How Long Can a Workers’ Comp Claim Stay Open?

Each state manages its own workers’ compensation system. So, the answer to this question varies by state. In general, workers’ compensation benefits usually last between one and three years. A few states are higher and a few states are lower. Claims in low-end states often have MMI (maximum medical improvement) issues.

Basically, MMI means physical therapy has plateaued and the victim won’t improve. So, if a state has less than a one-year cutoff, victims may be unable to complete physical therapy and reach MMI. In other words, these victims are still partially disabled but they aren’t entitled to partial disability benefits.

These same rules apply to both trauma injuries and occupational diseases. Trauma injuries, like falls, occur suddenly and without warning. Occupational diseases, like hearing loss, occur slowly over time.

Lost Wage Replacement

Most state workers’ compensation laws include a two-week waiting period for partial lost wage replacement benefits. After that, temporarily disabled victims are entitled to two-thirds of their average weekly wage (AWW) for the duration of those temporary disabilities.

A student’s grade point average changes over time. Hopefully, it goes up instead of down. Likewise, a worker’s AWW changes over time. It almost always goes up.

Assume an NFL player is hurt the week before training camp ends. During the offseason, many football players get nothing. During training camp, many players only get per diem allowances. Once games start, their incomes go through the roof.

Based on prior wages over the last six months, the NFL player’s AWW might be almost zero. His wage replacement benefits should reflect the time he will miss because of injury.

On a related note, the AWW includes more than regular cash compensation. It also includes per diem, expense reimbursement, and other irregular or non-cash compensation.

Insurance companies usually give permanently disabled victims lump-sum payments. The size of that payment depends on the nature and extent of the disability, as well as a few other factors. Insurance companies often make offers without considering the facts. For example, if Tim is an avid jogger and he has a knee disability, he’ll probably have to miss work in the future when his bad knee acts up.
Medical Bill Payment
Most likely, Tim will also incur future medical bills. He shouldn’t have to file a new workers’ comp claim every time the knee acts up. So, his initial disability settlement should include money for future medical bills well outside the initial one to three year coverage period.
Insurance company lawyers typically use generic charts to make future medical bill payment offers. Workers’ compensation lawyers typically partner with independent doctors who assess these cases and make recommendations. The second way is almost always the best way.
During the initial period, the medical bill payment benefit covers all reasonably necessary medical expenses, from the first moment of emergency care to the last day of physical therapy. Workers’ comp also covers medical devices, prescription drugs, and other ancillary medical costs.

Check out AskLegally’s workers’ comp calculator to see what your claim might be worth.

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