In this post I'm breaking down the details of how you actually get paid your workers’ compensation benefits. Let's dive right in.
Workers’ compensation benefits are technically awarded on a weekly basis, but here’s the catch: insurance companies usually make payments biweekly instead.
So, even if you’re entitled to $500 per week, you’ll most likely see a $1,000 check every two weeks.
It’s important to note that payments can get temporarily disrupted, especially after a hearing or if your claim is being actively reviewed. For example, if a judge orders that your benefits continue at a certain rate, the insurance company might briefly pause payments while they adjust their system, leading to a delay in your next check. In such cases, you might receive a lump sum for the missed period once payments resume.
Another factor to keep in mind is that workers’ compensation benefits aren’t always perfectly consistent. While many people fall into a rhythm of receiving their checks on the same day every other week, changes in the process—like a new hearing or a review of your case—can reset the payment schedule.
If you notice significant delays in receiving your payments, you have the right to raise the issue. Insurance companies are subject to penalties if they consistently make late payments.
Once you’ve reached a point in your recovery where your doctor determines that your condition won’t significantly improve, you’ve reached what’s known as Maximum Medical Improvement (MMI). At this stage, your injury is evaluated to see if it has left you with any long-term or permanent limitations.
There are two main types of permanent disability awards: Schedule Loss of Use (SLU) awards and Non-Schedule Awards. The type you qualify for depends on the nature of your injury.
Schedule Loss of Use (SLU) Awards apply to injuries involving specific body parts like your arms, legs, hands, feet, fingers, toes, hearing, and vision. Each of these body parts is assigned a specific number of weeks in compensation based on the percentage of loss determined by your doctor. For example, if you have a 20% loss of use in your arm, and a total arm is valued at 312 weeks of compensation, you’d be entitled to 20% of that—62.4 weeks of benefits.
Schedule loss of use awards are typically paid in the form of a lump sum rather than weekly or bi-weekly checks.
Non-Schedule Awards cover injuries that aren’t tied to specific body parts, such as back, neck, or head injuries. These cases are often more complex. The amount you receive is based on your percentage of permanent disability and how that affects your ability to work. For instance, if you’re found to have a 50% permanent partial disability, you could receive benefits for a set number of weeks while you’re unable to earn your full wages. The higher your disability percentage, the more weeks of compensation you’ll receive.
In non-schedule cases, payments are typically made weekly until the case reaches settlement, which we'll discuss below.
One key thing to understand is that your medical treatment is handled separately from your weekly benefits. In most cases, as long as the treatment is related to your injury and deemed necessary by your doctor, the insurance company is responsible for covering the costs. You won’t have to worry about co-pays or out-of-pocket expenses.
However, it’s not always that simple. Sometimes, insurance companies delay or deny treatment approvals, leading to frustrating holdups in your care. For certain types of treatment—like surgery or specialized therapies—your doctor may need to get prior authorization from the insurance company. This can take time, and it’s one of the most common sources of stress for injured workers.
In cases where the insurance company outright denies treatment, your attorney can request a hearing to get the issue resolved. It’s also worth noting that if you pay out of pocket for any necessary treatment, you may be able to get reimbursed, but this should be done with guidance from your attorney to avoid complications.
It’s also important to be aware of situations where your treatment could be billed to your private health insurance instead of workers’ compensation. While this might seem like a quick fix, it can create complications down the line and could leave you dealing with unpaid medical bills or even insurance fraud issues.
As long as your case is active and you’re still receiving medical care related to your injury, workers’ compensation should continue to cover your treatment costs. The only time this might change is if you agree to a full and final settlement that closes out your medical benefits.
At some point, you may reach a stage in your workers’ compensation case where a settlement becomes an option. Settling your claim can provide a lump-sum payment that gives you financial flexibility, but it’s a decision that comes with some important considerations.
The most common type of settlement is called a Section 32 settlement, where you agree to resolve your case in exchange for a one-time payment. This can cover both your lost wages and, in some cases, your future medical expenses. The biggest advantage of a settlement is the immediate financial boost—no more waiting for biweekly checks. However, it also usually means giving up your right to future benefits related to your injury, so it’s crucial to think carefully before agreeing to any terms.
When it comes to medical coverage, you often have a few options in a settlement. You can choose to keep your medical benefits open, which means the insurance company would still cover your ongoing treatment. Alternatively, you might agree to include your future medical expenses in the lump sum. If that’s the case, the insurance company may set aside a portion of the money specifically for your medical care, known as a Medicare Set-Aside (MSA). This amount is designed to cover the cost of your future treatment, but it’s critical to manage those funds carefully, as using them for non-medical expenses could leave you on the hook for future bills.
If you’ve got questions or need guidance on any part of your workers’ compensation case, I’m here to help. My goal is to make sure you get the benefits you’re entitled to without all the added stress. Feel free to reach out to me, Rex Zachofsky, anytime at 212-406-8989. There’s no pressure—just straightforward answers and support when you need it.
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