The workers’ compensation system is designed to provide injured workers with the financial support they need in the event that they suffer an injury that prevents them from working. Although every state has a workers’ compensation system, the procedures, rules, and requirements of each system varies between jurisdictions. In order to receive benefits from the workers’ compensation system, the worker must forgo his or her legal right to sue the employer in the courts. The workers’ compensation system is not free of judicial scrutiny, however, with courts having the power to review workers’ compensation board decisions. In order to seek judicial review, a worker must typically exhaust any appellate remedies made available to him or her through the workers’ compensation system.
One of the most highly litigated aspects of a workers’ compensation case is the determination of the nature and extent of an employee’s injuries. After an employee files a workers’ compensation case, independent and appointed medical professionals will examine the worker to determine the extensiveness of the injuries and whether they are temporary or permanent in nature. Doctors also evaluate whether the injury is either partial or total.
For a temporary total disability, the injured worker experiences an injury that prevents him or her from working during the recovery period. During this period, the workers’ compensation insurance company provides the worker with temporary total disability benefits. In some jurisdictions, temporary total disability benefits are also refereed to as wage loss or time loss benefits. The worker’s treating physician will evaluate the extent of the injury to determine the amount of time that the worker will need to recover from his or her injury.
Many workers’ compensation insurance companies will fight a doctor’s determination that the employee has suffered a temporary total disability and will contend that the worker is capable of returning to work. In this instance, an insurance company can request a Qualified Medical Evaluator (QME) to examine the worker. This physician acts as a neutral third party and provides his or her opinion regarding the nature and extent of the injury. If the worker is represented by an attorney, an Agreed Medical Examiner (AME) will conduct the examination.
Once a medical professional determines that the employee’s total temporary injury has healed, the employee can return to work and will no longer receive disability benefits. However, as treatment progresses, the doctor may determine that the nature and extent of the worker’s injuries are more permanent in nature and that the employee will be unable to return to gainful employment in the same capacity. At this point, the doctor will declare the individual’s status as maximal medical improvement, or MMI, and the temporary disability benefits will stop. The worker will then receive permanent total disability benefits.
In any case, a worker will be terminated from total temporary disability benefits after two years from the date that he or she started collecting them. There are some states that provide exceptions to this limitation for severe injuries, including burns, eye injuries, hepatitis, HIV, amputations, and some types of lung disease.
In general, temporary total disability payments amount to roughly two-thirds of the employee’s average weekly earnings. Most states have imposed weekly maximums, which put a cap on how much an employee can recover each week regardless of their pre-injury salary. For example, the weekly maximum for California workers’ compensation benefit recipients is $1,074.64.
