Workers
Compensation

Every state has its own rules about when wage replacement benefits start. Most states require a short waiting period – a set number of days you must be off work before benefits begin.

After that, some states have a retroactive period, which means if you’re out long enough to meet that requirement, you may also receive payment for the waiting period.

Here’s how it works:

Waiting Period: Most states require you to be off work for a certain number of days before wage replacement benefits start. These first few days are usually unpaid.

Retroactive Period: Retroactively means applying something after the fact – in other words, going back to cover a period that has already passed. If your state has a retroactive period rule, it means that once you’ve been off work long enough to meet that requirement, you may receive payment for the initial waiting days you were out, even though those days weren’t paid at first.

Imagine your state has:

• Waiting Period: 7 days
• Retroactive Period: 14 days

You get injured and cannot work for 16 days.

• For the first 7 days, you don’t receive wage replacement because of the waiting period.
• After you reach 14 days off work (the retroactive period), your benefits start – and you also get paid for those first 7 days retroactively.

If you had only missed 10 days, you would not receive payment for the first 7 days because you didn’t meet the retroactive threshold.

Because these timelines vary by state, the best way to know what applies to your claim is to ask your claims adjuster. They can explain your eligibility and when payments will begin.

Your claims adjuster will request your wages from your employer to calculate your weekly income and determine your benefits. The calculation of your weekly benefit varies by state, and may include overtime, bonuses, tips, the number of your dependents, and other sources of income. Please let your claims adjuster know about any other income you receive that may impact this calculation. Depending on your state, items such as commissions, lodging, paid time off may also be considered income. Please disclose to your adjuster a full list of possible income so an accurate calculation may be made.

Once the calculation of your wages is confirmed, your temporary replacement income will fall under one of two categories:

1. Temporary Total Disability (TTD) benefits are paid when your medical provider determines you are unable to complete your work duties because of your injury or provides work restrictions that your employer cannot accommodate. Temporary Total Disability benefits serve as wage loss replacement while you recover from your work injury. Your weekly benefits will be a percentage of your weekly gross (pre-tax) income. Each state has determined the percentage to be paid, in addition to any maximum or minimum rates. Some states also have limits on the number of weeks that these temporary benefits may be paid. In most cases, wage replacement benefits are not subject to income tax reporting.
2. Temporary Partial Disability (TPD) benefits are payable when you are able to return to work, but unable to earn your full pre-injury wages due to the injury and related work restrictions. Temporary Partial Disability benefits are provided to supplement your reduced earnings. Your weekly benefits will be based on the difference between your pre-injury weekly wages and the amount you are able to earn. In most states, this benefit is calculated as two-thirds of the difference between these amounts. Each state determines the percentage to be paid, in addition to any maximum or minimum rates. Some states also have limits on the number of weeks that these temporary benefits may be paid. Please communicate with your employer and your claims adjuster to make sure they have the information they need to make sure you are paid appropriately and timely.

Permanent disability benefits are provided to compensate you in cases where you are unable to fully recover from your injury. A permanent disability is one that is expected to continue indefinitely and may limit your ability to perform some or all of your activities.

Permanent disability benefit calculations vary by state. In most states, the process begins with a doctor’s evaluation. When your doctor determines that you have reached the maximum medical improvement (MMI) – meaning your condition is not expected to significantly change – they will prepare a report describing any permanent impairment. Most states use this medical opinion, along with their state-specific guidelines, to determine the dollar value of this benefit to compensate you for your loss.

Although the process can seem complex, your claims adjuster can explain your doctor’s findings. BHHC is committed to making this process as transparent as possible, so you can clearly understand how the value of your benefits is determined.