State Guidelines for Workers Compensation Benefits

by fihguide   ·  3 years ago  

Ever wondered how employee-friendly your state happens to be? You probably never gave it much thought — until you or someone you love got hurt or sick at work. Each state has its own rules and guidelines for workers compensation benefits, and they very widely.

Just as every claimant is unique, so too is each state’s individual rules. For example, states have different laws about which employers must carry workers’ comp insurance.

Company Size Guidelines for Providing Workers Compensation Benefits by State

Accidents and injuries can happen at any kind of workplace, no matter how large. Most state laws say employers must have workers’ comp insurance even if they only have one employee. There are some exceptions to this rule, however. For example, in Virginia, employers must have two or more employees before they have to buy coverage.

  • Arkansas, Georgia, Michigan, New Mexico, North Carolina and Wisconsin: Employers that employ three or more people must buy coverage.
  • Florida, Rhode Island and South Carolina: Workers’ comp coverage is a must with four or more employees.
  • Alabama, Mississippi, Missouri and Tennessee: Coverage becomes mandatory for employers with five or more workers.
  • New Jersey and Texas: No mandatory workers’ comp coverage laws exist. New Jersey’s laws say an employer must either obtain coverage or qualify to self-insure. In Texas, WC coverage is completely optional (though most employers do buy insurance that provides some workers compensation benefits).

Waiting Period Rules: How Long Before You’ll Get Paid Workers Compensation Benefits?

Each state has a waiting period before you can start collecting Temporary Total Disability payments. This is called the “statutory waiting period.” (Each state’s law determines how long you’ll wait to receive workers compensation benefits.)

Because this waiting period exists everywhere, always file your workers’ comp claim right away after an accident. If realize you’re unable to perform work tasks due to a chronic condition, file your claim immediately.

Here are the different waiting periods — where does your state fall on this list?

  • 3 days – Alabama, Alaska, California, Connecticut, Colorado, Delaware, Hawaii, Iowa, Illinois, Maryland, Minnesota, Missouri, New Hampshire, Oregon, Oklahoma, Rhode Island, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming
  • 4 days – Montana
  • 5 days – Idaho, Massachusetts, Mississippi, Nevada, North Dakota
  • 7 days – Arizona, Arkansas, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maine, Michigan, Nebraska, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia

Percentage of Wages Paid in TTD Benefits by State

As we explained in previous articles, doing the math to figure out your workers’ compensation benefit payment can be difficult. Payments for Temporary Total Disability (TTD) are most often 66.67% of your pre-tax wages.

This guideline does have exceptions, however. It all depends on where you live. Alaska, Iowa, Maine and Michigan pay 80% of after-tax earnings to TTD-eligible claimants.

Here are some other exceptions to the 66.67% payment rule:

  • Rhode Island pays 75% of your after-tax earnings.
  • New Jersey, Oklahoma and West Virginia pay 70% of your pre-tax wages.
  • Idaho pays 67%.
  • Massachusetts as well as New Hampshire pay 60%.
  • Wyoming pays 66.67% of your actual monthly wages.
  • Texas pays 70% for workers who earn more than $8.50/hour. All others receive 75%.
  • Ohio pays 72% for the first 12 weeks and 66.67% after 12 weeks.
  • Washington pays 60–75%, depending on your marital status and number of dependents.

Limitations on Medical Workers Compensation Benefits by State

In 45 out of 50 states, there’s no limit to how much you can get in medical workers compensation benefits. This means it would be impossible for you to get denied medical care based on the dollar amount.

For the five states that limit medical benefits (which they call “maximums”), state laws differ:

  • Ohio: Once you receive TTD benefits for 90 days, state law requires your doctor to perform a re-examination.
  • Arkansas: State law says an employer isn’t responsible for medical costs after six months if your case meets any condition that’s listed below:
    • You haven’t lost any more time from work.
    • You’ve been back at work for six months.
    • Your medical costs total at least $10,000.
  • Florida and Montana: Employees owe a set co-pay amount for medical care.
  • Tennessee: Your doctor must have a license to practice medicine in this state to prescribe or refer any psychological treatment. Otherwise, state law limits how much care you’ll get.

Maximum Length of Time You Can Get TTD Benefits by State

Thirty-four states provide benefits for the total time your disability stops you from working. However, 16 states do not. In Florida, Minnesota, Oklahoma, Texas, for example, workers’ comp TTD payments automatically end after 104 weeks. Montana doesn’t limit how long you can treat your workplace injury or illness. Still, state guidelines say you’re responsible for a co-payment.

Here are some other exceptions to that “no time limit” rule for getting workers compensation benefits:

  • Massachusetts: 156 weeks
  • West Virginia: 208 weeks
  • Utah: 312 weeks
  • Georgia, Missouri, New Jersey and Tennessee: 400 weeks
  • Arkansas and Mississippi: 450 weeks
  • Indiana, South Carolina and Virginia: 500 weeks

Believe your employer owes you more workers compensation benefits than you’re getting? Then we strongly recommend talking to a lawyer. We can match you with a workers’ comp lawyer near you who can review your case confidentially for free. Always get a second opinion if you feel your employer fails to follow state workers’ comp laws!

Related: How Maximum Medical Improvement Can Affect Workers’ Comp