Workers' Compensation Benefits Guide 2017: What Employees Need to Know

Eligibility and Scope of Coverage

In 2017, workers' compensation applies to most employees who suffer a work‑related injury or illness, regardless of fault. Coverage includes full‑time, part‑time, seasonal, and temporary workers, provided the employer carries a state‑mandated policy. Independent contractors are generally excluded unless they are deemed employees under state law. To qualify, the injury must arise out of and in the course of employment, meaning it occurred while performing job duties or as a direct result of workplace conditions.

Medical Benefits

Medical benefits cover all reasonable and necessary treatment related to the work injury. This includes doctor visits, hospital stays, surgeries, prescription medication, physical therapy, and durable medical equipment. Providers must be approved by the employer's insurance carrier, and employees typically receive a list of authorized clinicians. In 2017, many states began allowing telemedicine for follow‑up appointments, expanding access for remote workers.

Wage Replacement

Wage replacement benefits compensate for lost earnings while the employee is unable to work. The rate is usually a percentage of the worker's average weekly wage (AWW), commonly 66.67% in most states, with a statutory minimum and maximum. Benefits are paid after a waiting period—typically three days for most injuries. If the employee returns to work part‑time, partial wage replacement may be calculated proportionally.

Disability Classifications

Disabilities are categorized to determine benefit duration and amount:

• Temporary Total Disability (TTD): No ability to work for a limited period; benefits continue until the employee can return or reaches maximum medical improvement.
• Temporary Partial Disability (TPD): Ability to perform some work; benefits offset the difference between pre‑injury earnings and current wages.
• Permanent Total Disability (PTD): No reasonable chance of returning to any gainful employment; benefits are paid for life or until statutory limits.
• Permanent Partial Disability (PPD): Permanent loss of function or limb; compensation is based on a state‑specific schedule of awards.

Claim Process and Timelines

Filing a claim involves several steps:

In 2017, most states set a 30‑day deadline for the employer to file the claim with the insurer. Employees have 90 days to appeal a denial, after which a hearing may be requested before a workers' compensation board.

Common Issues and How to Address Them

Disputes often arise over medical provider choice, the extent of disability, or wage‑replacement calculations. Employees should keep detailed records of all medical visits, expenses, and communications. If a claim is denied, a timely appeal with supporting documentation—such as independent medical opinions—can improve the chance of reversal. Consulting an experienced workers' compensation attorney can be beneficial, especially for complex cases involving multiple injuries or long‑term disability.

Key Differences by State in 2017

Final Checklist for Employees

• Report injury within 24 hours.
• Obtain a copy of the employer's workers' compensation policy.
• Document all medical treatment and expenses.
• Track lost wages and partial earnings.
• File the claim form promptly and keep a copy.
• Meet all deadlines for appeals.