Frank’s, Gerkin, & McKenna discuss off-work benefits

Last month we discussed the average weekly wage and temporary disability rate. This month is about what off-work benefits (TTD) usually being and when they can end.

In most cases, the workers’ compensation insurer will pay off-work benefits when you cannot return because of your injury. Yet in some cases payment can be delayed. If the delay is expected to be more than 14-days after the accident, the insurance company must send you a letter stating why. The most common reasons are “medical information is needed” or the “claim is under investigation.”

Your weekly TTD payment will equal two-thirds of your average weekly wage. This average weekly wage is based on your average weekly wage for the 52 weeks prior to your date of injury.

If medical information is needed, then make sure your doctor faxes your records to the claims adjuster. If the claim is under investigation, this usually means there is a dispute. In those cases, the next letter from the insurance company is usually a “claim denial.”

Generally speaking, weekly benefits will be paid until you go back to work. Yet sometimes disputes arise about when you can go back. For example, your doctor might keep you of for another 4 to 6 weeks, but the insurance company’s doctor says there is no need to wait. When this happens, the insurance company can stop paying benefits based on what their company paid doctor said.

Follow us next month for a discussion about handling claim-denials and doctor disputes with an emergency petition under a special rule called 19(b).