How Long Until Workers Comp Starts Paying?
Find Out When Workers Compensation Will Send a Check for Income Benefits or Pay for Medical Care
Nothing good comes from a work-related injury or the diagnosis of an occupational disease.
And one of the worst things resulting from an occupational injury is the uncertainty of when you will receive a workers comp or authorization to get medical attention needed to heal and get back to work.
Some types of workers comp benefits should be given immediately after the accident, before filing a claim with the Commission, or completing a formal work injury report.
But other benefits could take much longer to get – days, weeks, or months – due to procedural rules or because the employer and insurer (or their claim administrator such as Sedgwick or Gallagher Bassett) have delayed the investigation or denied the claim.
Keep reading for answers to questions about when workers comp starts paying.
And remember: suffering a work-related injury is both painful and emotionally draining.
But hiring a skilled and top-rated workers compensation lawyer can ensure timely payment of benefits and reduce your stress while waiting to get a check or approval of the medical treatment.
Contact us today to see why fellow attorneys turn to us for help negotiating top-dollar workers comp settlements and how we can pursue prompt payment and resolution of your claim.
When Does Workers Comp Start to Cover My Medical Bills?
How Many Days Does it Take to Get a Workers Compensation Check?
In 2017 there were roughly four days of disability per claim. That means most workers compensation claims do not involve lost time from work greater than the waiting period for cash payments such as temporary total disability and temporary partial disability benefits. They are “medical-only” claims.
If you have a compensable injury under the Workers Compensation Act, your employer or its insurance carrier must pay all medical bills related to your workplace accident. This is true whether you miss no time from work and have a medical-only claim, or never return to work because you are disabled permanently. The payment of medical bills under workers comp is not dependent on missing days from work.
Getting medical attention is one of the first things you should do after an accident at work. You can seek medical treatment for an industrial accident or occupational disease before you file a workers compensation claim. You do not need an open workers compensation claim before you receive medical care.
But you must have reported your work injury to your employer and given it a reasonable amount of time to offer a panel of physicians to make those health care costs your employer’s responsibility. Your employer does not have to pay physician’s fees and other medical expenses until it receives notice of your work injury.
When you go to the emergency room or visit a doctor, make sure you tell the medical providers that you were hurt at work. You should also tell them that you have filed or plan to file a workers comp claim. Finally, you should ask the health care provider to bill your employer or its workers compensation insurance carrier directly.
If you have filed for workers comp benefits and you are receiving unpaid medical bills for a work-related injury, call an attorney immediately. There are steps you can take to stop the debt collection process and protect your credit score while waiting for your employer or its insurance company to process and pay these medical bills.
Many employers and workers comp insurance carriers will pay medical bills for initial treatment likely related to a work injury – even if they end up denying or disputing your claim. This is because there is no penalty for them doing so. In Virginia the voluntary payment of medical bills, even for treatment over a period of months, is not considered acceptance of a workmans comp claim.
In my experience many employers and insurance carriers will pay for your initial hospitalization or doctor’s visit after a workplace accident, as well as a few follow up visits. Only if it appears that your injury is severe and will not heal quickly, or if your treating physician recommends expensive diagnostic testing, will the insurance carrier start to deny authorization and payment of medical care.
If your workmans comp case is later denied or you decide not to pursue it, you will not be responsible for those medical bills paid voluntarily.
When Do Workers Comp Wage Loss Benefits Start? Understanding How the Seven-Day Waiting Period Applies to Workmans Comp Cash Benefits in Virginia.
Workers compensation cash benefits for temporary wage loss – both temporary total disability benefits (complete loss of wages) and temporary partial disability benefits (partial loss of wages, either due to lower pay rate or fewer hours) – are subject to a waiting period. This is true even if the insurance carrier accepts your claim immediately.
A waiting period is the time you must wait after suffering a work-related injury or contracting an occupational illness before you can begin collecting workmans comp cash benefits for your wage loss.
In Virginia the workers compensation waiting period is seven (7) days. You will not receive wage loss benefits for the first seven calendar days of disability resulting from the workplace accident.
Section 65.2-509 of the Workers Compensation Act does, however, have a provision to pay retroactive benefits for the waiting period if your injury is serious and results in a longer duration of time missed from work. In Virginia the retroactive period is 21 days. If you miss more than 21 days of work because of your on-the-job injury or occupational illness, you will receive income replacement for the first seven days of incapacity.
The workers comp waiting period may result in unrecoverable wage loss if you are: 1) injured for fewer days than the seven-day waiting period and therefore do not qualify for cash payments or 2) out of work for more than seven days but less than 21 days. These uncompensated periods are an additional cost and insult to you, the injured worker. If possible, use your sick leave, paid time off, short term disability coverage, or long term disability coverage to replace your income during this period.
You will stop receiving temporary disability benefits when: 1) you return to work at a wage equal to or greater than your pre-injury average weekly wage; 2) your employer or its insurance carrier establishes, through medical evidence, that you are no longer entitled to disability benefits; or 3) you have received 500 weeks of temporary disability benefits.
The time periods explained above are dependent on your employer or its insurance carrier approving your claim or the Commission awarding benefits.
When Do Workers Comp Benefits for Permanent Total Disability Start?
Permanent total disability benefits are paid to some injured employees whom remain disabled because of a workplace injury.
In Virginia permanent total disability (PTD) benefits are payable either for the rest of your life or until you are able to go back to work. Proving you qualify for PTD benefits is difficult. You must show that you are unable to work in any capacity, not just in your pre-injury job.
PTD benefits will not start until you have received 500 weeks of temporary disability benefits and prove that you’re entitled to PTD benefits.
I recommend filing your claim for permanent total disability benefits when you have received 474 weeks of temporary total disability benefits. This gives you six months to develop the medical evidence and have a hearing on your PTD claim before the 500-week period expires.
When Do Workers Comp Permanent Partial Disability Benefits Start?
Permanent partial disability (PPD) benefits are paid to injured employees whom are not disabled from all work but whom have a life-long impairment because of their work-related injury.
PPD benefits are not wage loss benefits. You do not have to miss time from work to receive them.
You can receive PPD benefits even if you do not suffer an amputation injury. A foot injury or hand injury, or even a knee injury or shoulder injury resulting in loss of use of a leg or arm, can result in the payment of PPD benefits. So can a neck, back, herniated disc, or spinal cord injury that affects the function of your arms or legs.
In Virginia PPD benefits are not available until you reach maximum medical improvement (MMI) for your workplace accident. For some of you it will take just a few weeks or months to reach MMI. But for others it may take years.
Reaching MMI is not enough, however, to get PPD benefits. Because you cannot receive PPD benefits at the same time you are receiving temporary disability benefits, you must wait until you are no longer receiving temporary disability benefits to get PPD. This can take years.
Where is My Workmans Comp Check? Does Workers Comp Pay Me Each Week?
Under the Workers Compensation Act your employer should pay you your wage loss benefits on the same schedule they paid you when you were working.
If you are paid on a weekly basis, you should receive your workers comp check weekly.
If you are paid biweekly, then you should receive your workers comp check every other week.
Unfortunately workers compensation checks are often late. But there are rules regarding when workers compensation payments must be made, so long as the Commission has entered an Order awarding wage loss benefits.
If your workers compensation check is more than 14 days late your employer and its insurance carrier may have to pay a 20% penalty.
Why Is My Workers Comp Claim Taking So Long? Tips to Get Your Benefits Sooner.
Workers comp is a slow process – even under the best circumstances. And the time periods for receiving workers comp wage loss and medical benefits discussed above are often best case scenarios. Some of you will have to wait even longer if your case is denied or under investigation.
If you have gone more than three weeks without workers compensation benefits after an accident, see if one of the following applies:
- The insurance claims adjuster has requested additional medical records, including records from before your accident. The insurance carrier is allowed to obtain and review medical records from the 10-year period before your work accident. The adjuster is looking for a basis to deny your claim, such as a pre-existing condition or arthritis. You can speed up the process by discussing any pre-existing problems with an attorney to determine if you should get these records on your own and send them to the insurance company. You may also want your current treating physician to write a statement addressing how the recent work injury caused any pre-existing condition to flare up.
- You do not have an out-of-work slip from your treating physician. Most insurance carriers require documentation that a doctor is taking you out of work before they will start paying workers comp benefits. Make sure you get an out-of-work note after every doctor’s appointment.
- You are restricted to light duty but have not provided marketing evidence. In Virginia you have an obligation to look for work if you are restricted to light duty. If you don’t look for work, the insurance carrier does not have to pay benefits. Some insurance carriers will wait to see if you’re looking for work and marketing your residual work capacity before paying workmans comp checks.
- You have not filed a claim for benefits. If you have not filed a formal claim for benefits with the Commission then the Commission will not pressure the insurance carrier to make a decision in your case. It will give the insurance carrier twenty days from the date you file your claim to make a formal decision. And even then the insurance carrier is allowed to stay it is still investigating. This is why you should file a claim for benefits immediately. The sooner a hearing is scheduled the sooner the insurance carrier will have to make a decision in your case.
- Your employer questions your credibility. Most claims adjusters will interview your co-workers and supervisors after receiving notice of a work accident. If there is conflicting evidence regarding whether and how you were hurt, the insurance carrier may delay the payment of benefits and force you to trial. I’ve seen many injured workers have to wait for their check because an employer cast doubt on their work injury. Usually the employer had no basis for doing so, other than its concern that its own workers compensation insurance premiums would increase.
- Your insurance claims adjuster is busy. Though I don’t like to make excuses for claims adjusters, it is possible that your case is being overlooked because the adjuster is busy. If you think this is true, ask for your adjuster’s claims supervisor or hire an attorney. My staff spends hours each day tracking down claims adjusters and getting answers regarding the authorization and payment of benefits.
- You have not received an Award Order. Virginia is an Award Order state. Without an Award Order the employer and its insurance carrier have no obligation to pay you benefits. And because there is no bad faith cause of action for workers comp in Virginia, the insurance carrier can drag its feet, even on valid claims. This is why it’s so important to hire an attorney – even if the insurance carrier is paying benefits voluntarily. The payments can stop at any time. You should file a claim and ask for a trial date as soon as possible to get an Award Order.
Get Your Virginia Workers Comp Benefits Faster
I recommend seeking advice from an experienced work injury attorney as soon as you are hurt on the job. Just because you should receive workers comp benefits doesn’t mean your employer and its insurance carrier will start paying workers comp benefits when they’re supposed to.
The workers compensation system is complicated and the insurance carrier is looking for a way to delay, deny, and dispute your claim for benefits. An experienced attorney can help you take the correct actions when you file a workmans comp claim. That includes gathering the best evidence, completing and submitting appropriate paperwork, negotiating with the insurance carrier, and presenting your case at trial.
Whatever you do, don’t give up. The insurance carrier is hoping you will think the available workers comp benefits are not worth the hassle and give up. If you do, the insurance carrier wins because it has saved money. And you’ll be forced to deal with a life-changing injury on your own.
Call now for a free consultation to see if hiring a workers compensation lawyer is the right step for you: 804-251-1620 or 757-810-5614. I help injured workers in Virginia get what they’re owed. And I want to help you.
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