Welcome to our Orthopedics Practice Workers’ Compensation Guide! This resource is designed to provide a general overview of workers’ compensation concerning orthopedic injuries. It’s essential to recognize that this guide is not a substitute for professional advice.
For more specific and detailed information tailored to your situation, we recommend visiting the official workers’ compensation portal. This portal is a reliable source for the latest regulations, forms, and additional resources, ensuring you have access to the most current and accurate information.
Your well-being is our primary concern, and we trust that this guide will be a helpful starting point in understanding workers’ compensation in the context of orthopedic care.
Protections for Injured Workers
An employee or their dependents are eligible for workers’ compensation benefits in the event of an injury or death occurring during the course of employment. The employer or their insurance carrier is responsible for covering necessary and reasonable medical treatment, loss of wages during rehabilitation, and documented benefits for permanent disability.
If a worker sustains an injury while employed by an uninsured employer, they can apply for medical and temporary benefits through the Division’s Uninsured Employers Fund (UEF).
All relevant and reasonable medical treatments, including prescriptions and hospitalization services related to the work injury, are covered by the employer’s insurance carrier or directly by the employer if they are self-insured.
The employer or insurance carrier has the authority to designate the authorized treating physician for work-related injuries. The injured worker can choose the treating physician only in cases where the employer refuses to provide medical treatment or in emergencies. In emergencies, the injured worker should promptly inform the employer about the treatment received.
If the injured worker faces a disability lasting more than seven days, they become eligible for temporary total benefits, equivalent to 70% of their average weekly wage, with a cap at 75% of the Statewide Average Weekly Wage (SAWW) and a minimum rate of 20% of the SAWW. These benefits are applicable when the worker cannot work due to their condition and is actively receiving medical care.
Temporary total disability benefits
Benefits are typically discontinued when the worker is cleared to return to work in any capacity or when they reach maximum medical improvement (MMI). MMI is a term indicating that further treatment will no longer enhance the medical condition of the injured worker. In some instances, the worker may be left with partial permanent injuries or total permanent injuries.
Permanent partial disability
In cases where a work-related injury or illness leads to a partial permanent disability, benefits are determined based on a percentage of specified “scheduled” or “non-scheduled” losses. “Scheduled” losses involve arms, hands, fingers, legs, feet, toes, eyes, ears, or teeth. “Non-scheduled” losses encompass any area or system of the body not explicitly mentioned in the schedule, such as the back, heart, or lungs. These benefits are paid weekly and commence after the conclusion of temporary disability.
Permanent total disability benefits
In certain cases where a work-related injury or illness prevents an employee from returning to any gainful employment, they may qualify for permanent total disability benefits. Permanent Total Disability is presumed if the worker has lost two major members or a combination of members, like eyes, arms, hands, legs, or feet. However, permanent total disability can also result from a combination of injuries rendering the worker unemployable.
These weekly benefits are initially provided for 450 weeks and extend beyond if the injured worker can demonstrate ongoing inability to earn wages. Earnings after 450 weeks offset the weekly computation in proportion to the income at the time of the injury. Permanent Total benefits are paid weekly and amount to 70% of the average weekly wage, not exceeding 75% of the Statewide Average Weekly Wage (SAWW) or falling below the minimum rate of 20% of the SAWW.
The Second Injury Fund (SIF), administered by the Division of Workers’ Compensation, disburses benefits to workers entirely and permanently disabled due to their latest work-related injury combined with pre-existing disabilities. The Second Injury Fund was established to incentivize employers to hire disabled workers, with the employer only covering the work-related portion of the total disability award.
Death Beneftis
In cases where a worker dies due to a work-related injury or illness, dependents may be eligible for death benefits. Weekly benefit payments are 70% of the deceased worker’s weekly wage, not exceeding the maximum benefit amount set annually by the Commissioner of Labor. The surviving dependents are determined by a judge of compensation after a hearing on the extent of dependency.
A surviving spouse and natural children in the decedent’s household at the time of death are conclusively presumed dependents. Surviving spouses, natural children not part of the household, and other alleged dependents (parents, grandparents, grandchildren, siblings, etc.) must prove actual dependency.
Dependent children remain so until the age of 18 or, if full-time students, until the age of 23. Physically or mentally disabled children may be eligible for extended benefits.
For a job-related death, the employer or its insurance carrier is responsible for paying up to $3,500 in funeral expenses. These funds go to whoever is liable for the funeral bill, whether the estate or an individual.
