The number of cases in which there is a large discrepancy between total and permanent disability benefits and regular benefits has greatly lessened over the years. There are, however, still some workers with high wage rates who can receive increases in benefits because they are classified as totally and permanently disabled. Also, coordination of benefits does not apply in the case of total and permanent disability. Most individuals who receive workers' compensation benefits will have those benefits reduced if they are receiving a pension or other benefits from their employer. This reduction or "coordination" does not apply if the worker is totally and permanently disabled. Finally, the presumption of disability is "conclusive" for the first 800 weeks. This means that if Jane Smith loses an arm and a leg, she is considered totally and permanently disabled for 800 weeks and she receives benefits whether she works or not. After 800 weeks, however, it becomes a question of fact. If because of some skill that she has, Jane has been able to return to work, and is in fact earning a living at the end of 800 weeks, her benefits will be stopped or reduced. If, however, she is still not able to work at the end of 800 weeks, benefits will continue.


Medical Benefits:

Posted July 22, 2016

Section 315 of the Workers' Disability Compensation Act provides that a worker is entitled to all reasonable and necessary medical care. This includes medical, surgical, and hospital services, dental services, crutches, hearing apparatus, chiropractic treatment and nursing care. The responsibility to provide medical care continues indefinitely so long as the need for the care is related to the industrial injury.

During the first ten days of treatment the employer has the right to choose the doctor. After that the worker is free to change doctors if he or she so desires. The worker, however, must notify the employer of the change. In practice, many large employers have company doctors. The worker ordinarily seeks treatment from the company doctor first. If the assistance of a specialist is necessary, the company doctor refers the worker to such a specialist. Small employers, on the other hand, often tell their workers that they should go to their family doctor or some other physician in the community. In certain circumstances if a worker refuses medical treatment or fails to follow medical advice, he or she may lose the right to continuing benefits. The courts, however, are reluctant to apply this principle and it must be a very serious case before it is applied.

For the most part, the doctors and other medical providers send their bills directly to the employer or its insurance carrier. If for some reason the worker pays the doctor directly, he or she is entitled to be reimbursed by the employer or insurance company. The law provides that medical providers such as doctors and hospitals cannot charge more than the amount specified in a fee schedule. If they attempt to charge more, the insurance company will pay only the maximum allowed by the schedule. The provider is not allowed to collect the difference from the worker.


Death Benefits:

Posted June 30, 2016

Generally, the same principles apply to death cases. In general, the question of causation is treated the same in death cases as in disability cases. A major difference is that in death cases there must be a dependent in order to receive wage loss benefits. It sometimes happens that a childless, unmarried worker is killed on the job leaving no dependents. In that case, his or her estate receives a burial allowance of up to $6,000 but nothing else.

Children of a deceased worker are conclusively presumed to have been dependent upon the worker. All other individuals including a spouse must prove that they were, in fact, dependents of the deceased worker. If they were only partially dependent upon the worker, this will reduce the amount of benefits that they can receive.

Generally speaking, the amount of benefits is 80 percent of the after-tax value of the wages the worker was receiving at the time he or she was injured. Section 356(2) provides for a minimum benefit rate in death cases. The rate is 50 percent of the state average weekly wage as of the date of injury. This is one of the few circumstances in which a benefit rate can actually be higher than 80 percent of the after-tax value of the injured worker's earnings.

Except in the case of minor children, death benefits are paid for a total of 500 weeks. If disability benefits were paid before the worker died, the 500 weeks are reduced accordingly. Assume John Doe contracted silicosis while working in a foundry. Assume that he was disabled and paid disability benefits for 200 weeks at which time he died. His widow would be entitled to 300 weeks of death benefits (500 less 200 weeks of disability benefits). If there is a dependent child, benefits continue for a longer period of time. If the child is physically or mentally incapacitated, benefits can continue indefinitely.